Chapter 58: Assessment and Management of Patients With Breast Disorders

The nurse is obtaining a history from a client who states recurrent breast tenderness. The client inquires if there is something wrong with her breasts. Which question by the nurse is best?

"Does the tenderness occur around the same time each month?"

A client has had a right modified radical mastectomy and axillary lymph node dissection. The nurse is teaching the client about measures to reduce the risk of complications. The client demonstrates understanding of the instructions when she states which of the following?

"I need to use an electric shaver when shaving my right armpit."

Atypical hyperplasia increases a women's risk for breast cancer about how many time compared with that of the general population?

4

The nurse is discussing mammography with a female patient at the clinic. The patient asks at what age she should begin getting yearly mammograms. What answer should the nurse provide to the patient?

40

The nurse is caring for four clients in an oncology unit. Following report on diagnosis and treatment, which client would the nurse identify as having the most life-threatening diagnosis?

A client with stage IV cancer receiving palliative care

A nurse is reviewing a female patient's history, which includes the following information: Age at menarche: 14 years Cesarean delivery: 2 pregnancies Age at first pregnancy: 35 years Alcohol use: approximately 1 to 2 glasses of wine/month The nurse identifies which of the following as a possible risk factor for developing breast cancer?

Age at first pregnancy

A client has just had a left radical mastectomy, and the nurse is providing information on complications that may arise due to removing the axillary lymph nodes. Which would not be included? infection reduced range of motion All would be included in the discussion. tissue necrosis

All would be included in the discussion

A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation?

Assist the client to pump the breasts to remove breast milk.

After teaching a group of students about the signs and symptoms of breast cancer, the instructor determines that additional teaching is needed when the group identifies which of the following?

Breast symmetry

The nurse working on a woman's cancer treatment floor performs nursing assessments on her assigned patients. It is most important for the nurse to report which of the following assessment findings?

Coolness and mottling of a newly constructed breast site

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?

Excisional biopsy

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?

First full-term pregnancy at age 34 years

A 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic?

Genetic counseling

Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon?

Gross swelling

The nurse is assessing the breast of a female patient and observes a prominent venous pattern on the left breast. What does the nurse understand that this can be indicative of?

Increased blood supply required by a tumor

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?

Infiltrating ductal carcinoma

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?

Inform the physician immediately.

The nurse is caring for a client who is beginning doxorubicin (Adriamycin) therapy for breast cancer. When preparing the client for probable side effects, which would the nurse include?

Information regarding wigs from the American Cancer Society

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which of the following complications does this technique help avoid?

Lymphedema

The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following?

Lymphedema

A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies?

Mammogram

Which of the following terms refers to breast pain?

Mastalgia

Which of the following terms is used to describe removal of the breast tissue and an axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer?

Modified radical mastectomy

The nurse recognizes which of the following statements as accurately reflecting a risk factor for breast cancer?

Mother affected by cancer before 60 years of age

Which of the following would be inconsistent as a risk factor for breast cancer?

Multiparity

An early sign of Paget's disease includes which of the following?

Nipple erythema

A patient is receiving adjuvant chemotherapy for breast cancer. Which of the following is most likely her node status and tumor size?

Node negative, tumor size 1.2 cm

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?

Nonmobile mass with irregular edges

The nurse is completing the admission history for a client who is admitted for a reduction mammoplasty. Which of the following client statements is uncommon when explaining the rationale for the procedure?

Others disapprove

Which of the following is an inaccurate manifestation of a fibroadenoma?

Premenstrual changes occur

On a follow-up visit, the patient is informed that her breast cancer has recurred. The nurse knows which of the following situations places the patient at risk for developing bone metastases?

Recurrence within 2 years of the original diagnosis

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer?

The lump is irregularly shaped

During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate?

Wear gloves and protective clothing to avoid any injuries

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?

The mass may be cystic and was ruptured when the needle was inserted

The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction?

The procedure removes all cancer from the body.

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?

ductal

A client with a fibroadenoma is being scheduled for diagnostic testing. Which of the following would the nurse expect as most likely?

Ultrasound

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?

Upper outer

A client is concerned about the lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What could be causing this condition?

cyclical hormonal changes

For a cancerous tumor, a client must undergo modified radical mastectomy, which includes axillary node removal and immediate reconstruction. The nurse explains to the client that the axillary nodes will be removed to:

provide prognostic information

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:

should continue to perform breast self-examination on her right breast

A nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms

yearly starting at age 40.

The nurse is caring for a group of breast cancer survivors post mastectomy. Which teaching point should the nurse include?

Do not lift objects greater than 15 lb

A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?

Refer the client to the American Cancer Society's Reach for Recovery program or another support program.

The nurse is educating a patient about the best time to perform BSE. When does the nurse inform her is the best time after menses to perform BSE?

5 to 7 days

During a breast examination, which finding most strongly suggests that a client has breast cancer?

A fixed nodular mass with dimpling of the overlying skin

The nurse is assessing an older adult female who has not seen her physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding?

It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer.

The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease?

The lump is round and movable.