Med Surg 2 Lewis Ch. 52-Breast Disorders
A patient with breast cancer has a lumpectomy with sentinel lymph node dissection that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply): a. well-differentiated tumor b. estrogen receptor-positive tumor c. overexertion of HER-2 cell marker d. involvement of two to four axillary nodes e. aneuploidy status from cell proliferation studies
a, b.
The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors (select all that apply)? a. nulliparity b. age 30 or over c. early menarche d. late menopause e. personal history of colon cancer
a, c, d, e.
A 72-year-old patient who had a mastectomy for breast cancer 6 months ago wants to have breast reconstructive surgery. The nurse knows that what is the most likely motivation for this patient seeking this surgery? a. improve the woman's self-image b. be able to experience sexual arousal c. to get a tummyt tuck as well as the breast mound d. restore the pre-mastectomy appearance of the breast
a.
To prevent capsular formation after breast reconstruction with implants, teach the patient to: a. gently massage the area around the implant b. bind the breasts tightly with elastic bandages c. exercise the arm on the affected side to promote drainage d. avoid strenuous exercise until the implant has healed
a.
When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is: a. being a woman over age 60 b. experiencing menstruation for 30 years or more c. using hormone therapy for 5 years for menopausal symptoms d. having a paternal grandmother with postmenopausal breast cancer
a.
A 24-year-old patient who has undergone breast augmentation earlier in the day will be discharged home in the early evening. What instructions should the nurse provide in order to minimize the patient's risk of complications in the immediate recovery period? a. avoid wearing a bra until postoperative day 3 b. ask the patient to avoid strenuous exercise during her recovery period c. sleep in a semi-Fowler's position until her scheduled follow-up appointment d. enlist a friend or family member to perform passive range-of-motion exercises
b.
A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). What point should the nurse emphasize when teaching the patient about her new drug regimen? a. "you may find that your medication causes some breast sensitivity." b. "it's important that you let your care provider know about any changes in your vision." c. "you'll find that this drug often alleviates some of the symptoms that accompany menopause." d. "it's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."
b.
The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which guidelines should the nurse provide to the audience? a. "mammograms are necessary if you have a family history of breast cancer." b. "it's recommended that you get a mammogram each year after you turn 40." c. "if you are not able to perform breast self-examination (BSE), you should go for regular mammograms." d. "you should ensure that your primary care provider performs a breast exam each time you visit."
b.
Which task could the registered nurse delegate to unlicensed assistive personnel (UAP) during the care of a patient who has had recent transverse rectus abdomens musculocutaneous (TRAM) flap surgery? a. document the condition of the patient's incisions b. mobilize the patient in a slightly hunched position c. change the patient's abdominal and chest dressings d. change the parameters of the patient-controlled analgesic (PCA) pump
b.
A 29-year-old primiparous patient has a 3-week-old infant whom she is breastfeeding. The woman has sought care because of recent breast tenderness, redness, and fever. Which teaching point should the nurse prioritize when following up her care? a. encourage patient to continue breastfeeding her infant b. refer patient for a mammogram as quickly as possible c. ensure patient adheres to her prescribed antibiotic regimen d. teach patient to use warm compresses and educate her about self-limiting nature of illness
c.
You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. To best promote the participants' learning and adherence, you would include (select all that apply): a. a short audiotape on the BSE procedure b. a packet of articles from the medical literature c. written guidelines for mammography and CBE d. a discussion of the value of early breast cancer detection e. community resources where they can obtain an ultrasound and MRI
c, d.
A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants? a. inappropriate lactation necessitates breast biopsy b. nipple discharge of any type is considered a precursor to cancer c. unexpected nipple discharge of any type warrants medical follow-up d. galactorrhea is a normal age-related change and a frequent perimenopausal symptom
c.
Preoperatively, to meet the psychologic needs of a woman scheduled for a modified radical mastectomy, you would: a. discuss the limitations of breast reconstruction b. include her significant other in all conversations c. promote an environment for expression of feelings d. explain the importance of regular follow-u screening
c.
The nurse is caring for a client with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? a. keep the affected arm flat at the patient's side b. apply an elastic bandage on the affected arm c. assess blood pressure only on the unaffected arm d. restrict exercise of the affected arm for 1 week
c.
When doing breast self-examination, the female patient should report which findings to her physician? a. palpable rib margins b. denser breast tissue c. left nipple deviation d. different sized breasts
c.
A 51-year-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? a. immobilize the patient's right arm until post-op day 3 b. maintain the patient's right arm in a dependent position when at rest c. administer diuretics prophylactically for the prevention of lymphedema d. promote gradually increasing mobility as soon as possible following surgery
d.
A modified radical mastectomy has been scheduled for your patient with breast cancer. Postoperatively, to restore arm function on the affected side, you would: a. apply heating pads or blankets to increase circulation b. place daily ice packs to minimize the risk of lymphedema c. teach passive exercises with the affected arm in a dependent position d. emphasize regular exercises for the affected shoulder to increase range of motion
d.
In teaching a patient who wants to perform BSE, you inform her that the technique involves both the palpation of the breast tissue and: a. palpation of the cervical lymph nodes b. hard squeezing of the breast tissue c. a mammogram to evaluate breast tissue d. inspection of the breasts for any changes
d.
The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care? a. evaluate left arm lymphatic accumulation b. maintain joint flexibility and left arm function c. teach her about chemotherapy and radiation therapy d. assess the patient's response to the diagnosis of breast cancer
d.
You are caring for a young woman who has painful fibrocystic breast changes. Management of this patient would include: a. scheduling a biopsy to rule out malignant changes b. teaching that symptoms will probably subside if she stops using oral contraceptives c. preparing her for surgical removal of the lumps, since they will become larger and more painful d. explaining that restrictions of coffee and chocolate and supplements of vitamin E may relieve some discomfort
d.