Chapter 52: Breast Disorders
A patient who has stage IIB breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected and three contain malignant cells. What is teh best goal for the nurse to use in planning care? A Assess the pt's response to pathology report B. Maintain joint flexibility and l. arm function B. Prevent L. arm lymphatic fluid accumulation D. Prepare her for chemo and radiation therapy
A. Because the nurse acts as the pt. advocate and because this time is an extremely stressful period for the patient and family, the nurses initial plan focuses on the patients response to the pathology report as part of a comprhensive patient assessment.
What is the nurse's priority assessment in a 41 year old female paitent who reports a lump in the upper, outer margin of the right breast? A. Related pain B. Family history C. Onset of mass D. Characteristics
A. Breast cancer is usually associated with nonpainful and nontender lesions of the breast, so this information is very important in assessing breast masses
What should the nurse include in patient teaching when preparing a 45 year old patient for a routine mammography? A. Additional xrays can be needed for dense breast tissue B. Ultrasound confirms the presence of nonvisible mass C. Early detection of malignany tumore prevents mettastasis D. Continue to obtain clinical breast examinations every 3 years
A. Dense breast tissue on mammography can appear as a suspicious region of the breast. Once identified, additional mammograms can target the region for further examination
Two years after breast conserving surgery for a malignany left breast tumor, the nurse assesses the patient. Which patient assessment data is a priority? A. Irregular, fixed mass i the left axilla B. Temperature, HR, lung sounds C. Left upper extremity persistent edema D. Keloid formation around wound edges
A. The most frequent site of breast cancer recurrence is the site of the original tumor, so the presence of an irregular and fixed mass in the L. axilla is the nurse priority. Fixed and irregular are characteristics of a malignant breast tumor and require follow up care
A pt. who had breast cancer is now having breast reconstructive surgery. To enhance the quality of the reconstructive surgery, what is the nurse's priority patient assessment when the patient returns for enlargement of the expander? A. Color of the affected skin B. Attitiude on reconstruction C. Desired size of new breast D. Tenderness near expander
A. Color of the affected skin. The nurses priority assessment is the color of the skin over and surrounding the expander because abnormal skin color can indicate poor perfusion to the region and risk the viability to the tissue. This is the nurses priority because the purpose of teh expander is to stretch the patiesn skin that will eventually cover the breast implant. The skin over the expander should be pink, warm, and supple. Skin with poor perfusion can look dusky and pale and be cool and friable.
Which of the following factors are poor prognostic indicators of breast cancer (select all that apply)? A. Previous breast cancer B. Well-differentiated tumor C. High incidence of aneuploidy D. Estrogen and progesterone receptor positive E. Many cells in synthesis phase of cell cycle
A. History of previous breast cancer increases the risk of recurrence. Tumors that are well differentiated tend to be less affressive than undifferentiated tumors. Tumors unreponsive to hormonal therapy tend to be more aggressive
The nurse is volunteering at a community center to teach women regarding breast cancer. The nurse would include which of the following 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
ACDE. 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.
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
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
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
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
A 22 year old female patient has come to the clinic for oral contraceptives. The nurse uses the opportunity for patient teaching about BSE. What shoudl the nurse include in patient teaching? A. Women at high risk for breast cancer begin BSE at 3o years old B. Perform BSE monthly on the day of the first pill in each package C. Older women use BSE annually as breast tissue density declines D. Healthy women need to have annual mammograms beginning at age 50
B. The nurse instructs the pt to use the packageing for the oral contraceptives as a convienient reminder to perform BSE monthly to increase adherence
Which of the following female patients should report her results from breast self-examination? A. Denser breast tissue B. Left nipple deviation C. Palpable rib margins D. Different size breasts
B. Unilateral deviation of a nipple and nipple retraction are clinical indicators of breast cancer and should be reported promplty to the HCP. The breasts of most women are slightly different sizes
The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which of the following 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. 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.
A 24-year-old patient who has undergone breast augmentation earlier in the day will be discharged home in the early evening. What instructions should the nurse provide in order to minimize the patient's risk of complications in the immediate recovery period? A. Avoid wearing a bra until postoperative day 3. B. Ask the patient to avoid strenuous exercise during her recovery period. C. Sleep in a semi-Fowler's position until her scheduled follow-up appointment. D. Enlist a friend or family member to perform passive range-of-motion exercises.
B. As with all types of breast surgery, strenuous exercise is contraindicated during the recovery period following breast augmentation. A bra should be worn to prevent dehiscence. Passive range-of-motion exercises should be avoided, and sleeping in a semi-Fowler's position is not necessary
Which of the following tasks should the registered nurse delegate to nursing assistive personnel (NAP) 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. 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 tasks amenable to delegation.
A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). Which of the following points 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 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. 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.
A 32 year old pt has stage IIB breast cancer that is estrogen receptor positive. What medication should the nurse avoid administering to the patient? A. diethylstilbestrol (DES) B. exemestane (Aromasin) C. trastuzumab (Herceptin) D. doxorubicin (Adriamycin)
B. exemestane (Aromasin) Is an aromatase inhibitor is used in the treatment of postmenopausal women. This drug interferes with the enzyme that helps synthesize endogenous estrogen but does not block the production of ovarian estrogen. Aromatase inhibitors are of little benefir in premenopausal women with breast cancer.
Which benign breast disorder is the most similar to breast cancer? A. Ductal ectasia B. Fibroadenoma C. Breasat abscess D. Cyclic mastalgia
C. A breast abscess is a benign breast disorder most likely to be confused with a malignany breast lesion because it shares moe characteristics of breast cancers than other benign breast disorders. A breast abscess can be red and edematous in apperance characteristic of inflammatory breast cancer. The abscess also is likely to be a palpable mass, a potential characteristic of breast cancer.
A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. Which of the following points about nipple discharge should the nurse teach to participants? A. Inappropriate lactation necessitates breast biopsy. B. Nipple discharge of any type is considered a precursor to cancer. C. Unexpected nipple discharge of any type warrants medical follow-up. D. Galactorrhea is a normal age-related change and a frequent perimenopausal symptom.
C. Although most cases of nipple discharge are not related to malignancy, further assessment is indicated. Galactorrhea is not considered a normal age-related change, nor is it a common perimenopausal symptom.
The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. Which of the following interventions would 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 on unaffected arm only. D. Restrict exercise of the affected arm for 1 week.
C. 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 to reduce fluid volume in the arm.
A 29-year-old primiparous patient has a 3-week-old infant whom she is breastfeeding. The woman has sought care because of recent breast tenderness, redness, and fever. Which of the following teaching points should the nurse prioritize when following up her care? A. Encourage patient to continue breastfeeding her infant. B. Refer patient for a mammogram as quickly as possible. C. Ensure patient adheres to her prescribed antibiotic regimen. D. Teach patient to use warm compresses and educate her about self-limiting nature of illness.
C. Mastitis normally requires antibiotic therapy, the success of which is often dependent on close adherence to the prescribed regimen. Breastfeeding should indeed be continued if possible, but effective treatment of her infection would be the immediate priority. Mastitis is not necessarily self limiting and mammography is not normally indicated.
A 51-year-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. Which of the following interventions 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. Mobility should be encouraged beginning in postanesthetic recovery and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery and the limb should never be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.