Breast Disorders Practice Questions NCLEX
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 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 Women are at an increased risk for 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; and 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 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 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 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.
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 older than 60 years. B. experiencing menstruation for 40 years or longer. C. using hormone replacement therapy during menopause. D. having a paternal grandmother with postmenopausal breast cancer.
A. being a woman older than 60 years. The identifiable risk factors most associated with breast cancer include female gender and advancing age. The incidence of breast cancer in women under 25 years of age is very low and increases gradually until age 60. After age 60 the incidence increases dramatically.
The client has undergone a wedge resection for cancer of the left breast. which discharge instruction should the nurse teach? a. Don't lift more than 5 pounds with the left hand until release by HCP b. The cancer has been totally removed and no follow-up therapy will be required. c. The client should empty the Hemovac drain about every 12 hours. d. The client should arrange an appointment with a plastic surgeon for reconstruction.
Answer: A 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 activities.
During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. The nurse's first action should be to a. palpate the breasts for the presence of any discrete lumps. b. explain that this is a temporary condition caused by hormonal changes. c. refer the patient for mammography and biopsy of the breast tissue. d. teach the patient about dietary changes to reduce the breast size.
Answer: A Rationale: If discrete, circumscribed lumps are present, the patient should be referred for further testing to determine whether breast cancer is present. Gynecomastia is usually a temporary change, but it can be caused by breast cancer. Mammography and biopsy will not be needed unless lumps are present in the breast tissue. Dietary changes will not affect the condition. Cognitive Level: Application Text Reference: p. 1348 Nursing Process: Implementation NCLEX: Physiological Integrity
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? a. Ask of the client is afraid of having general anesthesia. b. Determine how the client feels about radiation and chemotherapy. c. Tell the client she will need reconstruction with either procedure d. Find out if the client has any history of breast cancer in her family.
Answer: B 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 qual to hose with a modified radical mastectomy.
Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and an axillary lymph node dissection is appropriate to assign to an LPN/LVN? a. Administering an analgesic 30 minutes before the scheduled arm exercises b. Teaching the patient how to avoid injury to the right arm c. Assessment of the patient's range of motion for the right arm d. Evaluation of the patient's understanding of discharge instructions about drain care
Answer: A Rationale: LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN-level education and scope of practice. Cognitive Level: Application Text Reference: pp. 1356-1361 Nursing Process: Implementation NCLEX: Safe and Effective Care Environment
A 38-year-old woman is scheduled for a breast-conservation therapy with a lumpectomy. As the nurse prepares her for surgery, she begins to cry and says, "I just do not know how to handle all of this." An appropriate response to the patient by the nurse is, a. "Would you like to talk about how you are feeling right now?" b. "I can see you are really upset. Would you like to be alone for a while?" c. "The important thing is that the tumor was found and is going to be removed." d. "With this surgery you will have very little change in the appearance of your breast."
Answer: A Rationale: The nurse encourages the patient to express feelings about the diagnosis and surgery. The response beginning, "I can see you are really upset" may indicate that the nurse is uncomfortable being with the patient while she is upset. The response beginning, "The important thing is that the tumor was found" places the nurse's value system above the patient's current concerns. And the response, "With this surgery you will have very little change in the appearance of your breast" does not address all the patient's possible concerns and is not true. Cognitive Level: Application Text Reference: p. 1360 Nursing Process: Implementation NCLEX: Psychosocial Integrity
After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that no further teaching is needed? a. "I will avoid reaching over the stove with my left hand." b. "I will need to do breast self-examination on my right breast monthly." c. "I will keep my left arm elevated until I go to bed." d. "I will remember to use my right arm and to rest the left one."
Answer: A Rationale: The patient should avoid any activity that might injure the left arm, such as reaching over a burner. Breast self-examination should be done to the right breast and the left mastectomy site. The left arm should be elevated when the patient is lying down also. The left arm should be used to improve range of motion and function. Cognitive Level: Application Text Reference: pp. 1359-1360 Nursing Process: Evaluation NCLEX: Physiological Integrity
The client who has had a mastectomy tells the nurse,"my husband will leave me now since I am not a whole women anymore." Which response by the nurse is most therapeutic? a. "You're afraid your husband will now find you sexually appealing?" b. "Your husband should be grateful you will be able to live and be with him." c. "Maybe your husband would like to attend a support group for spouses." d. "You dont know that is true. You need to give him a chance"
Answer: A Restating the client's feelings is a therapeutic response.
When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a a. cousin who was diagnosed with breast cancer at age 38. b. mother who was diagnosed with breast cancer at age 42. c. sister who died from ovarian cancer at age 56. d. grandmother who died from breast cancer at age 72.
Answer: B Rationale: A significant family history of breast cancer means that the patient has a first-degree relative who developed breast cancer, especially if the relative was premenopausal. Cognitive Level: Application Text Reference: p. 1348 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance
A patient with a small breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. only a small incision is necessary, resulting in minimal breast pain and scarring. b. if the specimen is positive for malignancy, the patient can be told at the visit. c. if the specimen is negative for malignancy, the patient's fears of cancer can be put to rest. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
Answer: B Rationale: An FNA should only be done when an experienced cytologist is available to read the specimen immediately. If the specimen is positive for malignancy, the patient can be given this information immediately. No incision is needed. If the specimen is negative for malignancy, the patient will require biopsy of the lump. FNA is not guided by mammography. Cognitive Level: Application Text Reference: p. 1345 Nursing Process: Planning NCLEX: Physiological Integrity
A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. When discussing this issue with the patient, the nurse explains that a. HRT does not appear to increase the risk for breast cancer unless there are other risk factors. b. she and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer. c. HRT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. d. alternative therapies with herbs and natural drugs are as effective as estrogen in relieving the symptoms of menopause.
Answer: B Rationale: Because HRT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increase the risk for non-BRCA-associated cancer as well as for BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms. Cognitive Level: Application Text Reference: p. 1348 Nursing Process: Implementation NCLEX: Physiological Integrity
At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that a. her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer. b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer. c. because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes. d. genetic mutations increase cancer risk only in combination with other risk factors such as obesity.
Answer: B Rationale: Family history is a risk factor for breast cancer, and the nurse should discuss testing for BRCA genes with the patient. Although the BRCA gene is associated with increased risk for breast and ovarian cancer, the patient may be at risk if her mother had either one. About 5% to 10% of patients with breast cancer may have a genetic abnormality that contributes to breast cancer development. Risk factors are cumulative, but a family history alone will increase breast cancer risk. Cognitive Level: Application Text Reference: p. 1349 Nursing Process: Implementation NCLEX: Physiological Integrity
A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse's response to the patient is based on the knowledge that the most likely cause of the breast lump is a. fibrocystic complex. b. fibroadenoma. c. breast abscess. d. adenocarcinoma.
Answer: B Rationale: Fibroadenoma is the most frequent cause of breast lumps in women under 25 years of age. Fibrocystic changes occur most frequently in women ages 35 to 50. Breast abscess is associated with pain and other systemic symptoms. Breast cancer is uncommon in women younger than 25. Cognitive Level: Application Text Reference: p. 1347 Nursing Process: Implementation NCLEX: Physiological Integrity
When teaching a 22-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that a. BSE will reduce the risk of dying from breast cancer. b. performing BSE right after the menstrual period will improve comfort. c. BSE should be done daily while taking a bath or shower. d. annual mammograms should be scheduled in addition to BSE.
Answer: B Rationale: Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces breast cancer mortality. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40. Cognitive Level: Application Text Reference: p. 1344 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance
A patient with a breast biopsy positive for cancer is to undergo lymphatic mapping and sentinel lymph node dissection (SLND). The nurse explains that this procedure a. can identify specific lymph nodes that have malignant cells, so only involved nodes need to be excised. b. reduces the need for extensive lymph node dissection for pathologic examination. c. eliminates the need for excision of more than one lymph node for staging of breast cancer. d. will confirm the absence of tumor spread if the sentinel lymph node is negative for malignant changes.
Answer: B Rationale: The SLND may eliminate further lymph node dissection if the initial nodes are negative for malignancy. The procedure identifies which lymph nodes drain first from the tumor site, but not which ones are malignant. Several lymph nodes may be dissected for pathologic examination. Tumor may have distant metastases even when no malignancies are found in the lymph nodes. Cognitive Level: Comprehension Text Reference: p. 1351 Nursing Process: Implementation NCLEX: Physiological Integrity
A woman with a positive biopsy for breast cancer is considering whether to have a modified radical mastectomy or breast conservation surgery (lumpectomy) with radiation therapy. Which information should the nurse provide? a. The postoperative survival rate for each is about the same, but there is a decreased rate of cancer recurrence after mastectomy. b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity. c. The hair loss associated with post-lumpectomy chemotherapy is not acceptable to some patients. d. The treatment period for the mastectomy is shorter, and breast reconstruction can provide a normal-appearing breast.
Answer: B Rationale: The impact on breast function and appearance is less with lumpectomy and radiation, but there is some effect on breast sensitivity. The rate of cancer recurrence is the same for the two procedures. Chemotherapy may be used after either lumpectomy or mastectomy, but it is not always needed. The treatment period is shorter after mastectomy, but breast reconstruction does not provide a normal-appearing breast. Cognitive Level: Application Text Reference: pp. 1352-1353 Nursing Process: Implementation NCLEX: Physiological Integrity
A patient has a permanent breast implant inserted in the outpatient surgery area. Which instructions will the nurse include in the discharge teaching? a. Resume normal activities 2 to 3 days after the mammoplasty. b. Check wound drains for excessive blood or any foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Take aspirin every 4 hours to reduce inflammation.
Answer: B Rationale: The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery. Cognitive Level: Comprehension Text Reference: p. 1362 Nursing Process: Implementation NCLEX: Physiological Integrity
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? a. This is a benign process, which does not require follow up b. The client should eliminate chocolate and caffeine from the diet. c. The client should practice breast self-examinations monthly. d. This is the way breast cancer begins and the client needs surgery.
Answer: C ACS no longer recommends breast self-examination for all women, but it is advisable for women with known breast conditions to perform BSE monthly to detect potential cancer
Which recommendation is the American Cancer Society's (ACS) 2015 guideline for early detection of breast cancer? a. Beginning at age 18, have a biannual clinical breast examination by an HCP b. Beginning at age 30, perform monthly breast self-exams. c. At age 45, through 54, receive a yearly mammogram. d. Beginning at age 50, have a breast sonogram every 5 years.
Answer: C 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 years after the age 55. Before age 45 and after age 55 it should be a discussion between the women and her HCP to determine if more frequent mammograms are warranted. A mammogram can detect disease that will not be large enough to feel.
A 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure. She says she does breast self-examination (BSE) monthly and asks whether it is necessary to have an annual mammogram. The nurse's best response to the patient is, a. "If your mammogram was painful, it is especially important that you have it done annually." b. "An ultrasound examination of the breasts, which is not painful or a source of radiation, can be substituted for a mammogram." c. "Because of your age, it is even more important for you to have annual mammograms." d. "Unless you find a lump while examining your breasts, a mammogram every 2 years is recommended after age 60."
Answer: C Rationale: Annual mammograms are recommended for women over age 40 as long as they are in good health. The incidence of breast cancer increases in women over 60. Pain with a mammogram does not indicate any greater risk for breast cancer. Ultrasound may be used in some situations to differentiate cystic breast problems from cancer but is not a substitute for annual mammograms. Cognitive Level: Application Text Reference: p. 1344 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance
A 33-year-old patient tells the nurse that she has fibrocystic breasts but reducing her sodium and caffeine intake and other measures have not made a difference in the fibrocystic condition. An appropriate patient outcome for the patient is a. calls the health care provider if any lumps are painful or tender. b. states the reason for immediate biopsy of new lumps. c. monitors changes in size and tenderness of all lumps in relation to her menstrual cycle. d. has genetic testing for BRCA-1 and BRCA-2 to determine her risk for breast cancer.
Answer: C Rationale: Because fibrocystic breasts may increase in size and tenderness during the premenstrual phase, the patient is taught to monitor for this change and to call if the changes persist after menstruation. Pain and tenderness are typical of fibrocystic breasts, and the patient should not call for these symptoms. New lumps may be need biopsy if they persist after the menstrual period, but the biopsy is not done immediately. The existence of fibrocystic breasts is not associated with the BRCA genes. Cognitive Level: Application Text Reference: pp. 1346-1347 Nursing Process: Planning NCLEX: Health Promotion and Maintenance
A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to a. teach the patient about the need to monitor serum electrolyte levels. b. ask the patient to call the health care provider before using any over-the-counter (OTC) pain relievers. c. instruct the patient to call if she notices ankle swelling. d. have the patient schedule frequent eye examinations.
Answer: C Rationale: Herceptin can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. OTC pain relievers do not interact with Herceptin. Changes in visual acuity may occur with tamoxifen, but not with Herceptin. Cognitive Level: Analysis Text Reference: p. 1356 Nursing Process: Implementation NCLEX: Physiological Integrity
Following a modified radical mastectomy, a patient tells the nurse the health care provider has recommended a flap procedure for breast reconstruction but that she did not understand how this was done. The nurse explains that the most common procedure, a transverse rectus abdominis musculocutaneous (TRAM) flap, involves a. relocating muscle tissue from the back and using it to form a breast. b. removing a portion of an abdominal muscle to use as breast tissue. c. pulling part of the abdominal muscle up to the breast area through a tunnel in the chest. d. relocating the arteries from the abdominal muscle to improve circulation to the implant.
Answer: C Rationale: In the TRAM flap, part of the rectus abdominis muscle is tunneled to the breast area and molded to form a breast. In the latissimus dorsi musculocutaneous flap, muscle tissue from the back is used to replace breast tissue. The abdominal muscle is not detached but is still attached to the rectus muscle. The arteries are not relocated. Cognitive Level: Application Text Reference: pp. 1362-1363 Nursing Process: Implementation NCLEX: Physiological Integrity
Which statement by a 32-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that the goals of therapy are being met? a. "I am not sure how my husband will react when I tell him about this cancer." b. "I am ready to die if that is God's plan for me." c. "I need to know all the options before making a decision about treatment." d. "I will do whatever the doctor thinks is best."
Answer: C Rationale: One goal for the patient with breast cancer is active participation in the decision-making process. The response beginning, "I am not sure how my husband will react" indicates that the goal of satisfaction with the support provided by significant others is still unmet. The response, "I am ready to die if that is God's plan for me" suggests that the patient may not be willing to have treatment. The response, "I will do whatever the doctor thinks is best" indicates that the patient is not participating actively in treatment decisions. Cognitive Level: Application Text Reference: p. 1359 Nursing Process: Evaluation NCLEX: Psychosocial Integrity
A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate intervention for the nurse to include in implementing postoperative care for the patient includes a. teaching the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes for the best pain relief. b. insisting that the patient examine the surgical incision when the dressings are removed. c. posting a sign at the bedside warning against blood pressures or venipunctures in the right arm. d. encouraging the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.
Answer: C Rationale: The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery. Cognitive Level: Application Text Reference: pp. 1358-1359 Nursing Process: Implementation NCLEX: Physiological Integrity
Following a modified radical mastectomy, the health care provider recommends chemotherapy even though the lymph nodes were negative for cancer cells. The patient tells the nurse that she does not know what to do about chemotherapy because she has heard that she may not even need chemotherapy and that the side effects are uncomfortable. The nursing diagnosis that best reflects the patient's problem is a. anxiety related to prospect of additional cancer therapy. b. fear related to uncomfortable side effects of chemotherapy. c. decisional conflict related to lack of knowledge about prognosis and treatment options. d. risk for ineffective health maintenance related to reluctance to consider additional treatment.
Answer: C Rationale: The patient's statements indicate that she is having difficulty making a decision about treatment because of a lack of understanding about prognosis and treatment. Although she may have some anxiety and fear, these are not the priorities at this time. The patient expresses concerns about chemotherapy rather than reluctance to consider additional treatment. Cognitive Level: Application Text Reference: p. 1356 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity
A patient with an abnormal mammogram is scheduled for stereotactic core biopsy. Which information will the nurse include when teaching the patient about the procedure? a. "You will need to avoid eating or drinking anything for 6 hours before the procedure." b. "Any discomfort after the biopsy may be treated with mild pain relievers such as aspirin." c. "The core biopsy is evaluated immediately and you will get the results before leaving." d. "Several samples of tissue in the abnormal area will be obtained during the procedure."
Answer: D Rationale: During stereotactic breast biopsy, a biopsy gun is used to remove several core samples in the area of abnormality. The procedure is done using a local anesthetic, so there is no need to be NPO before the procedure. Aspirin should not be used because it will increase bleeding at the site. The biopsy is sent to pathology, and results are not usually available immediately. Cognitive Level: Application Text Reference: p. 1345 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance
While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent? a. "Do you currently smoke cigarettes?" b. "Have you ever had any breast injuries?" c. "Is there any family history of fibrocystic breast changes?" d. "At what age did you start having menstrual periods?"
Answer: D Rationale: Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk. Cognitive Level: Application Text Reference: p. 1349 Nursing Process: Assessment NCLEX: Physiological Integrity
A 34-year-old woman has undergone a modified radical mastectomy for a breast tumor. The pathology report identified the tumor as a stage I, estrogen-receptor-positive adenocarcinoma. The nurse will plan on teaching the patient about a. raloxifene (Evista). b. estradiol (Estrace). c. trastuzumab (Herceptin). d. tamoxifen (Nolvadex).
Answer: D Rationale: Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used post-mastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2/neu antigen. Cognitive Level: Application Text Reference: p. 1355 Nursing Process: Planning NCLEX: Physiological Integrity
The nurse provides discharge teaching for a patient who has had a left modified radical mastectomy and axillary lymph node dissection. The nurse determines that teaching has been successful when the patient says, a. "I should keep my left arm supported in a sling when I am up until my incision is healed." b. "I may expose my left arm to the sun for several hours each day to increase circulation and promote healing." c. "I can do whatever exercises and activities I want as long as I do not elevate my left hand above my head." d. "I will continue to exercise my left arm with finger-walking up the wall or combing my hair."
Answer: D Rationale: The patient should continue with arm exercises to regain strength and range of motion. The left arm should be elevated to the level of the heart when the patient is up. Sun exposure is avoided because of the risk of sunburn. The left hand should be elevated at or above heart level to reduce swelling and lymphedema. Cognitive Level: Application Text Reference: pp. 1359-1360 Nursing Process: Evaluation NCLEX: Physiological Integrity
The client has a mastectomy for cancer of the breast and asked the nurse about a TRAM flap procedure. Which information should the nurse explain to the client. a. the surgeon will insert a saline-filled sac under the skin to simulate a breast. b. the surgeon will pull the client's own tissue under the skin to create a breast. c. The surgeon will use tissue from inside the mouth to make nipple d. The surgeon will make the breast an size the client wants the breast to be.
Anwer: B 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 build collateral circulation in the area.
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." 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." 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 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 an 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. 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." 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 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 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 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, nontender lump with induration Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to 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.
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 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.
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. E. Assess mouth and throat.
C. Monitor cardiac rhythm. 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.
Preoperatively, to meet the psychologic needs of a woman scheduled for a modified radical mastectomy, you would A. discuss the limitations of breast reconstruction. B. include her significant other in all conversations. C. promote an environment for expression of feelings. D. explain the importance of regular follow-up screening.
C. promote an environment for expression of feelings. Throughout interactions with a woman with breast cancer, you should be aware of the extensive psychologic impact of the disease. Effective care includes sensitivity to the woman's efforts to cope with a life-threatening disease. You should provide a safe environment for the expression of the full range of feelings.
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." 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.
A modified radical mastectomy with an axillary lymph node dissection has been scheduled for your patient with breast cancer. What will you do postoperatively to restore arm function on the affected side? 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 exercise for the affected shoulder to increase range of motion.
D. Emphasize regular exercise for the affected shoulder to increase range of motion. Restoring arm function on the affected side after mastectomy and axillary lymph node dissection 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, with progressive increases in activity encouraged. Postoperative arm and shoulder exercises are instituted gradually under a surgeon'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.
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. 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. 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. 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.
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 the lymphedema? A. Keep affected arm flat at the patient's side. B. Apply an elastic bandage on the affected arm. C. Assess blood pressure only on unaffected arm. D. Restrict exercise of the affected arm for 1 week.
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 the lymphedema? A. Keep affected arm flat at the patient's side. B. Apply an elastic bandage on the affected arm. C. Assess blood pressure only on unaffected arm. D. Restrict exercise of the affected arm for 1 week.