Breast Cancer

The client who has had a mastectomy tells the nurse, "My husband will leave me now since I am not a whole woman anymore." Which response by the nurse is most therapeutic? 1. "You're afraid your husband will not find you sexually appealing?" 2. "Your husband should be grateful you will be able to live and be with him." 3. "Maybe your husband would like to attend a support group for spouses." 4. "You don't know that is true. You need to give him a chance."

1. "You're afraid your husband will not find you sexually appealing?" Rationale: This is restating the client's feelings and is a therapeutic response.

The client has been diagnosed with cancer in the breast. Which referral is most important for the nurse to make? 1. The hospital social worker. 2. CanSurmount. 3. Reach to Recovery. 4. I CanCope.

3. Reach to Recovery. Rationale: Reach to Recovery is a specific referral program for clients diagnosed with breast cancer.

The client frequently finds lumps in her breasts, especially around her menstrual period. Which information should the nurse teach the client regarding breast self-care? 1. This is a benign process, which does not require follow-up. 2. The client should eliminate chocolate and caffeine from the diet. 3. The client should practice breast self-examination monthly. 4. This is the way breast cancer begins and the client needs surgery.

3. The client should practice breast self-examination monthly. Rationale: The American Cancer Society no longer recommends breast self-examination (BSE) for all women, but it is advisable for women with known breast conditions to perform BSE monthly to detect potential cancer.

When doing breast self-examination, the female patient should report which findings to her physician? A. Palpable rib margins B. Denser breast tissue C. Left nipple deviation D. Different sized breasts

C. Left nipple deviation Rationale: Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other problem and should be reported to the health care provider. Dense breast tissue, palpable rib margins, and different sized breasts are all normal findings.

To prevent capsular formation after breast reconstruction with implants, teach the patient to a. gently massage the area around the implant. b. bind the breasts tightly with elastic bandages. c. avoid strenuous exercise until the implant has healed. d. exercise the arm on the affected side to promote drainage.

a. gently massage the area around the implant. Rationale: Although providers have different approaches to the prevention of contracture formation, gentle manual massage around the implant is a routine practice.

The client who is scheduled to have a breast biopsy with sentinel node dissection states, "I don't understand. What does a sentinel node biopsy do?" Which scientific rationale should the nurse use to base the response? 1. A dye is injected into the tumor and traced to determine the spread of cells. 2. The surgeon removes the nodes that drain the diseased portion of the breast. 3. The nodes felt manual will be removed and sent to pathology. 4. A visual inspection of the lymph nodes will be made while the client is sleeping.

1. A dye is injected into the tumor and traced to determine the spread of cells. Rationale: A sentinel node biopsy is a procedure in which a radioactive dye is injected into the tumor and then traced by instrumentation and color to try to identify the exact lymph nodes the tumor could have shed into.

The client has undergone a wedge resection for cancer of the left breast. Which discharge instruction should the nurse teach? 1. Don't lift more than five (5) pounds with the left hand until released by the HCP. 2. Cancer has been totally removed and no follow-up therapy will be required. 3. The client should empty the Hemovac drain about every 12 hours. 4. The client should arrange an appointment with a plastic surgeon for reconstruction.

1. Don't lift more than five (5) pounds with the left hand until released by the HCP. Rationale: The client has had surgery on this side of the body. Pressure on the incision should be limited until the client is released by the HCP to perform normal daily activities.

The client is being discharged after left wedge resection. Which discharge instructions should the nurse include? Select all that apply. 1. Notify the HCP of a temperature of 100°F. 2. Carry large purses and bundles with the right hand. 3. Do not go to church or anywhere with crowds. 4. Try to keep the arm as still as possible until seen by the HCP. 5. Have a mammogram of the right and left breasts yearly.

1. Notify the HCP of a temperature of 100°F. 2. Carry large purses and bundles with the right hand. 5. Have a mammogram of the right and left breasts yearly. Rationale: 1. It is a common instruction for any client who has had surgery to notify the HCP if a fever develops. This could indicate a postoperative infection. 2. The client who has had a mastectomy is at risk for lymphedema in the affected arm because the lymph nodes are removed during the surgery. The client should protect the arm from injury and carry heavy objects with the opposite arm. 5. The client has developed a malignancy in one breast and is at a higher risk for developing another tumor in the remaining breast area.

The client who is four (4) months pregnant finds a lump in her breast and the biopsy is positive for Stage II cancer of the breast. Which treatment should the nurse anticipate the HCP recommending to the client? 1. A lumpectomy is to be performed after the baby is born. 2. A modified radical mastectomy. 3. Radiation therapy to the chest wall only. 4. Chemotherapy only until the baby is born.

2. A modified radical mastectomy. Rationale: A modified radical mastectomy is recommended for this client because the client is not able to begin radiation or chemotherapy, which are part of the regimen for a lumpectomy or wedge resection. Many breast cancers developed during pregnancy are hormone-sensitive and have the ideal grounds for growth. The tumor should be removed as soon as possible.

The client is diagnosed with breast cancer and is considering whether to have a lumpectomy or a more invasive procedure, a modified radical mastectomy. Which information should the nurse discuss with the client? 1. Ask if the client is afraid of having general anesthesia. 2. Determine how the client feels about radiation and chemotherapy. 3. Tell the client she will need reconstruction with either procedure. 4. Find out if the client has any history of breast cancer in her family.

2. Determine how the client feels about radiation and chemotherapy. Rationale: The client should understand the treatment regimen for follow-up care. A lumpectomy requires follow-up with radiation therapy to the breast and then systemic chemotherapy. If the cancer is in its early stages, this regimen has results equal to those with a modified radical mastectomy.

The client had a mastectomy for cancer of the breast and asks the nurse about a TRAM flap procedure. Which information should the nurse explain to the client? 1. The surgeon will insert a saline-filled sac under the skin to simulate a breast. 2. The surgeon will pull the client's own tissue under the skin to create a breast. 3. The surgeon will use tissue from inside the mouth to make a nipple. 4. The surgeon can make the breast any size the client wants the breast to be.

2. The surgeon will pull the client's own tissue under the skin to create a breast. Rationale: The TRAM flap procedure is one in which the client's own tissue is used to form the new breast. Abdominal tissue and fat are pulled under the skin with one end left attached to the site of origin to provide circulation until the body builds collateral circulation in the area.

Which recommendation is the American Cancer Society's (ACS) 2015 guideline for the early detection of breast cancer? 1. Beginning at age 18, have a biannual clinical breast examination by an HCP. 2. Beginning at age 30, perform monthly breast self-exams. 3. At age 45 through 54, receive a yearly mammogram. 4. Beginning at age 50, have a breast sonogram every five (5) years.

3. At age 45 through 54, receive a yearly mammogram. Rationale: The ACS recommends a yearly mammogram for the early detection of breast cancer beginning at age 45 and going to age 55 and approximately every two (2) years after the age of 55. Before age 45 and after age 55 it should be a discussion between the woman and her HCP to determine if more frequent mammograms are warranted. A mammogram can detect diseases that will not be large enough to feel.

The client who had a right modified radical mastectomy four (4) years before is being admitted for a cardiac work-up for chest pain. Which intervention is most important for the nurse to implement? 1. Determine when the client had chemotherapy last. 2. Ask the client if she received Adriamycin, an antineoplastic agent. 3. Post a message at the HOB for staff not to use the right arm for venipunctures or BPs. 4. Examine the chest wall for cancer sites.

3. Post a message at the HOB for staff not to use the right arm for venipunctures or BPs. Rationale: The nurse should post a message at the head of the client's bed to not use the right arm for blood pressure or laboratory draws. This client is at risk for lymphedema, and this is a lymphedema precaution.

The nurse is teaching a class on breast health to a group of ladies at a senior citizen's center. Which risk factor is the most important to emphasize to this group? 1. The clients should find out about their family history of breast cancer. 2. Men at this age can get breast cancer also and should be screened. 3. Monthly breast self-examination is the key to early detection. 4. The older a woman gets, the greater the chance of developing breast cancer.

4. The older a woman gets, the greater the chance of developing breast cancer. Rationale: The greatest risk factor for developing breast cancer is being female. The second greatest risk factor is being elderly. By age 80, one (1) in every eight (8) women develops breast cancer.

A 72-year-old patient who had a mastectomy for breast cancer 6 months ago wants to have breast reconstructive surgery. The nurse knows that what is the most likely motivation for this patient seeking this surgery? A. Improve the woman's self-image B. Be able to experience sexual arousal C. To get a tummy tuck as well as the breast mound D. Restore the pre-mastectomy appearance of the breast

A. Improve the woman's self-image Rationale: The most likely motivation for this patient to seek breast reconstructive surgery is to improve her self-esteem. With this surgery, she will not be able to experience sexual arousal or restore the pre-mastectomy appearance of the breast. The abdominoplasty (tummy tuck) effect will only be a possibility with the transverse rectus abdominis musculocutaneous (TRAM) flap, not with a breast implant or tissue expansion.

The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors? (select all that apply). A. Nulliparity B. Age 30 or over C. Early menarche D. Late menopause E. Personal history of colon cancer

A. Nulliparity C. Early menarche D. Late menopause E. Personal history of colon cancer Rationale: Women are at an increased risk for the development of breast cancer if they are over the age of 50; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen with early menarche or late menopause; have had a first full-term pregnancy after the age of 30 or are nulliparous.

A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. For the other tests done to determine the risk for cancer recurrence or spread, what results in support a more favorable prognosis? (select all that apply). A. Well-differentiated tumor B. Estrogen receptor-positive tumor C. Involvement of two to four axillary nodes D. Overexpression of the HER2 protein E. High DNA proliferative index

A. Well-differentiated tumor B. Estrogen receptor-positive tumor Rationale: In general, the more well-differentiated the tumor, the less aggressive it is. Poorly differentiated tumors appear morphologically disorganized and are more aggressive. Other information useful for treatment decisions and determining the prognosis is the patient's estrogen and progesterone receptor status. Receptor-positive tumors (1) commonly show histologic evidence of being well-differentiated, (2) frequently have a diploid (more normal) DNA content and low proliferative indices, (3) have a lower chance for recurrence, and (4) are frequently hormone-dependent and responsive to hormonal therapy.

What are the current guidelines for breast cancer screening? A. Yearly mammograms starting at age 40 B. Breast self-examination (BSE) monthly for women starting at age 20 C. Breast ultrasound every 5 years after age 50 D. Clinical breast examination (CBE) yearly starting at age 20

A. Yearly mammograms starting at age 40 Rationale: Yearly mammograms should start at age 40 and continue for as long as a woman is in good health. BSE is considered optional, but if done, it should start at age 20. Breast ultrasound is used with mammography to differentiate a solid mass from a cystic mass, to evaluate a mass in a pregnant or lactating woman, or to locate and biopsy a suspicious lesion seen on magnetic resonance imaging (MRI). It is not used in screening. CBE preferably is done at least every 3 years for women between the ages of 20 and 30 years and every year for women beginning at age 40.

A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). What point should the nurse emphasize when teaching the patient about her new drug regimen? A. "You may find that your medication causes some breast sensitivity." B. "It's important that you let your care provider know about any changes in your vision." C. "You'll find that this drug often alleviates some of the symptoms that accompany menopause." D. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."

B. "It's important that you let your care provider know about any changes in your vision." Rationale: Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.

The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which guidelines should the nurse provide to the audience? A. "Mammograms are necessary if you have a family history of breast cancer." B. "It's recommended that you get a mammogram each year after you turn 40." C. "If you are not able to perform breast self-examination (BSE), you should go for regular mammograms." D. "You should ensure that your primary care provider performs a breast exam each time you visit."

B. "It's recommended that you get a mammogram each year after you turn 40." Rationale: Annual mammograms are recommended after age 40. They are recommended for all women, not solely those with a family history of breast cancer. BSE is not a replacement for mammography, and clinical breast examinations are not necessary at each office visit, but recommended at least every 3 years for women in their 20s and 30s, and then every year beginning at age 40

The 60-year-old woman comes to the clinic 3 years after her last regular appointment. She reports occasional diffuse breast tenderness, aching, and soreness. What do you anticipate will happen first? A. Magnetic resonance imaging (MRI) B. Mammography C. Teaching the patient to take vitamin E D. Teaching continual wearing of a support bra

B. Mammography Rationale: Although these symptoms can indicate benign mastalgia, mammography is anticipated to exclude cancer and provide information on the cause of mastalgia. Usually, mastalgia improves after menopause, and the current recommendation for mammograms is yearly after age 40. MRI is used for screening in high-risk women, including those whose mammography or ultrasound result is suspicious for malignancy and women who previously had occult breast cancer detected by mammography. Self-help measures to treat mastalgia are considered after cancer has been excluded.

Which task could the registered nurse delegate to unlicensed assistive personnel (UAP) during the care of a patient who has had recent transverse rectus abdominis musculocutaneous (TRAM) flap surgery? A. Document the condition of the patient's incisions. B. Mobilize the patient in a slightly hunched position. C. Change the patient's abdominal and chest dressings. D. Change the parameters of the patient-controlled analgesic (PCA) pump.

B. Mobilize the patient in a slightly hunched position. Rationale: Mobilization of a postsurgical patient may be delegated, and the patient who has had a TRAM flap should not stand or walk fully erect, in order to minimize strain on the incisions. Changing dressings, assessing wounds, and reprogramming a PCA pump are not appropriate tasks to delegate to UAP.

The nurse is caring for an obese 67-year-old woman after a right mastectomy with axillary lymph node dissection. Which should the nurse include in the discharge instructions? A. "Arm exercises should not be started for 4 to 6 weeks." B. "Discontinue arm exercises if you have discomfort or pain." C. "Special massage therapy can decrease swelling in your arm." D. "Keep your right arm in a sling to decrease pain and swelling."

C. "Special massage therapy can decrease swelling in your arm." Rationale: Decongestive therapy may be used for acute lymphedema and includes a massage-like technique to mobilize the subcutaneous accumulation of fluid. Arm exercises should be performed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The arm exercises should be initiated after surgery and increased gradually. Pain medications should be administered 30 minutes before arm exercises. The operative arm should be kept at the level of the heart but not in a sling; a sling discourages the use of the arm.

The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer? A. A 25-year-old female with fibrocystic breast disease B. A 59-year-old male who has inherited the APC gene C. A 72-year-old female with a family history of breast cancer D. A 43-year-old male who is obese and leads a sedentary lifestyle

C. A 72-year-old female with a family history of breast cancer Rationale: The risk factors most associated with breast cancer are female gender, advancing age, and family history. The incidence of breast cancer increases dramatically after age 60. Mutations in BRCA genes may cause 5% to 10% of breast cancers; APC gene is associated with colon cancer. Obesity and physical inactivity increase the risk for breast cancer. Fibrocystic breast disease is not associated with the development of breast cancer.

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease lymphedema? A. Keep the affected arm flat at the patient's side. B. Apply an elastic bandage on the affected arm. C. Assess blood pressure only on the unaffected arm. D. Restrict exercise of the affected arm for 1 week.

C. Assess blood pressure only on the unaffected arm. Rationale: Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended and gradually increased starting in the recovery room to reduce the fluid volume in the arm.

The nurse performs a breast examination on a 68-year-old female patient. Which clinical manifestation, if assessed by the nurse, indicates that further evaluation for breast cancer is needed? A. Bilateral pendulous breasts B. Right breast is warm, painful to touch C. Irregular, nontender lump with induration D. Palpable lump that is tender and movable

C. Irregular, non-tender lump with induration Rationale: Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and non-tender. Nipple retraction, peau d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to the touch, indurated, and painful. Atrophy of the mammary glands associated with aging may result in pendulous breasts. Manifestations of fibrocystic breast changes include palpable lumps that are round, well-delineated, and freely movable. The lump is usually tender and increases in size and tenderness before menstruation.

The nurse is caring for a 52-year-old woman with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make? A. Observe for alopecia. B. Determine visual acuity. C. Monitor cardiac rhythm. D. Assess mouth and throat.

C. Monitor cardiac rhythm. Rationale: Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The nurse should monitor for cardiac dysrhythmias, electrocardiogram changes, and clinical manifestations of heart failure. Other adverse effects of doxorubicin include stomatitis and alopecia, but these effects are not as serious as cardiac problems. Tamoxifen may cause visual changes.

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. What would you include to best promote the learning and adherence of the participants? (select all that apply). A. Short audiotape on the BSE procedure B. Packet of articles from the medical literature C. Written guidelines for mammography and CBE D. Discussion of the value of early breast cancer detection E. Need to get a mammogram starting at age 35

C. Written guidelines for mammography and CBE D. Discussion of the value of early breast cancer detection Rationale: When teaching women about breast cancer screening guidelines, include information about potential benefits, limitations, and harm (chance of a false-positive result). Allow time for questions about the procedure and a return demonstration. At every periodic health examination, ask the woman who is performing BSE to demonstrate her technique. Demonstration of BSE and provision of written guidelines are appropriate teaching methods.

The nurse teaches a 53-year-old patient about screening for early detection of breast cancer. Which statement by the patient requires an intervention by the nurse? A. "I should plan to have a mammogram every year." B. "I will see a health care provider every year for a breast examination." C. "A breast examination should be done right after my menstrual period." D. "Self-breast examination is a reliable way to detect breast cancer early."

D. "Self-breast examination is a reliable way to detect breast cancer early." Rationale: Screening for the early detection of breast cancer includes yearly mammograms starting at age 40 and clinical breast examination every year at age 40. An alternative suggestion is to begin screening mammograms at age 50. Breast self-examination has benefits and limitations and may not be a reliable method for early detection of breast cancer. BSE is optional but should be done in premenopausal women right after the menstrual period when the breasts are less lumpy and tender.

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care? A. Evaluate left arm lymphatic accumulation. B. Maintain joint flexibility and left arm function. C. Teach her about chemotherapy and radiation therapy. D. Assess the patient's response to the diagnosis of breast cancer.

D. Assess the patient's response to the diagnosis of breast cancer. Rationale: Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care for this patient. The approach for the care of the left arm and teaching the patient about further therapy will be based on this assessment.

A young woman was just told by her physician that she has breast cancer. What is your most appropriate action? A. Offer to answer questions. B. Call the chaplain. C. Leave her alone to give her privacy. D. Encourage her to talk about her feelings.

D. Encourage her to talk about her feelings. Rationale: In a crisis, talking about feelings and letting the patient take the lead is the best approach.

A 51-year-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? A. Immobilize the patient's right arm until postoperative day 3. B. Maintain the patient's right arm in a dependent position when at rest. C. Administer diuretics prophylactically for the prevention of lymphedema. D. Promote gradually increasing mobility as soon as possible following surgery.

D. Promote gradually increasing mobility as soon as possible following surgery. Rationale: Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery, and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.

In teaching a patient who wants to perform BSE, you inform her that the technique involves palpation of the breast tissue and A. palpation of cervical lymph nodes. B. hard squeezing of the breast tissue. C. a mammogram to evaluate breast tissue. D. inspection of the breasts for any changes.

D. inspection of the breasts for any changes. Rationale: BSE is performed by palpation of breast tissue with three levels of pressure. Breasts also should be inspected for size, shape, redness, scaliness, or dimpling of the breast skin or nipple.

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. Which recommendations you would include? (select all that apply) a. Women over age 55 may have biennial screening. b. Screening should end when the woman reaches age 65. c. Women aged 45 to 54 years should be screened annually. d. Regular screening mammography should start at the age of 45 years. e. Clinical breast examinations can be used if the woman has average risk.

a. Women over age 55 may have biennial screening. c. Women aged 45 to 54 years should be screened annually. d. Regular screening mammography should start at the age of 45 years. Rationale: For women at average risk for breast cancer, the American Cancer Society (ACS) recommended guidelines include: • Women should undergo regular screening mammography starting at age 45 years. • Women aged 45 to 54 years should be screened annually. • Women 55 years and older should transition to biennial screening or be able to continue screening annually. • Women should continue screening if their overall health is good, and they have a life expectancy of 10 years or longer. • The ACS does not recommend depending on clinical breast examination for breast cancer screening among average-risk women at any age.

When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is a. being a woman over age 60. b. experiencing menstruation for 30 years or more. c. using hormone therapy for 5 years for menopausal symptoms. d. having a paternal grandmother with postmenopausal breast cancer.

a. being a woman over age 60. Rationale: The identifiable risk factors most associated with breast cancer include female gender and advancing age. The incidence of breast cancer is very low in women younger than 25 years and increases gradually with age until 60 years. After age 60, the incidence increases dramatically

A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply) a. well-differentiated tumor. b. estrogen receptor-positive tumor. c. overexpression of HER-2 cell marker. d. involvement of two to four axillary nodes. e. aneuploidy status from cell proliferation studies.

a. well-differentiated tumor. b. estrogen receptor-positive tumor. Rationale: In general, the more well differentiated the tumor is, the less aggressive it is. Poorly differentiated tumors appear morphologically disorganized and are more aggressive. Another diagnostic test useful for treatment decisions and prognosis is determination of estrogen and progesterone receptor status. Receptor-positive tumors (1) often show histologic evidence of being well differentiated, (2) often have a diploid (more normal) DNA content and low proliferative indices, (3) have a lower chance for recurrence, and (4) are often hormone dependent and responsive to hormone therapy.

Preoperatively, to meet the psychologic needs of a woman scheduled for a simple mastectomy, you would a. discuss the limitations of breast reconstruction. b. include her significant other in all conversations. c. promote an environment for the expression of feelings. d. explain the importance of regular follow-up screening.

c. promote an environment for the expression of feelings. Rationale: Throughout interactions with a patient with breast cancer, you should be aware of the extensive psychologic impact of the disease. Effective care includes sensitivity to the patient's efforts to cope with a life-threatening disease. You should provide a safe environment for the expression of the full range of feelings.

You are caring for a patient with breast cancer following a simple mastectomy. Postoperatively, to restore arm function on the affected side, you would a. apply heating pads or blankets to increase circulation. b. place daily ice packs to minimize the risk of lymphedema. c. teach passive exercises with the affected arm in a dependent position. d. emphasize regular exercises for the affected shoulder to increase range of motion.

d. emphasize regular exercises for the affected shoulder to increase range of motion. Rationale: Restoring arm function on the affected side after mastectomy and axillary lymph node sampling is a key nursing goal. Place the woman in a semi-Fowler's position with the arm on the affected side elevated on a pillow. Flexing and extending the fingers should begin in the recovery room, and progressive increases in activity should be encouraged. Postoperative arm and shoulder exercises are started gradually under a HCP's direction. These exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks.

You are caring for a young woman who has painful fibrocystic breast changes. Management of this patient would include a. scheduling a biopsy to rule out the presence of breast cancer. b. teaching that symptoms will subside if she stops using oral contraceptives. c. preparing her for surgical removal of the lumps, since they will become larger and more painful. d. explaining that restricting coffee and chocolate and supplementing with vitamin E may relieve some discomfort.

d. explaining that restricting coffee and chocolate and supplementing with vitamin E may relieve some discomfort. Rationale: Some relief for cyclic breast pain may be obtained with reducing caffeine and dietary fat; taking vitamin E, gamma-linolenic acid (i.e., evening primrose oil); and wearing a supportive bra. Compresses, ice, analgesics, and antiinflammatory drugs may help. Drugs may be recommended, including tamoxifen and danazol (Danocrine).