Chapter 54: Caring for Clients with Breast Disorders

A patient is having a biopsy that will remove the entire mass, plus a margin of surrounding tissue. What type of biopsy will be documented on the operative permit? a. Excisional biopsy b. Incisional biopsy c. Core biopsy d. Ultrasound-guided core biopsy

a Excisional biopsy is the standard procedure for complete pathologic assessment of a palpable breast mass. The entire mass, plus a margin of surrounding tissue, is removed. Incisional biopsy surgically removes a portion of a mass. Core needle biopsy is similar to FNA, except a larger-gauge needle is used (usually 14 gauge). A local anesthetic is applied, and tissue cores are removed via a spring-loaded device. The principles for ultrasound-guided core biopsy are similar to those of stereotactic core biopsy, but by using ultrasound guidance, computer coordination and mammographic compression are not necessary.

A client is concerned with lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What would the physician indicate is the client's condition? a. fibrocystic breast disease b. lactating mastitis c. breast cancer d. All options are correct.

a Fibrocystic breast disease is a benign breast condition that affects women primarily between the ages of 30 and 50 years. When fibrocystic disease develops, single or multiple breast cysts appear in one or both breasts.

The nurse is reviewing the health care provider's notes from the client who has just left the clinic. The nurse learns that a malignant breast tumor is suspected. On palpation, the mass most likely had what characteristic? a. Nontenderness b. A size of ≤ 5 mm c. Softness and a regular shape d. Mobility

a Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she: a. should continue to perform breast self-examination on her right breast. b. is lucky that the cancer was caught in time. c. should schedule a follow-up appointment in 6 months. d. will have irregular menses.

a Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider. Modified radical mastectomy shouldn't affect the menstrual cycle.

A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when she 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"

a If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.

A client who came to the clinic after finding a mass in her 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.

a 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.

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

a Infiltrating ductal carcinoma—the most common histologic type of breast cancer accounts for 80% of all cases. The tumors arise from the duct system and invade the surrounding tissues. They often form a solid irregular mass in the breast.

Following a client's breast augmentation surgery, the nurse meets with the client and her husband to discuss discharge instructions. Discharge instructions include all of the following except: a. Notify the surgeon if you hear squishing or sloshing sounds around the breast. b. Take a mild aspirin-free analgesic for discomfort. c. Restrict arm movements for 3 days. d. Wear a sports or supportive (wireless) bra day and night for several weeks.

a It is normal to hear squishing or sloshing sounds around the breast from trapped air and fluid until they disappear approximately a week after surgery. A mild aspirin-free analgesic is recommended for pain control. Arm movement is restricted for 3 days and then the client may resume nonstrenuous activities. Instructions would include wearing a sports or supportive bra day and night for several weeks.

The nurse is providing health education regarding disorders that affect breast tissue. Which symptom is least suggestive of a breast disorder? a. differences in breast size b. breast tenderness c. nipple discharge d. breast mass

a It is not uncommon for women to have one breast larger than the other. Common disorders that affect breast tissue generally manifest with one or more of the following symptoms: breast tenderness or pain, breast mass, nipple discharge, and change in breast appearance.

A school nurse at a middle school finds that students are typically surprised to hear the role of women's breasts. What is their primary function? a. lactation b. sexual fulfillment c. sexual attraction d. All options are correct.

a The breasts' primary function is the production of milk, a process referred to as lactation.

A client presented to the ED with purulent drainage from the left nipple, and was admitted to the hospital with a diagnosis of mastitis. The client was started on intravenous antibiotic therapy, and placed on which precautions? a. contact b. standard c. droplet d. airborne

a The client is placed on contact isolation precautions because the soiled dressings are highly infectious. Standard precautions are the basic level of infection control that should be used in the care of all patients in all settings. Droplet precautions should be utilized when working within 3 feet of a patient who is coughing or sneezing. Airborne precautions should be utilized when exposure to microorganisms transmitted via the airborne route is anticipated.

Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do? a. Inform the physician immediately. b. Squeeze the nipple to check for drainage. c. Check the area after the next menses. d. Put a heating pad on the area to reduce inflammation.

a The client should notify the physician immediately because a breast lump may be a sign of breast cancer. The client shouldn't squeeze the nipple to check for drainage until the physician examines the area. The client shouldn't wait until after the next menstrual period to inform the physician of the breast lump because prompt treatment may be necessary. Placing a heating pad on the area would have no effect on a breast lump.

A client has been diagnosed with breast cancer and is awaiting cytology results of a biopsy. During client education, the nurse discusses the possible types of breast malignancies. Which is the most common type? a. ductal b. inflammatory c. medullary d. infiltrating lobular

a The most common malignancy is ductal carcinoma (80%); followed by infiltrating lobular carcinoma (10%); medullary carcinoma, mucinous carcinoma, and tubular ductal carcinoma; and inflammatory breast cancer, the rarest but most aggressive form of breast cancer.

The most common route of regional spread is to which area? a. Axillary lymph nodes b. Internal mammary nodes c. Supraclavicular nodes d. Thyroid nodes

a The most common route of regional spread is to the axillary lymph nodes. Other sites of lymphatic spread include the internal mammary and supraclavicular nodes.

A client is very concerned about possibly having breast cancer, especially after caring for a close family member who recently died from the disease. The nurse informs the client that the primary and most common sign of breast cancer is a: a. painless mass in the breast, most often in the upper outer quadrant. b. painful mass in the breast, most often in the upper outer quadrant. c. painless mass in the breast, most often in the lower quadrant near the nipple. d. painful mass in the breast, most often in the lower quadrant near the nipple.

a The primary sign of breast cancer is a painless mass in the breast, most often in the upper outer quadrant.

A breastfeeding client is reporting pain in her left breast and describes her 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.

a 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.

A client is to undergo an ultrasound-guided core biopsy. The client tells the nurse that a friend of hers had a stereotactic core biopsy. She 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."

a Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid? a. lymphedema b. mastalgia c. breast cancer d. fibroadenoma

a Validating the lack of lymph node metastasis allows the surgeon to preserve more breast, axillary tissue, and chest muscle. Leaving more normal lymph nodes intact reduces the potential for complications such as lymphedema caused by the extensive disruption of lymphatic circulation.

A client is meeting with a plastic surgeon to discuss reconstructive surgery following treatment for breast cancer. What are the advantages of a saline-filled breast implant versus a silicone gel-filled breast implant? Select all that apply. a. smaller incision b. can be inserted using a transumbilical incision c. adjustable volume facilitates symmetrical appearance d. softer, lighter, more natural feel e. lasts longer

a, b, c A smaller incision, a transumbilical incision, and adjustable volume are all advantages of a saline-filled breast implant. Advantages of a silicone gel-filled breast implant are that it feels more natural and lasts longer than a saline-filled breast implant.

Which type of biopsy would the nurse tell the client is a usual procedure for any palpable breast mass found on mammography? a. Stereotactic b. Excisional c. Incisional d. Tru-Cut core

b An excisional biopsy is the usual procedure for any palpable breast mass. Stereotactic biopsy uses computer location of the suspicious area found on biopsy, followed by core needle insertion and sampling of tissue for pathologic examination. Incisional biopsy is performed on a palpable mass when tissue sampling alone is required. A Tru-Cut core biopsy is used when a tumor is relatively large and close to the skin surface.

A 33-year-old female client with three children has had a follow-up mammogram after an abnormal BSE. Mammogram findings reveal incidental microscopic abnormal tissue growth in the left breast lobules. The physician orders tamoxifen for the client. The nurse understands that the physician is implementing which primary prevention modality to treat this client? a. Long-term surveillance b. Chemoprevention c. Prophylactic mastectomy d. Radiation therapy

b Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts.

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 her use of oral contraceptives.

b 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.

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor? a. Age-related physiologic changes b. Medication adverse effects c. Poor nutrition d. Fluid overload

b Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.

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

b 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.

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

b 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.

The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer? a. Onset of menses before 14 years of age b. Mother affected by cancer before 60 years of age c. Multiparity d. No alcohol consumption

b Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age). Nulliparity and later maternal age at first birth are associated with increased risk for breast cancer. Alcohol use remains controversial; however, a slightly increased risk is found in women who consume even one drink daily and doubles among women drinking three drinks daily.

A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women: a. perform breast self-examination annually. b. have a mammogram annually. c. have a hormonal receptor assay annually. d. have a physician conduct a clinical examination every 2 years.

b The American Cancer Society guidelines state that women age 40 and older should have a mammogram annually and a clinical examination at least annually (not every 2 years). All women should perform breast self-examination monthly (not annually). The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.

A woman with a 3-cm breast tumor is scheduled for a lumpectomy followed by 5 to 7 weeks of radiation therapy. The patient asks the nurse if this procedure would cure her. What is the nurse's best response? a. "Yes, without regional node involvement, lumpectomy, followed by radiation, is curative." b. "Lumpectomy, followed by radiation, has the same predicted long-term survival rates as a mastectomy." c. "No, but this combination of treatment has shown a 10-year remission rate." d. "No, but recurrences can be treated with a mastectomy."

b The best response is to provide accurate information that won't increase anxiety. Choice "D" is also correct information but, according to limited research, less than 20% of women have recurrences that require a mastectomy. Providing this information before surgery is not recommended.

A 49-year-old woman reports that her last known menstrual cycle occurred over 1 year ago. Her records indicate gravida 0, para 0. Upon further review of the chart, the nurse notes that the client has a positive maternal history of hypertension. Moreover, the client has a positive paternal history of diabetes. With no additional significant history noted, which of the nurse's findings is consistent as a risk factor for breast cancer for this client? a. Late menopause b. Nulliparity c. Family history of hypertension d. Family history of breast cancer

b There are a number of risk factors associated with breast cancer. This client's history indicates nulliparity, which is a risk factor for breast cancer. Late menopause (after 55 years of age) is also a risk for breast cancer, but this client experienced her last menstrual period at age 48, so this is not a risk factor for this client. Family history of breast cancer is a risk factor, but this client's history only indicates family histories of hypertension and diabetes. Other risk factors associated with breast cancer include increasing age, personal history of breast cancer, genetic mutations to BRCA1 and BRCA2, early menarche (before 12 years of age), late age at first full-term pregnancy (after 30 years of age), hormone therapy, exposure to ionizing radiation during adolescence or early adulthood, history of benign proliferative breast disease, obesity, and alcohol intake of more than one drink per day.

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

b, c, d 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 her home and would not be discharged with urinary catheter in place.

For which of the following population groups would an annual clinical breast examination be recommended? a. Women over age 21 b. Women over age 25 c. Women over age 40 d. All postpubescent females with a family history of breast cancer

c Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently.

A client is considering use of chemoprevention because she is at high risk for developing breast cancer. What can the nurse do to assist the patient with her decision? a. Inform the patient that medication should not be used prophylactically due to the many side effects. b. Inform the patient that she should take every measure available to her to prevent this disease. c. Provide the patient with information regarding the benefits, risks, and possible side effects. d. Provide the patient with information about bilateral mastectomy for the prevention of this disease.

c Nurses can help women who are considering chemoprevention by providing them with information about the benefits, risks, and possible side effects of both tamoxifen and raloxifene.

A nurse is reviewing a female client's history, which includes the following information:Age at menarche: 14 yearsCesarean delivery: 2 pregnanciesAge at first pregnancy: 35 yearsAlcohol use: approximately 1 to 2 glasses of wine/monthThe nurse identifies which as a possible risk factor for the client to develop breast cancer? a. Age at menarche b. Cesarean deliveries c. Age at first pregnancy d. Alcohol use

c Risk factors for breast cancer include an early menarche (before 12 years), nulliparity, late age at first full-term pregnancy, and an alcohol intake of 2 to 5 drinks daily.

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

c 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.

A patient has undergone surgery for breast cancer and the findings of the surgery are as follows:Invasive undifferentiated tumorSize 2.2 cmAxillary lymph nodes negativeHigh ERBB2 expressionWhich of these findings would suggest a favorable prognosis? a. Undifferentiated tumor b. Size c. Negative lymph nodes d. High ERBB2

c The finding suggesting a favorable prognosis would be negative axillary lymph nodes. Other favorable factors would include noninvasive tumors or invasive tumors less than 1 cm in size, well-differentiated tumors, and low ERBB2 expression.

Which group of clients is at high risk of developing breast cancer? a. Women who do not consume alcohol b. Women who are obese c. Women who have sex with multiple partners d. Women who consume a low-fat, low-calorie diet

b The groups of clients who are at higher risk of developing breast cancer are aging women and women who are obese, had early menarche or late menopause, or have a family history. Additional risk factors include exposure to ionizing radiation as children or adolescents, women already diagnosed with cancer of the breast or elsewhere, and those who consume a high-fat, high-calorie diet and drink 2 to 5 alcoholic drinks per day.

Which is a characteristic of a breast cancer mass? a. Occurs as disseminated masses b. Symmetrical mass c. Tender upon palpation d. Firm, hard, embedded in surrounding tissue

d A characteristic of a breast cancer mass is a firm, hard, embedded lesion in surrounding tissue. It has an irregular shape, usually is not tender, and occurs as a single mass in one breast.

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

d 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.

A client who is 4 months postpartum reports significant left breast pain, edema, redness, and an elevated temperature. What would be an important client education topic for this client? a. Complete all medication as prescribed. b. Refrain from bathing until pain subsides. c. Apply cool compresses to relieve pain. d. Pump and save milk for later use.

a Take antibiotics as prescribed for the entire treatment period. Bathe or shower regularly and apply a medical grade lanolin ointment such as Lansinoh to dry or cracked nipples. Apply warm soaks to the breast or let warm water from a shower flow over the breast. Express milk with a breast pump until the infection is resolved sufficiently to resume breastfeeding.

What is the likelihood of a woman developing breast cancer? a. one in eight b. one in 10 c. one in five d. one in 20

a One woman in eight develops breast cancer, a mass of abnormal cells.

A group of students are reviewing the anatomy and physiology of the breasts. The students demonstrate understanding of breast structure when they identify the tail of Spence as an extension of which quadrant? a. Upper outer b. Upper inner c. Lower outer d. Lower inner

a The tail of Spence is an area of breast tissue that extends from the upper outer quadrant of the breast into the axilla. The upper and lower inner quadrants are closer to the midline. The lower outer quadrant is below the upper outer quadrant.

A client has been referred to the breast clinic after her 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

a 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.

A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred? a. The mass has been absorbed into the tissues of the breast. b. The mass may be cystic and was ruptured when the needle was inserted. c. The mass may not have been located correctly. d. The mass is not palpable because it is an inflammatory lesion.

b A simple cyst often disappears on aspiration, and the fluid is usually discarded.

The nurse is educating a patient about the best time to perform breast self-examination (BSE). When does the nurse inform her is the best time after menses to perform BSE? a. 3 to 4 days b. 5 to 7 days c. 8 to 9 days d. After the 10th day

b Most women notice increased tenderness and lumpiness before their menstrual periods; therefore, BSE is best performed after menses (day 5 to day 7, counting the first day of menses as day 1).

A nurse is reviewing a client's history for possible risk factors associated with breast cancer. Which of the following would the nurse identify as increasing the client's risk? a. Menarche at age 14 years b. One of three living children born prematurely c. First full-term pregnancy at age 34 years d. Menopause at age 50 years

c Risk factors associated with breast cancer include menarche before age 12 years, menopause after age 55 years, nulliparity, and late age at first full-term pregnancy.

A client has fibrocystic breast disease. Assuming that there are no sudden or unusual changes, the nurse would suggest that the client have follow-up appointments with her physician every ____ months. Record your answer with a whole number.

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During a teaching demonstration on breast self-examination (BSE), the nurse should always explain that the majority of breast cancers are found in the: a. Upper, outer quadrant. b. Lower, outer quadrant. c. Upper, inner quadrant. d. Lower, inner quadrant.

a Breast cancers are usually found in the upper outer quadrant where the majority of breast tissue is located.

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this client knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this client's fears? a. Provide written material on the procedure that has been scheduled for the client. b. Provide the client with relevant information about expected recovery. c. Give the client current information on breast cancer survival rates. d. Offer the client alternative treatment options.

b Providing the client with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the client alternative treatment options is not within the nurse's normal scope of practice. Addressing survival rates may or may not be beneficial for the client. Written material is rarely sufficient to meet clients' needs.

A client has been diagnosed with stage II breast cancer. The client tells the nurse that the physician 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." What would be the nurse's best response? 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."

d 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.

An adult woman's mother died of left breast cancer. If the client and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? a. More aggressive chemotherapy b. Left mastectomy c. Radiation therapy d. Bilateral mastectomy

d Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the client's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.

The nurse is caring for a 52-year-old woman 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."

d 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.

A client returns to the recovery room following a mastectomy. An initial postoperative assessment is performed by the nurse. What is the nurse's priority assessment? a. Checking for urinary retention and the need to void. b. Checking the dressing, drain, and amount of drainage. c. Checking level of pain first upon the clients return from the operating room. d. Assessing the vital signs and oxygen saturation levels.

d The nurse prioritizes vital signs and breathing based on principles of ABCs.

The nurse is educating a group of women at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than BSE? a. Breast self-awareness b. Mammography every year c. Hormone replacement d. Ultrasound with mammography

a Current practice is shifting from educating about BSE to promoting breast self-awareness, which is a woman's attentiveness to the normal appearance and feel of her breasts.

A client has just been told she needs 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 she might have? a. By encouraging her to verbalize her 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 her medical history

a During the preoperative visit, the nurse assesses the client for any specific educational, physical, or psychosocial needs that she may have. This can be accomplished by encouraging her to verbalize her fears, concerns, and questions. Reviewing her medical history may be beneficial, but it is not the best way to ascertain her needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating physician.

Which primary prevention modality aims to prevent the disease before it starts? a. Long-term surveillance b. Chemoprevention c. Mastectomy d. Radiation therapy

b Chemoprevention and prophylacitc mastectomy are primary prevention modalities that aim at preventing the disease before it starts. Radiation therapy is used to treat a disease. Long-term surveillance will not prevent a disease but just monitor it's progress.

Which is inconsistent as a risk factor for breast cancer? a. Late menopause b. Multiparity c. Older age d. Family history of breast cancer

b Nulliparity is a risk factor for breast cancer, along with late menopause, older age, and family history of breast cancer, among others.

A woman 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

d 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.

Most women diagnosed with breast cancer exhibit which risk factor? a. being older than 50 years old b. chronic alcohol consumption c. African American race d. early menarche

a Most women diagnosed with breast cancer have none of the identified risk factors except being female or being older than 50 (Mayo Clinic, 2007, National Cancer Institute, 2006).

A client newly diagnosed with breast cancer states that her health care provider suspects regional lymph node involvement and told her 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.

d 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.

A client in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The client shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well overall to her 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 she recovers. b. Encourage the client to proceed with the next phase of treatment. c. Recommend that the client remain optimistic for the sake of her children. d. Arrange a referral to a community-based support program.

d The client is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her 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 her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She cannot be expected to be optimistic at all times.