Ch. 58: Assessment and Management of Patients With Breast Disorders

A 32-year-old client is concerned with the lumps that have developed in her breasts and is fearful of cancer. She reports variability in the size of the lumps. What could be causing her condition?

Cyclical hormonal changes

A client has had a right modified radical mastectomy and axillary lymph node dissection. The nurse is teaching the client about measures to reduce the risk of complications. The client demonstrates understanding of the instructions when she states which of the following?

"I need to use an electric shaver when shaving my right armpit."

During a breast examination, which finding most strongly suggests that a client has breast cancer?

A fixed nodular mass with dimpling of the overlying skin

A 54-year-old woman presents to her healthcare provider's office where you practice nursing. She is very concerned that she might have breast cancer, especially after caring for her sister that recently died from the disease. Included in your discussion is the primary and most common sign of breast cancer. Which of the following would meet this criterion?

A painless mass in the breast, most often in the upper outer quadrant

A nurse is reviewing a female patient's history, which includes the following information: Age at menarche: 14 years Cesarean delivery: 2 pregnancies Age at first pregnancy: 35 years Alcohol use: approximately 1 to 2 glasses of wine/month The nurse identifies which of the following as a possible risk factor for developing breast cancer?

Age at first pregnancy

Kara Carpenter is a 54-year-old woman who just had a left radical mastectomy. The nurse caring for her is providing information on complications that may arise due to removing the axillary lymph nodes. Which of the following would not be included?

All would be included in the discussion.

A client returns to the recovery room following a mastectomy. An initial postoperative assessment is performed by the nurse. What is the nurse's priority assessment?

Assessing the vital signs and oxygen saturation levels.

A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation?

Assist the client to pump the breasts to remove breast milk.

A nurse is describing the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which of the following?

Bone mineral density

The nurse is educating a group of women at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than BSE?

Breast self-awareness

After teaching a group of students about the signs and symptoms of breast cancer, the instructor determines that additional teaching is needed when the group identifies which of the following?

Breast symmetry

A group of students is reviewing information about breast cancer and metastasis in preparation for an examination. The students demonstrate the need for additional study when they identify which of the following as a common site for metastasis?

Colon

How can breast cancer prevention programs best serve at-risk women from lower socioeconomic backgrounds?

Develop screening and educational programs.

The nurse is caring for a group of breast cancer survivors post mastectomy. Which teaching point should the nurse include?

Do not lift objects greater than 15 lb

The nurse advises a patient scheduled for external beam radiation that side effects are minimal and usually well tolerated. The most common and annoying side effect is:

Fatigue.

Which of the following is a characteristic of a breast cancer mass?

Firm, hard, embedded in surrounding tissue

A nurse is reviewing a client's history for possible risk factors associated with breast cancer. Which of the following would the nurse identify as increasing the client's risk?

First full-term pregnancy at age 34 years

A 28-year-old woman is learning about breast self-examination. The nurse teaches the woman that the best time of each month to examine her breasts is during the:

First week after menstruation.

The nurse is assessing the breast of a female patient and observes a prominent venous pattern on the left breast. What does the nurse understand that this can be indicative of?

Increased blood supply required by a tumor

Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon?

Gross swelling

A patient is told that she has a common form of breast cancer where the tumor arises from the duct system and invades the surrounding tissues, often forming a solid irregular mass. What type of cancer does the nurse prepare to discuss with the patient?

Infiltrating ductal carcinoma

The nurse is caring for a client who is beginning doxorubicin (Adriamycin) therapy for breast cancer. When preparing the client for probable side effects, which would the nurse include?

Information regarding wigs from the American Cancer Society

The nurse is assessing an older adult female who has not seen her physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding?

It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer.

A female patient is receiving paclitaxel (Taxol), as part of her treatment regimen for a larger, node-negative cancer. The nurse recognizes the possible side effects related to paclitaxel (Taxol) when the patient is diagnosed with which of the following conditions.

Joint pain

Which of the following options are available to women with an increased risk of developing breast cancer?

Long-term follow-up

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which of the following complications does this technique help avoid?

Lymphedema

The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following?

Lymphedema

A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include?

Maintaining an ideal weight

A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies?

Mammogram

A client is scheduled to undergo a procedure to lift her breasts that have drooped because of significant weight loss. The nurse identifies this procedure as which of the following?

Mastopexy

The nurse recognizes which of the following statements as accurately reflecting a risk factor for breast cancer?

Mother affected by cancer before 60 years of age

Which of the following would be inconsistent as a risk factor for breast cancer?

Multiparity

An early sign of Paget's disease includes which of the following?

Nipple erythema

The nurse teaches the female patient who is premenopausal to perform breast self-examination (BSE) at which time frame?

On day 5 to day 7, counting the first day of menses as day 1

The nurse is completing the admission history for a client who is admitted for a reduction mammoplasty. Which of the following client statements is uncommon when explaining the rationale for the procedure?

Others disapprove

On a follow-up visit, the patient is informed that her breast cancer has recurred. The nurse knows which of the following situations places the patient at risk for developing bone metastases?

Recurrence within 2 years of the original diagnosis

A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?

Refer the client to the American Cancer Society's Reach for Recovery program or another support program.

A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis?

Tamoxifen

Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)?

Tamoxifen

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer?

The lump is irregularly shaped

The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease?

The lump is round and movable

A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred?

The mass may be cystic and was ruptured when the needle was inserted

The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction?

The procedure removes all cancer from the body.

A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following?

Timing of symptoms in relation to the menstrual cycle

A group of students are reviewing the anatomy and physiology of the breasts. The students demonstrate understanding of breast structure when they identify the tail of Spence as an extension of which quadrant?

Upper outer

During a teaching demonstration on BSE, the nurse should always explain that the majority of breast cancers are found in the:

Upper, outer quadrant

During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate?

Wear gloves and protective clothing to avoid any injuries.

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:

should continue to perform breast self-examination on her right breast

A patient is scheduled to receive radiation therapy for 6 weeks after her lumpectomy. The patient states she is worried about the side effects of the radiation. What can the nurse inform her about the side effects of the radiation?

"The radiation can cause some skin breakdown towards the end of treatment in the axillary folds."

The nurse is assisting a patient with breastfeeding. The patient said that with her last baby, she had a problem with her nipples becoming irritated. What can the nurse suggest to the patient to prevent this problem? (Select all that apply.)

-Daily washing with water -Massage with breast milk or lanolin -Exposure to air

The nurse is discussing mammography with a female patient at the clinic. The patient asks at what age she should begin getting yearly mammograms. What answer should the nurse provide to the patient?

40

The nurse working on a woman's cancer treatment floor performs nursing assessments on her assigned patients. It is most important for the nurse to report which of the following assessment findings?

Coolness and mottling of a newly constructed breast site

A female patient comes to the clinic with the complaint that she is having a greenish-colored discharge from the nipple and the breast feels warm to touch. What does the nurse suspect these symptoms may indicate?

Infection

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?

Nonmobile mass with irregular edges