TB 52 (breast cancer)

28. A client has just returned to the postsurgical unit from postanesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this client's immediate plan of care? A. Acute pain related to tissue manipulation and incision B. Ineffective coping related to surgery C. Risk for trauma related to postsurgical injury D. Chronic sorrow related to change in body image

ANS: A Rationale: Although many clients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma. PTS: 1 REF: p. 1725 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A breastfeeding client is reporting pain in the left breast and describes the breast as feeling "doughy." The client is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend? A. Apply cold compresses as prescribed. B. Avoid wearing a bra until the infection clears. C. Avoid washing the breasts. D. Perform gentle massage to stimulate neutrophil migration.

ANS: A Rationale: Treatment of mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. A broad-spectrum antibiotic agent may be prescribed for 7 to 10 days. The client should wear a snug bra and perform personal hygiene carefully. Massage is not recommended. PTS: 1 REF: p. 1717 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

22. A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor? A. Women's knowledge of how their breasts normally look and feel B. The rapport that exists between the client and the primary care provider C. Synchronizing women's routines around BSE with the performance of mammograms D. Women's knowledge of the pathophysiology of breast cancer

ANS: A Rationale: Current practice emphasizes the importance of breast self-awareness, which is a client's attentiveness to the normal appearance and feel of the breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the client and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The client does not need to understand the pathophysiology of breast cancer to perform BSE effectively. PTS: 1 REF: p. 1713 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice

27. A client has just been told they need to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this client for specific educational, physical, or psychosocial needs the client might have? A. By encouraging the client to verbalize questions and concerns B. By discussing the possible findings of the biopsy C. By discussing possible treatment options if the diagnosis is cancer D. By reviewing the client's medical history

ANS: A Rationale: During the preoperative visit, the nurse assesses the client for any specific educational, physical, or psychosocial needs that the client may have. This can be accomplished by encouraging the client to verbalize fears, concerns, and questions. Reviewing the client's medical history may be beneficial, but it is not the best way to ascertain the client's needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating health care provider. PTS: 1 REF: p. 1716 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

18. The nurse is providing care to a client with a suspected malignant breast tumor. The nurse knows that the mass likely had which characteristic upon palpation? A. Non-tender on palpation B. Less than or equal to 5 mm C. Soft on palpation D. Mobile

ANS: A Rationale: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy. PTS: 1 REF: p. 1719 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

31. A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when they can take a shower. What should the nurse respond? A. "Not until the drain is removed" B. "On the second postoperative day" C. "Now, if you wash gently with soap and water" D. "Seven days after your surgery"

ANS: A Rationale: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed. PTS: 1 REF: p. 1729 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

7. A client who came to the clinic after finding a mass in the breast is scheduled for a diagnostic breast biopsy. During the nurse's admission assessment, the nurse observes that the client is distracted and tense. What is the nurse's best action? A. Acknowledge the fear the client is likely experiencing. B. Describe the support groups that exist in the community. C. Assess the client's stress management skills. D. Document a nursing diagnosis of ineffective coping.

ANS: A Rationale: In the breast cancer diagnostic phase, it is appropriate to acknowledge the client's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills may be necessary, but the nurse should begin by acknowledging the client's feelings. Fear is not necessarily indicative of ineffective coping. PTS: 1 REF: p. 1725 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice

35. A client who has had a lumpectomy calls the clinic to talk to the nurse. The client tells the nurse that they have developed a tender area on the breast that is red and warm and looks like someone "drew a line with a red marker." What would the nurse suspect is the client's problem? A. Mondor disease B. Deep vein thrombosis (DVT) of the breast C. Recurrent malignancy D. An area of fat necrosis

ANS: A Rationale: Superficial thrombophlebitis of the breast (Mondor disease) is an uncommon condition that is usually associated with pregnancy, trauma, or breast surgery. Pain and redness occur as a result of a superficial thrombophlebitis in the vein that drains the outer part of the breast. The mass is usually linear, tender, and erythematous. Fat necrosis is a condition of the breast that is often associated with a history of trauma. The scenario described does not indicate a recurrent malignancy. DVTs of the breast do not occur. PTS: 1 REF: p. 1719 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

8. A client has been referred to the breast clinic after the most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A. Lumpectomy and radiation B. Partial mastectomy and radiation C. Partial mastectomy and chemotherapy D. Total mastectomy and chemotherapy

ANS: A Rationale: Treatment for breast cancer depends on the disease stage and type, the client's age and menopausal status, and the disfiguring effects of the surgery. For this client, lumpectomy is the most likely option because the nodule is well-defined. The client usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice. PTS: 1 REF: p. 1723 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

24. A client is to undergo an ultrasound-guided core biopsy. The client tells the nurse that a friend of theirs had a stereotactic core biopsy. The client wants to understand the differences between the two procedures. What would be the nurse's best response? A. "An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation." B. "An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster." C. "An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster." D. "An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive."

ANS: A Rationale: Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy. PTS: 1 REF: p. 1716 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice

32. A client has been discharged home after a total mastectomy without reconstruction. The client lives alone and has a home health referral. When the home care nurse performs the first scheduled visit on this client, what should the nurse assess? Select all that apply. A. Adherence to the exercise plan B. Overall psychological functioning C. Integrity of surgical drains D. Understanding of cancer E. Use of the breast prosthesis

ANS: A, B, C Rationale: Clients who have difficulty managing their postoperative care at home may benefit from a home health care referral. The home care nurse assesses the client's incision and surgical drain(s), adequacy of pain management, adherence to the exercise plan, and overall physical and psychological functioning. It is unnecessary to assess the client's understanding of cancer at this stage of recovery. Prostheses may be considered later in the recovery process. PTS: 1 REF: p. 1730 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

10. A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous? A. Eversion of the right nipple and mobile mass B. A nonmobile mass with irregular edges C. A mobile mass that is soft and easily delineated D. Nonpalpable right axillary lymph nodes

ANS: B Rationale: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer. PTS: 1 REF: p. 1722 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

17. A nurse is examining a client who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this client's diagnosis? A. The client will be scheduled for radiation therapy. B. The client might be referred for a biopsy. C. The client's breast mass is considered an age-related change. D. The client's diagnosis is likely related to use of oral contraceptives.

ANS: B Rationale: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use. PTS: 1 REF: p. 1719 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

25. A client at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the client asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response? A. "An incisional biopsy is performed because it's known to be less painful and more accurate than other forms of testing." B. "An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment." C. "An incisional biopsy is performed to assess the potential for recovery from a mastectomy." D. "An incisional biopsy is performed on clients who are younger than the age of 40 and who are otherwise healthy."

ANS: B Rationale: Incisional biopsy surgically removes a portion of a mass. This is performed to confirm a diagnosis and to conduct special studies that will aid in determining treatment. Incisional biopsies cannot always remove the whole mass, nor are they always beneficial to the client. The procedure is not chosen because of the potential for pain, the possibility of not recovering from mastectomy, or the client's age. PTS: 1 REF: p. 1716 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

20. A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the client's history that his father was treated for breast cancer. What should the nurse provide to the client before he leaves the clinic? A. A referral for a mammogram B. Instructions about breast self-examination (BSE) C. A referral to a surgeon D. A referral to a support group

ANS: B Rationale: Instructions about BSE should be provided to men if they have a family history of breast cancer because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a client for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary. PTS: 1 REF: p. 1713 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

A 45-year-old client comes into the health clinic for an annual checkup. The client mentions to the nurse that they have noticed dimpling of the right breast that has occurred over the past few months. What assessment would be most appropriate for the nurse to make? A. Inspect the client's breasts for signs of infection. B. Palpate the area for a breast mass. C. Assess the client's knowledge of breast cancer. D. Assure the client that this is likely an age-related change.

ANS: B Rationale: It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the client to the primary provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer. The client's knowledge of breast cancer is relevant, but not a time-dependent priority. This finding is not an age-related change. Assessment for signs of malignancy is a priority over infection, which is unlikely to cause these changes. PTS: 1 REF: p. 1710 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

16. The nurse is performing a comprehensive health history of a client who is in their 50s. The nurse should identify what risk factor that may increase this client's risk for breast cancer? A. The client breastfed each of their children. B. The client gave birth to their first child at age 40. C. The client experienced perimenopausal symptoms starting at age 46. D. The client experienced menarche at age 13.

ANS: B Rationale: Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the client's health history are considered to be risk factors for breast cancer. PTS: 1 REF: p. 1721 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

26. A client is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in the left breast. What are the criteria for discharging this client home? Select all that apply. A. Client must understand when they can begin ambulating. B. Client must have someone to accompany them home. C. Client must understand activity restrictions. D. Client must understand care of the biopsy site. E. Client must understand when they can safely remove the urinary catheter.

ANS: B, C, D Rationale: Prior to discharge from the ambulatory surgical center or the office, the client must be able to tolerate fluids, ambulate, and void. The client must have somebody to accompany them home and would not be discharged with urinary catheter in place. PTS: 1 REF: p. 1717 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select

3. A client aged 48 years comes to the clinic because they have discovered a lump in the breast. After diagnostic testing, the client receives a diagnosis of breast cancer. The client asks the nurse when the teenage daughters should begin mammography. What is the nurse's best advice? A. Age 28 B. Age 35 C. Age 38 D. Age 48

ANS: C Rationale: A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the daughters should begin mammography at age 38 to 43 years. PTS: 1 REF: p. 1720 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

33. A client has just been diagnosed with breast cancer and the nurse is performing a client interview. In assessing this client's ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask? A. "What is your level of education?" B. "Are you feeling all right these days?" C. "Is there someone you trust to help you make treatment choices?" D. "Are you concerned about receiving this diagnosis?"

ANS: C Rationale: A trusted ally to assist in making treatment choices is beneficial to the client's coping ability. It is condescending and inappropriate to ask if the client is "feeling all right these days" or is concerned about the diagnosis. The client's education level is irrelevant. PTS: 1 REF: p. 1725 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply NOT: Multiple Choice

29. A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements? A. Modified tendons and ligaments B. Connective tissue and smooth muscle C. Lobules and ducts D. Endocrine glands and sebaceous glands

ANS: C Rationale: Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle. PTS: 1 REF: p. 1710 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice

9. A 23-year-old client comes to the free clinic stating, "I think I have a lump in my breast. Do I have cancer?" The nurse instructs the client that a diagnosis of breast cancer is confirmed by what method? A. Supervised breast self-examination B. Mammography C. Fine-needle aspiration D. Serial chest x-rays

ANS: C Rationale: Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although false-negative and false-positive findings are possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays can be used to pinpoint rib metastasis. However, neither test is considered diagnostic of breast cancer. PTS: 1 REF: p. 1716 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice

12. The nurse is caring for a client who has just had a radical mastectomy and axillary node dissection. When providing client education regarding rehabilitation, what should the nurse recommend? A. Avoid exercise of the arm for the next 2 months. B. Keep cuticles clipped neatly. C. Avoid lifting objects heavier than 10 pounds (4.5 kg). D. Use a sling until healing is complete.

ANS: C Rationale: Following an axillary dissection, the client should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary. PTS: 1 REF: p. 1730 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

6. During a recent visit to the clinic, a client presents with erythema of the nipple and areola on the right breast. The client states this started several weeks ago and they were fearful of what would be found. The nurse should promptly refer the client to the primary provider because the client's signs and symptoms are suggestive of what health problem? A. Peau d'orange B. Nipple inversion C. Paget disease D. Acute mastitis

ANS: C Rationale: Paget disease presents with erythema of the nipple and areola. Peau d'orange, which is associated with breast cancer, is caused by interference with lymphatic drainage, but does not cause these specific signs. Nipple inversion is considered normal if long-standing; if it is associated with fibrosis and is a recent development, malignancy is suspected. Acute mastitis is associated with lactation, but it may occur at any age. PTS: 1 REF: p. 1720 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

19. At which age should a healthy client begin annual mammograms? A. 20 years old B. 30 years old. C. 45 years old D. 55 years old

ANS: C Rationale: The ACS has changed the mammography recommendations to state that healthy women should have mammography every year beginning at age 45. PTS: 1 REF: p. 1713 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice

14. When planning discharge teaching with a client who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the client that they should report what sign or symptom to the health care provider immediately? A. Fatigue B. Temperature greater than 36.9°C (98.5°F) C. Sudden cessation of output from the drainage device D. Gradual decline in output from the drain

ANS: C Rationale: The client should report sudden cessation of output from the drainage device, which could indicate an occlusion. Gradual decline in output is expected. A temperature of 38°C (100.4°F) or greater should also be reported to rule out postoperative infection, but a temperature of 36.9°C (98.5°F) is not problematic. Fatigue is expected during the recovery period. PTS: 1 REF: p. 1728 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

4. A client scheduled for a simple mastectomy in 1 week is having preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? A. Limit intake of green leafy vegetables. B. Increase water intake to 8 glasses per day. C. Stop taking aspirin. D. Have nothing by mouth for 6 hours before surgery.

ANS: C Rationale: The nurse should instruct the client to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding. PTS: 1 REF: p. 1717 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

2. The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising the arms is necessary. What is the nurse's best response? A. "It helps to spread out the fat that makes up your breast." B. "It allows you to simultaneously assess for pain." C. "It will help to observe for dimpling more closely." D. "This is what breast cancer experts recommend."

ANS: C Rationale: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the client to raise both arms overhead. Citing expert opinion does not address the client's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue. PTS: 1 REF: p. 1710 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

21. The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE: A. at the time of menses. B. at any convenient time, regardless of cycles. C. weekly. D. between days 5 and 7 after menses.

ANS: D Rationale: BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended. PTS: 1 REF: p. 1713 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

34. A client has been diagnosed with stage II breast cancer. The client tells the nurse that the health care provider has recommended breast conservation surgery followed by radiation. The client's husband has done some online research and is asking why his wife does not have a modified radical mastectomy "to be sure all the cancer is gone." The nurse knows that breast conservation surgery was recommended for which reason? A. "Modified radical mastectomies are very hard on a client, both physically and emotionally, and they really aren't necessary anymore." B. "According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial." C. "Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence." D. "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy."

ANS: D Rationale: Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence. PTS: 1 REF: p. 1731 NAT: Client Needs: Safe, Effective Care Environment: Management of Care TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

23. A client is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the client is aware of what potential consequence? A. Chronic breast pain B. Unclear mammography results C. Increased risk of breast cancer D. Decreased nipple sensation

ANS: D Rationale: During the preoperative consultation, the client should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication. PTS: 1 REF: p. 1739 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice

36. A client calls the clinic and tells the nurse they have had bloody drainage from the right nipple. The nurse makes an appointment for this client, expecting the health care provider or practitioner to order what diagnostic test on this client? A. Breast ultrasound B. Radiography C. Positron emission tomography (PET) D. Galactography

ANS: D Rationale: Galactography is a diagnostic procedure that involves injection of less than 1 mL of radiopaque material through a cannula inserted into the ductal opening on the areola, which is followed by mammography. It is performed to evaluate an abnormality within the duct when the client has bloody nipple discharge on expression, spontaneous nipple discharge, or a solitary dilated duct noted on mammography. X-ray, PET, and ultrasound are not typically used for this purpose. PTS: 1 REF: p. 1717

30. A nurse has assessed that a client is not yet willing to view the mastectomy site. How should the nurse best assist the client in developing a positive body image? A. Ask the client to describe the current appearance of the breast. B. Help the client to understand that many women have gone through the same unpleasant experience. C. Explain to the client that their body image does not have to depend on their physical appearance. D. Provide the client with encouragement in an empathic and thoughtful manner.

ANS: D Rationale: Gentle encouragement can help client progress toward accepting the change in appearance. The nurse should not downplay the significance of physical appearance. Explaining that others have had similar experiences may or may not benefit the client. Asking the client to describe the appearance of the breast is likely to exacerbate the client's reluctance to do so. PTS: 1 REF: p. 1726 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice

5. The nurse is caring for a 52-year-old client whose aunt and mother died of breast cancer. The client states, "My doctor and I talked about tamoxifen to help prevent breast cancer. Do you think it will work?" What would be the nurse's best response? A. "Yes, it's known to have a slight protective effect." B. "Yes, but studies also show an increased risk of osteoporosis." C. "You won't need to worry about getting cancer as long as you take tamoxifen." D. "Tamoxifen is known to be a highly effective protective measure."

ANS: D Rationale: Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis. PTS: 1 REF: p. 1721 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

15. A client newly diagnosed with breast cancer states that the health care provider suspects regional lymph node involvement and told the client that there are signs of metastatic disease. The nurse learns that the client has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis? A. The client is not a surgical candidate. B. The client's breast cancer is considered highly treatable. C. There is a 10% chance that the client's cancer will self-resolve. D. The client has a 15% chance of 5-year survival.

ANS: D Rationale: The 5-year survival rate is approximately 15% for stage IV breast cancer. Surgery is still a likely treatment, but the disease would not be considered to be "highly treatable." Self-resolution of the disease is not a possibility. PTS: 1 REF: p. 1722 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

11. A client in their 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The client shares with the nurse being somewhat worried about the future, but the client appears to be adjusting well overall to the diagnosis and surgery. What nursing intervention is most appropriate to support this client's coping? A. Encourage the client's spouse or partner to be supportive while the client recovers. B. Encourage the client to proceed with the next phase of treatment. C. Recommend that the client remain optimistic for the sake of their children. D. Arrange a referral to a community-based support program.

ANS: D Rationale: The client is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach the client about talking with others who have had similar experiences. The nurse may educate the client's spouse or partner to listen for concerns, but the nurse should not tell the client's spouse what to do. The client must consult with the health care provider and make one's own decisions about further treatment. The client needs to express any sadness, frustration, and fear. The client cannot be expected to be optimistic at all times. PTS: 1 REF: p. 1725 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 52: Assessment and Management of Clients With Breast Disorders KEY: Integrated Process: Caring BLM: Cognitive Level: Apply NOT: Multiple Choice