Chapter 6: Disorders of the Breasts

29. A client is diagnosed with fibrocystic breast disease. After teaching the client about this condition, the nurse determines that the teaching was successful based on which client statement? A. "I need to cut out drinking coffee like I'm used to doing." B. "It's important that I stop smoking or my condition will get worse." C. "I guess I'll have to find a replacement for milk and cheese." D. "No more cookies and baked goods for me."

A. "I need to cut out drinking coffee like I'm used to doing." Rationale: Caffeine is a stimulant, and eliminating it will help reduce symptoms of fibrocystic breast disease. Thus cutting out coffee from the client's intake indicates understanding of the situation. Although smoking cessation is important for anyone, cigarettes, along with dairy products such as milk and cheese, and sweets, such as cookies and baked goods, are not associated with symptoms of fibrocystic breast disease.

16. A woman diagnosed with breast cancer is to receive trastuzumab. What information would the nurse incorporate into the explanation about how this drug works? A. It blocks the effect of the HER-2/neu protein inhibiting the growth of cancer cells. B. The drug blocks the conversion of androgens to estrogens. C. It interferes with hormone receptors that allow estrogen to enter a cell. D. The drug ultimately attacks areas where micrometastasis has occurred.

A. It blocks the effect of the HER-2/neu protein inhibiting the growth of cancer cells. Rationale: Trastuzumab is immunotherapy approved for breast cancer. Breast cancers that overexpress the protein HER-2/neu are associated with a more aggressive form of disease and a poorer prognosis. Trastuzumab target the HER2 pathway to inhibit the growth of cancer cells. The aromatase inhibitors work by inhibiting the conversion of androgens to estrogens. SERMs Interfere with the hormone receptors that allow estrogen to enter the cell and stimulate it to divide. The goal of any chemotherapeutic regimen is to perform a system sweep of the body to reduce the chances that distant tumors will grow or micrometastasis will occur

30. A laboratory technician arrives to draw blood for a complete blood count (CBC) for a client who had a left-sided mastectomy 8 hours ago. The client has an intravenous line with fluid infusing in her right antecubital space. The nurse enters the room and sees the technician beginning to place a tourniquet on the client's right arm. Which response by the nurse would be most appropriate? A. Stop the technician immediately. B. Have the technician come back later on. C. Notify the surgeon to obtain the specimen via a cut-down procedure. D. Tell the technician to obtain the specimen from the client's left arm.

A. Stop the technician immediately. Rationale: The nurse should immediately stop the technician from obtaining the specimen. The left arm cannot be used because the mastectomy was performed on that side. The right arm has an intravenous infusion, so obtaining blood from this arm would be inappropriate, most likely leading to inaccurate results. Telling the technician to come back later on does not address the situation at present. Notifying the surgeon may be appropriate, but a cut-down procedure is invasive, and other less invasive options should be attempted first before considering such a procedure.

2. 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? A. caffeine B. cigarettes C. dairy products D. sweets

A. caffeine Rationale: Caffeine is a stimulant and eliminating it will help reduce symptoms of fibrocystic breast disease. Cigarettes, dairy products, and sweets are not associated with symptoms of fibrocystic breast disease.

20. A woman comes to the clinic and tells the nurse that she has read an article about certain foods that have anticancer properties and help boost the immune system. During the discussion, the nurse would expect the client to identify which foods? Select all that apply. A. garlic B. soybeans C. milk D. leeks E. flax seed

A. garlic B. soybeans D. leeks E. flax seed Rationale: Phytochemical-rich foods include green tea and herbal teas; garlic; whole grains and legumes; onions and leeks; soybeans and soy products; tomato products (cooked tomatoes); fruits (citrus, apricots, pumpkin, berries); green leafy vegetables (spinach, collards, romaine); colorful vegetables (carrots, squash, tomatoes); cruciferous vegetables (broccoli, cabbage, cauliflower); and flax seeds.

8. As part of discharge planning, the nurse refers a woman to Reach to Recovery. The nurse initiates this referral to facilitate which goal? A. help support women who have undergone mastectomies B. raise funds to support early breast cancer detection programs C. provide all supplies needed after breast surgery for no cost D. collect statistics for research for the American Cancer Society

A. help support women who have undergone mastectomies Rationale: Reach for Recovery is an organization that gives women and their families opportunities to express their feelings, verbalize their fears, and get answers. Reach to Recovery volunteers provide living proof that people can survive breast cancer and lead productive lives. Reach to Recovery helps raise funds, provide supplies, and collect statistics, but these are not the program's primary purpose

6. 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? A. mammogram B. hormone receptor status C. fine-needle aspiration D. genetic testing for BRCA

A. mammogram Rationale: The characteristics of the palpated mass suggest that it is a benign mass, most likely a fibroadenoma. However, since other breast lesions have similar characteristics, the lump needs to be evaluated via mammography. Hormone receptor status is used to determine if a malignant mass is stimulated to grow by estrogen or progesterone. A fine-needle aspiration may be done later on if there is reason to suspect a malignancy. Genetic testing for the BRCA genes would be done to determine a woman's risk for breast cancer, but this would not be done next.

28. A woman who has undergone a right modified-radical mastectomy returns from surgery. The nurse would focus immediate interventions on which area as the priority? A. respiratory function B. body image C. lymphedema prevention D. incisional care

A. respiratory function Rationale: Upon return from surgery, the nurse's priority would be on the client's respiratory function, encouraging the client to turn, cough, and deep breathe at frequent intervals, at least every 2 hours, to help expand collapsed alveoli, clear inhalation anesthetic agents from the body, and prevent postoperative atelectasis and pneumonia. Body image and prevention of lymphedema would be priorities later on in the client's course of care. The client will most likely have a surgical dressing in place that most likely would not be removed in the immediate postoperative period. Question format: Mult

27. 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? A. tamoxifen B. letrozole C. exemestane D. cortisone

A. tamoxifen Rationale: Tamoxifen is an example of a SERM used as adjunctive treatment for breast cancer. Letrozole and exemestane are aromatase inhibitors used to treat advanced breast cancer. Cortisone is a steroid and would not be used.

5. A 42-year-old woman is scheduled for a mammogram. Which statement would the nurse include when teaching the woman about the procedure? A. "The room will be darkened throughout the procedure." B. "Each breast will be firmly compressed between two plates." C. "Make sure to refrain from eating or drinking after midnight." D. "A dye will be injected to highlight the breast tissue and its ducts."

B. "Each breast will be firmly compressed between two plates." Rationale: A mammogram involves taking X-ray pictures of the breasts while they are compressed between two plastic plates. There is no need to darken the room or to refrain from eating or drinking after midnight. A ductography involves the injection of dye to highlight the breast ducts.

31. A client is being discharged after having a right-sided modified radical mastectomy. After teaching the client about ways to minimize lymphedema, the nurse determines that the teaching was successful based on which client statement? A. "I should use lotion on my hands after working in my garden." B. "I need to avoid wearing tops that have elastic in the sleeves." C. "I should have my blood pressure taken in my right arm." D. "I need to limit my driving to once a week."

B. "I need to avoid wearing tops that have elastic in the sleeves." Rationale: Lymphedema increases when there is obstruction to the lymph flow. Wearing clothing with elasticized sleeves would compress the extremity, possibly cause trauma, and obstruct the flow, thus increasing the woman's risk. However, wearing a well-fitted compression sleeve would promote drainage return. Wearing gloves when gardening and using the unaffected arm for blood pressure readings help to reduce the risk of injury and subsequent lymphedema. Driving would have no effect on lymphedema.

12. After teaching a woman how to perform breast self-examination, which statement would indicate that the nurse's instructions were successful? A. "I should lie down with my arms at my side when looking at my breasts." B. "I should use the fingerpads of my three middle fingers to apply pressure to my breast." C. "I don't need to check under my arm on that side if my breast feels fine." D. "I need to work from left to right down my breast towards my ribs."

B. "I should use the fingerpads of my three middle fingers to apply pressure to my breast." Rationale: When performing breast self-examination, the client should use the pads of the middle three fingers to palpate the breast. When performing the visual part of the procedure, the woman should look at her breasts with her arms up behind the head, with arms down at the sides, and while bending forward. When palpating the breast, the woman should check the breasts as well as the area between the breast and the axilla, the axilla itself, and the area above the breast up to the clavicle and across the shoulder. When palpating, the woman should use a spiral, pie wedge, or vertical strip approach.

21. During a wellness visit to the clinic, a 30-year-old woman asks the nurse if there is anything she can do to reduce her risk for developing breast cancer. Which suggestions would be appropriate? Select all that apply. A. "Eat three servings of fruit daily." B. "Keep your weight gain under 11 pounds (5 kilograms)." C. "Eat at least seven portions of complex carbohydrates daily." D. "Limit your intake of refined sugar products." E. "Use salt liberally when cooking"

B. "Keep your weight gain under 11 pounds (5 kilograms)." C. "Eat at least seven portions of complex carbohydrates daily." D. "Limit your intake of refined sugar products." Rationale: The American Institute for Cancer Research (AICR), which conducts extensive research, made the following recommendations to reduce a woman's risk for developing breast cancer: engaging in daily moderate exercise and weekly vigorous physical activity; consuming at least five servings of fruits and vegetables daily; not smoking or using any tobacco products; keeping a maximum body mass index (BMI) of 25 and limiting weight gain to no more than 11 pounds (5 kilograms) since age 18; consuming seven or more daily portions of complex carbohydrates, such as whole grains and cereals; limiting intake of processed foods and refined sugar; restricting red meat intake to approximately 3 ounces (.08 kilograms) daily; limiting intake of fatty foods, particularly those of animal origin; and restricting intake of s alted foods and use of salt in cooking.

17. When describing programs for breast cancer screening, the nurse includes breast self examination (BSE). Which statement most accurately reflects the current thinking about breast self-examination? A. BSE is essential for early breast cancer detection. B. A woman performing BSE has breast awareness. C. BSE plays a minimal role in detecting breast cancer. D. A clinical breast exam has replaced BSE.

B. A woman performing BSE has breast awareness Rationale: Breast self-examination (BSE) is a technique that enables a woman to detect any changes in her breasts. Breast self-exams, once thought essential for early breast cancer detection, are now considered optional. Instead, breast awareness is stressed. Breast awareness refers to a woman being familiar with the normal consistency of both breasts and the underlying tissue. This emphasis is now on awareness of breast changes, not just discovery of cancer . Research has shown that breast self-examination plays a small role in detecting breast cancer compared with self-awareness. However, doing breast self-examination is one way for a woman to know how her breasts normally feel so that she can notice any changes that do occur. Clinical breast examination has not replaced BSE.

14. A laboratory technician arrives to draw blood for a complete blood count (CBC) for a client who had a right-sided mastectomy 8 hours ago. The client has an intravenous line with fluid infusing in her left antecubital space. To obtain the blood specimen, the technician places a tourniquet on the client's right arm. Which action by the nurse would be most appropriate? A. Assist in holding the client's arm still. B. Suggest a finger stick be done on one of the client's left fingers. C. Tell the technician to obtain the blood sample from the client's left arm. D. Call the surgeon to perform a femoral puncture.

B. Suggest a finger stick be done on one of the client's left fingers Rationale: The most appropriate action would be to suggest that a finger stick be done. The right arm cannot be used because the mastectomy was performed on that side. The left arm has an intravenous infusion, so obtaining blood from this arm would be inappropriate, most likely leading to inaccurate results. Holding the client's arm still is inappropriate because neither arm should be used. Less invasive options should be attempted first before considering a femora l puncture.

22. A nurse is conducting a refresher program for a group of nurses about chemotherapy used for breast cancer. After teaching the group about the different types of chemotherapeutic agents used to treat breast cancer, the nurse determines that the teaching was successful when the group identifies which agent as an example of an aromatase inhibitor? Select all t A. tamoxifen B. letrozole C. raloxifene D. exemestane E. anastrozole

B. letrozole D. exemestane E. anastrozole Rationale: Letrozole, exemestane, and anastrozole are examples of aromatase inhibitors. Examples of SERMs include tamoxifen and raloxifene

15. The nurse is developing a plan of care for a woman with breast cancer who is scheduled to undergo breast-conserving surgery. The nurse interprets this as which procedure? A. removal of nipple and areolar area B. lump removal followed by radiation C. entire breast removal without lymph nodes D. axillary lymph node removal

B. lump removal followed by radiation Rationale: Breast-conserving surgery is the wide local excision (or lumpectomy) of the tumor along with a 1-cm margin of normal tissue. A lumpectomy is often used for early-stage localized tumors and is followed by radiation to eradicate residual microscopic cancer cells. A simple mastectomy is the removal of all breast tissue, the nipple, and the areola. The axillary nodes and pectoral muscles are spared. A modified radical mastectomy involves removal of breast tissue, the axillary nodes, and some chest muscles, but not the pectoralis major, thus avoiding a concave anterior chest.

7. 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? A. trastuzumab B. tamoxifen C. cortisone D. estrogen

B. tamoxifen Rationale: The objective of endocrine therapy is to block or counter the effect of estrogen in the pathogenesis of cancer. The best-known agent is tamoxifen. Use of estrogens in postmenopausal women increases a woman's risk for breast cancer. In addition, estrogen is a considered to play a major role in the development of breast cancer and as such would not be used. Cortisone is a steroid and would not be used. Trastuzumab is an immunotherapeutic agent.

13. Evaluation of a woman with breast cancer reveals that her mass is approximately 1.25 inches in diameter. Three adjacent lymph nodes are positive. The nurse interprets this as indicating that the woman has which stage of breast cancer? A. 0 B. I C. II D. III

C II Rationale: Stage II breast cancer is characterized by a tumor from 1 to 2 inches in diameter with spread to adjacent lymph nodes. Stage 0 cancer is an early stage in which the cancer is extremely localized. Stage I cancer involves a tumor that is localized and less than 1 inch in diameter. Stage III cancer involves a tumor that is 2 inches or larger with spread to other lymph nodes and tissue

1. 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? A. "I need to wear gloves when doing any gardening." B. "Any blood pressures need to be taken in my right arm." C. "I should wear clothing with elasticized sleeves." D. "I need to avoid driving to and from work every day."

C. "I should wear clothing with elasticized sleeves." Rationale: Lymphedema increases when there is obstruction to the lymph flow. Wearing clothing with elasticized sleeves would compress the extremity, possibly cause trauma, and obstruct the flow, thus increasing the woman's risk. Wearing gloves when gardening and using the unaffected arm for blood pressure readings help to reduce the risk of injury and subsequent lymphedema. Driving would have no effect on lymphedema.

23. A woman comes to the clinic and asks the nurse about when she should have her first mammogram. The woman is at low risk and has no family history of breast cancer. Using the recommendations of the American Cancer Society, the nurse would suggest the woman have her first mammogram at which age? A. 30 years B. 35 years C. 40 years D. 45 years

C. 40 years Rationale: The American Cancer Society still recommends annual mammograms and clinical breast exams for women starting at age 40.

4. 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? A. Ask the client how she feels about having her breast removed. B. Attach a sign above her bed to have BP, IV lines, and lab work in her right arm. C. Encourage her to turn, cough, and deep breathe at frequent intervals. D. Position her right arm below heart level.

C. Encourage her to turn, cough, and deep breathe at frequent intervals. Rationale: Upon return from surgery, the nurse should encourage the client to turn, cough, and deep breathe at frequent intervals, at least every 2 hours, to help expand collapsed alveoli, clear inhalation anesthetic agents from the body, and prevent postoperative atelectasis and pneumonia. Asking the client how she feels about her breast removal should be done at a later time, whe n she is more alert and oriented and has had time to think about what has happened. The sign should state that no BP, IV lines, and lab work should be done on the client's right arm. The right arm should be elevated on a pillow to promote lymph drainage.

18. 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? A. risk for deficient fluid volume B. activity intolerance C. disturbed body image D. impaired urinary elimination

C. disturbed body image Rationale: The diagnosis of breast cancer and subsequent removal of the breast via surgery can affect all aspects of life for the woman, but most significantly her body image due to the loss of a body part. Therefore, the most important nursing diagnosis would be disturbed body image. Deficient fluid volume, activity intolerance, and impaired urinary elimination are possible due to the effects of surgery, but these are not as important preoperatively as the clie nt's body image.

10. A woman comes to the clinic reporting a greenish-colored nipple discharge On examination, the area below the areola is red and slightly swollen, with tortuous tubular swelling. The nurse interprets these findings as suggestive of which disorder? A. fibrocystic breast disorder B. intraductal papilloma C. duct ectasia D. fibroadenoma

C. duct ectasia Rationale: Duct ectasia is manifested by a greenish nipple discharge. Subareolar redness and swelling can be noted, along with tortuous tubular swellings beneath the areola. Fibrocystic breast disorder is characterized by lumpy, tender breasts with possible clear to yellow nipple discharge. Intraductal papilloma is manifested by a wart-like growth in the mam mary ducts near the nipple that is soft, nontender, mobile, and poorly delineated. A serous, serosanguinous, or watery discharge from the nipple may occur. Fibroadenoma is characterized by a firm, rubbery, well-circumscribed, freely mobile mass, usually located in the upper outer quadrant of the breast.

24. A nurse is preparing a presentation for a group of community nurses about benign and malignant breast masses. The nurses demonstrate understanding when they identify which as an indication of a benign breast mass? Select all that apply. A. absence of pain B. unilateral location C. firm consistency D. absence of dimpling E. fixed to the chest wall

C. firm consistency D. absence of dimpling Rationale: Benign breast masses are typically painful, firm, and rubbery in consistency, often bilateral, no dimpling and mobile, without being affixed to the chest wall.

19. A nurse is conducting a class on breast cancer prevention. Which statement would the nurse include in the discussion? A. "Most often a lump is felt before it is seen." B. "Early breast cancer usually has some symptoms." C. "If the mass is not painful, it is usually benign." D. "If lump is palpable, it has been there for some time."

D. "If lump is palpable, it has been there for some time." Rationale: Early breast cancer has no symptoms. If a lump can be palpated, the cancer has been there for quite some time. The earliest sign of breast cancer is often an abnormality seen on a screening mammogram before the woman or the health care professional feels it. A healthy, asymptomatic presentation is typical.

11. When performing a clinical breast examination, which would the nurse do first? A. Palpate the axillary area. B. Compress the nipple for a discharge. C. Palpate the breasts. D. Inspect the breasts.

D. Inspect the breasts Rationale: The first step in the clinical breast exam is to inspect the woman's breasts. The nurse then palpates the breasts, compresses the nipple to check for a discharge, and finally palpates the axillary area.

26. A woman comes to the clinic. Assessment reveals a firm, rubbery, movable mass in the upper outer quadrant of the left breast. The edges of the mass are clearly delineated. The nurse interprets these findings as suggestive of which disorder? A. fibrocystic breast disorder B. duct ectasia C. intraductal papilloma D. fibroadenoma

D. fibroadenoma Rationale: Fibroadenoma is characterized by a firm, rubbery, well-circumscribed, freely mobile mass, usually located in the upper outer quadrant of the breast. Duct ectasia occurs when the milk ducts become congested with secretions and debris, resulting in periductal inflammation. Periareolar infections consist of active inflammation around nondilated subareolar breast ducts— a condition termed periductal mastitis. Fibrocystic breast disorder is characterized by lumpy, tender breasts with possible clear to yellow nipple discharge. Intraductal papill oma is manifested by a wart-like growth in the mammary ducts near the nipple that is soft, nontender, mobile, and poorly delineated. A serous, serosanguinous, or watery discharge from the nipple may occur.

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

D. myelosuppression Rationale: Chemotherapy typically causes side effects of nausea, vomiting, hair loss, fatigue, and myelosuppression. Of these, myelosuppression would be the most serious because it increases the risk for infection, bleeding, and a reduced red blood cell count, which can lead to anemia.

3. A nurse has completed the assessment of a client. The nurse suspects that the client may have a malignant breast mass based on which finding? A. painful lump B. absence of dimpling C. regularly shaped mass D. nipple retraction

D. nipple retraction Rationale: Malignant breast masses typically are difficult to palpate, painless, irregularly shaped, and immobile, with nipple retraction and skin dimpling.

25. A nurse is working with a woman who has been diagnosed with severe fibrocystic breast disease. After describing the medications that can be used as treatment, the nurse determines that additional teaching is needed when the client identifies which drug as being used? A. tamoxifen B. bromocriptine C. danazol D. penicillin

D. penicillin Rationale: Treatment of severe fibrocystic breast disease may include the use of tamoxifen, bromocriptine, or danazol. Penicillin would be used to treat an infection such as mastitis.