Chapter 6

The nurse is developing the discharge plan for a woman who has had a left-sided radical mastectomy. The nurse is including instructions for ways to minimize lymphedema. Which statement by the client indicates the need for additional instruction? "I need to avoid driving to and from work every day." "I should wear clothing with elasticized sleeves." "I need to wear gloves when doing any gardening." "Any blood pressures need to be taken in my right arm."

"I should wear clothing with elasticized sleeves."

A client who has had a mastectomy is to undergo breast reconstruction with augmentation. After teaching the client about the procedure, the nurse determines that the teaching was successful based on which client statement? "I'll use the same technique for breast self-exam as before." "Once implanted, the implants are good for the rest of my life." "My implants will feel softer than normal breast tissue." "The implants will be placed directly under my skin."

"I'll use the same technique for breast self-exam as before."

The nurse is caring for a 52-year-old woman whose sisters and mother died of breast cancer. The client states, "My doctor wants me to take tamoxifen to help prevent breast cancer. What do you think?" What would be the nurse's best response? "I would recommend raloxifene." "Tamoxifen reduces the incidence." "We call this drug a chemotherapy agent." "Tamoxifen prevents osteoporosis."

"Tamoxifen reduces the incidence."

At what age should a woman with no risk factors begin mammography screening for breast cancer?

40

A young client desires to know her risk of developing breast carcinoma. She has a positive family history of breast carcinoma. The nurse would suggest that she should undergo which diagnostic test? DNA ploidy status BRCA-1 genetic marker digital mammography fine-needle biopsy

BRCA-1 genetic marker

When preparing for a class on breast cancer, the nurse should explain which nonmodifiable risk factors? Select all that apply. being a 52-year-old female menarche at age 11 BRCA1 gene high-fat dietary intake failing to breastfeed infants

BRCA1 gene menarche at age 11 being a 52-year-old female

A woman who has undergone a right-sided modified-radical mastectomy returns from surgery. Which nursing intervention would be most appropriate for the nurse to include in the client's plan of care at this time? Position her right arm below heart level. Attach a sign above her bed to have BP, IV lines, and lab work in her right arm. Ask the client how she feels about having her breast removed. Encourage her to turn, cough, and deep breathe at frequent intervals

Encourage her to turn, cough, and deep breathe at frequent intervals.

Which breast disorder is not benign? fibroadenomas Paget disease duct ectasia fibrocystic breasts

Paget disease

A nurse is teaching a group of young adult women about the different benign breast disorders. When describing fibrocystic breast changes, which characteristics would the nurse include? Select all that apply. The lesions move freely when the breast is palpated. Clear nipple discharge may or may not be present. The pain is cyclic and usually decreases after the onset of menses. The changes usually involve one breast. These changes are most common between the ages of 20 and 50.

The lesions move freely when the breast is palpated. Clear nipple discharge may or may not be present. The pain is cyclic and usually decreases after the onset of menses. These changes are most common between the ages of 20 and 50.

A nurse is counseling a woman diagnosed with fibrocystic breast changes about self-care measures. Which instructions would the nurse include when teaching this client? Select all that apply. Use barrier contraceptive methods. Limit salt intake. Avoid caffeinated beverages. Apply ice to breasts. Wear a supportive bra.

Wear a supportive bra. Limit salt intake. Avoid caffeinated beverages.

In which client would the nurse suspect cancer? a 25-year-old with multiple small, round, and smooth lesions on both breasts that are painful during menstruation a 30-year-old with a mobile, rubbery, firm, well-circumscribed, nontender lump a 45-year-old with thickening in one breast with nipple irritation and retraction and a pink discharge a 40-year-old with nipple retraction and a watery discharge

a 45-year-old with thickening in one breast with nipple irritation and retraction and a pink discharge

A 27-year-old lactating client presents with the report of a solid, painless lump in her left breast. On examination, the nurse notes that the lump is mobile and slightly tender to pressure. The nurse suspects this is: mastitis. an inflamed milk duct. a fibroadenoma. malignant mass.

a fibroadenoma.

Which pharmacologic treatment would not be therapeutic for a woman with fibrocystic breast changes? antihistamines oral contraceptives anti-inflammatory agents diuretics

antihistamines

A nurse is teaching a woman how to perform breast self-examination as part of breast self-awareness. The nurse determines that the teaching was successful when the client states that she will complete the visual portion of the exam with her body in which position? Select all that apply. arms hanging down at her side sitting in a chair leaning backwards lying on her back with both arms raised arms raised up behind the head body bending forward

arms hanging down at her side arms raised up behind the head body bending forward

A client is receiving chemotherapy as part of her treatment plan for breast cancer. The nurse assesses the client and determines that the client may be experiencing myelosuppression based on which finding? nausea diarrhea fever fatigue

fever

A client diagnosed with breast cancer is receiving chemotherapy. The nurse assesses the client for possible side effects of this therapy. Which side effect would the nurse report immediately to the health care provider? diarrhea bone marrow suppression stomatitis nausea

bone marrow suppression

A woman has been treated for a tumor of the left breast that has not responded to chemotherapy. The woman has just found out that she has the BRCA mutations and discusses her options with her primary care provider. Which treatment would be most difficult for this woman? more aggressive chemotherapy bilateral mastectomy radiation therapy left mastectomy

bilateral mastectomy

Edema and enlargement in the ducts and glands of the breast that occur as effects of hormones are called: fibroadenomas. fibrocystic breast changes. duct ectasia. intraductal papilloma.

fibrocystic breast changes.

The nurse determines that a woman has implemented prescribed therapy for her fibrocystic breast disease when the client reports that she has eliminated which from her lifestyle? dairy products sweets cigarettes caffeine

caffeine

A nurse is working with a community group to foster early detection of breast cancer. Which components would the group address? Select all that apply. clinical breast examination breast self-examination mammography nutritional intake breast cancer awareness

clinical breast examination breast self-examination mammography

A client with breast cancer is receiving tamoxifen. After teaching the client about this drug, the nurse determines that the teaching was successful when the client identifies that she is at increased risk for which conditions? Select all that apply. ovarian cancer hot flashes cataract vaginal infection deep vein thrombosis

deep vein thrombosis hot flashes cataract

A breast biopsy indicates the presence of malignant cells, and the client is scheduled for a mastectomy. Which nursing diagnosis would the nurse most likely include in the client's preoperative plan of care as the priority? disturbed body image impaired urinary elimination risk for deficient fluid volume activity intolerance

disturbed body image

Which are modifiable risk factors for breast cancer? Select all that apply. duration of breastfeeding sedentary lifestyle smoking alcohol consumption obesity

duration of breastfeeding sedentary lifestyle smoking alcohol consumption obesity

A nurse is assigned to educate a group of women on cancer awareness. Which risk factors for breast cancer are modifiable? Select all that apply. postmenopausal use of estrogen and progestins failing to breastfeed for up to a year after pregnancy early menarche or late menopause not having children until after age 30 previous abnormal breast biopsy

failing to breastfeed for up to a year after pregnancy postmenopausal use of estrogen and progestins not having children until after age 30

nurse practitioner is performing a clinical breast exam and notes a mass. Which findings would lead the nurse practitioner to suspect that the mass is benign? Select all that apply. firmness on palpation absence of nipple retraction clearly delineated margins irregularly shaped skin dimpling

firmness on palpation absence of nipple retraction clearly delineated margins

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 complication? fibrocystic breast disease fibroadenoma breast abscess lymphedema

lymphedema

A client is considering breast augmentation. What would the nurse recommend to the client to ensure that there are no malignancies? breast biopsy mammogram mastopexy ultrasound

mammogram

During a clinical breast examination, the nurse palpates a well-defined, firm, mobile lump in a 60-year-old woman's left breast. The nurse notifies the primary care provider. What would the nurse anticipate the care provider to prescribe next? mammogram fine-needle aspiration genetic testing for BRCA genes hormone receptor status

mammogram

A woman with breast cancer is undergoing chemotherapy. Which side effect would the nurse interpret as being most serious? fatigue hair loss myelosuppression vomiting

myelosuppression

woman's breast examination reveals a small mass. Which characteristics would lead the nurse to suspect that the mass is malignant? Select all that apply. mobile hard on palpation rubbery feel clearly delineated painless skin dimpling

painless skin dimpling hard on palpation

A nurse is providing postoperative care to a client who has had surgery to remove a malignant tumor from her breast. The nurse encourages the client to cough and deep breathe based on the understanding that this activity accomplishes which actions? Select all that apply. expands collapsed alveoli reduces the risk for lymphedema prevents venous stasis promotes faster clearance of inhaled anesthetics prevents postoperative atelectasis

promotes faster clearance of inhaled anesthetics prevents postoperative atelectasis expands collapsed alveoli

A client with advanced breast cancer, who has had both chemotherapy and radiation therapy, is to start hormonal therapy using a selective estrogen receptor modulator (SERM). Which agent would the nurse expect the client to receive? tamoxifen letrozole exemestane cortisone

tamoxifen

A client with advanced breast cancer who has had both chemotherapy and radiation therapy is to start endocrine therapy. Which agent would the nurse expect the client to receive? estrogen trastuzumab cortisone tamoxifen

tamoxifen

As part of a presentation on breast cancer being given to a local woman's group, the nurse describes the need for early detection through screening. Applying the guidelines from the American Cancer Society, the nurse would emphasize which recommendation? breast self-examination at least yearly for women over age 20 mammograms every 3 years for women between the ages of 20 and 39 years yearly mammograms for women starting at age 40 clinical breast examinations every 2 years for women over age 30

yearly mammograms for women starting at age 40