Chapt 58 Breast Disorders Med Surg
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? a) Encourage the client to proceed with the next phase of treatment. b) Tell the client's spouse or partner to be supportive while she recovers. c) Recommend that the client remain cheerful for the sake of her children. d) Refer the client to the American Cancer Society's Reach for Recovery program or another support program.
Refer the client to the American Cancer Society's Reach for Recovery program or another support program. The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, either through Reach for Recovery or another formal support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't 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 can't be expected to be cheerful at all times.
Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)? a) Tamoxifen b) Exemestane c) Letrozole d) Anastrozole
Tamoxifen Tamoxifen is an example of a SERM. It acts by competing for estrogen-receptor binding sites. Anastrozole, letrozole, and exemestane are examples of aromatase inhibitors, drugs that block estrogen production.
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 schedule a follow-up appointment in 6 months. b) is lucky that the cancer was caught in time. c) should continue to perform breast self-examination on her right breast. d) will have irregular menses.
should continue to perform breast self-examination on her right breast. 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 nurse is meeting with a woman scheduled to have a modified radical mastectomy to remove an aggressive breast tumor. The woman tells the nurse that she agreed to have the surgery before considering alternative options. Which of the following statements is the nurse's best response? a) "If I were you, I would consider a second opinion." b) "You might want to consider a less invasive surgical procedure." c) "You have a very competent surgeon and you should move forward as planned." d) "Tell me more about your fears and concerns."
"Tell me more about your fears and concerns." The type of surgery recommended depends on the stage of the tumor and the client's informed decision about treatment options. The client should be encouraged to express her concerns. Surgery should not be performed until the client is comfortable with the scheduled procedure. The type of surgery recommended depends on the stage of the tumor. A less invasive procedure may not remove all of the affected tissue. The nurse should not share her opinion with the client but rather support the client in making the best decision.
The nurse teaches the female patient who is premenopausal to perform breast self-examination (BSE) at which time frame? a) With the onset of menstruation b) On day 5 to day 7, counting the first day of menses as day 1 c) On day 2 to day 4, counting the first day of menses as day 1 d) Any time during the month
On day 5 to day 7, counting the first day of menses as day 1 BSE is best performed after menses, when less fluid is retained. Because most women notice increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is not recommended with the onset of menses. Because the tenderness, lumpiness, and fluid retention problems noticed by women in relation to onset of menses and generally continues through menses, BSE is not recommended during that time. Because most women notice increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is best performed when the time for menses is taken into account.
In which stage of breast development does breast budding occur? a) 3 b) 2 c) 1 d) 4
2 Correct Explanation: Breast budding occurs in Stage 2 of breast development. Stage 1 describes a prepubertal breast. Stage 3 involves further enlargement of breast tissue and the areola. Stage 4 occurs when the nipple and areola form a secondary mound on top of the breast tissue
Atypical hyperplasia increases a women's risk for breast cancer about how many times compared with that of the general population? a) 4 b) 6 c) 8 d) 2
4 Correct Explanation: Atypical hyperplasia increases a women's risk for breast cancer about four to five times compared with that of the general population.
Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which of the following complications does this technique help avoid? a) Lymphedema b) Fibroadenoma c) Breast cancer d) Mastalgia
Lymphedema Correct Explanation: Validating the lack of lymph node metastasis allows the surgeon to preserve more breast and 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 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? a) Reduce the frequency of removing and reapplying the dressings. b) Assist the client to pump the breasts to remove breast milk. c) Instruct the client to wear a tight-fitting bra. d) Encourage the client to include protein content in the diet.
Assist the client to pump the breasts to remove breast milk. The nurse should help the client pump the breasts and remove breast milk to prevent engorgement. Because the client has decided to continue breastfeeding, the client should wear a loose-fitting bra. Including protein content in the diet would be unrelated to the client's current situation. Frequency of dressing changes does not play a role in the intervention
Which of the following is considered a diagnostic tool for breast cancer? a) Clinical breast exam b) Ultrasonography c) Mammography d) Breast biopsy
Breast biopsy Correct Explanation: Breast biopsy is a tool used to diagnose breast cancer. Ultrasonography, mammography, and clinical breast exam are all tools used to screen for breast cancer.
A 33-year-old female patient with three children has had a follow-up mammogram following an abnormal BSE. Mammogram findings reveal an incidental microscopic abnormal tissue growth in the left breast lobules. The physician orders tamoxifen (Soltamox) for the patient. The nurse understands that the physician is implementing which of the following primary prevention modalities to treat this patient? a) Chemoprevention b) Radiation therapy c) Prophylactic mastectomy d) Long-term surveillance
Chemoprevention Correct Explanation: Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts.
A 43-year-old client is a single parent and has been admitted for a left mastectomy after confirmation of cancer from a node biopsy. She has a daughter who is 12 years old. What are primary issues for the nurse to discuss with this client? a) Effect of surgery on the family's coping abilities. b) History of breast cancer in the family. c) How body image changes will affect her sexual relationships. d) Concerns regarding the cancer and how the surgery will affect her.
Concerns regarding the cancer and how the surgery will affect her. The two primary concerns are the confirmation of cancer and the impending mastectomy. The other issues are important, but not as high a priority at this time.
A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies? a) Breast biopsy b) Mammogram c) Mastopexy d) Ultrasound
Mammogram Correct Explanation: When caring for a client considering breast augmentation, the nurse should provide her with a general guideline to have a mammogram to verify that there are no malignancies. Mastopexy involves a breast life for drooping breasts. Ultrasound or breast biopsy would not be necessary unless there was evidence of a problem.
Which of the following terms refers to breast pain? a) Mastalgia b) Mammoplasty c) Mastitis d) Gynecomastia
Mastalgia Mastalgia refers to breast pain. Mastitis is an inflammation or infection of the breast. Gynecomastia refers to overdeveloped breast tissue typically seen in adolescent boys. Mammoplasty refers to a surgical procedure to reconstruct or change the size or shape of the breast.
A 32-year-old client is concerned with the lumps that have developed in her breasts and is fearful of cancer. She reports variability in the size of the lumps. What could be causing her condition? a) Cyclical hormonal changes b) Progesterone c) Caffeine d) Nicotine
Cyclical hormonal changes Correct Explanation: Fibrocystic disease results from hormonal changes during the menstrual cycle. The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.
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) Menopause after age 50 b) Menarche at age 14 c) First full-term pregnancy at age 34.
First full-term pregnancy at age 34 years Correct Explanation: 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.
Which of the following is a characteristic of a breast cancer mass? a) Firm, hard, embedded in surrounding tissue b) Occurs as disseminated masses c) Symmetrical mass d) Tender upon palpation
Firm, hard, embedded in surrounding tissue Correct Explanation: A characteristic of a breast cancer mass is a firm, hard, embedded lesion in surrounding tissue. It has an irregular shape, usually not tender, and occurs as a single mass in one breast.
When the female patient demonstrates a wartlike growth near the nipple, causing bloody nipple discharge, the patient is exhibiting signs of which disease process? a) Intraductal papilloma b) Fibroadenoma c) Paget's disease d) Acute mastitis
Intraductal papilloma Correct Explanation: Intraductal papilloma is a wartlike growth that often involves the large milk ducts near the nipple, causing bloody nipple discharge. Surgery usually involves removal of the papilloma and a segment of the duct where the papilloma is found. Paget's disease is a malignancy of mammary ducts with early signs of erythema of nipple and areola. Acute mastitis is demonstrated by nipple cracks or abrasions along with reddened and warm breast skin and tenderness. Fibroadenoma is characterized as the occurrence of a single, nontender mass that is firm, mobile, and not fixed to breast tissue or chest wall.
Which of the following is one of the most important prognostic factor in breast cancer? a) Age of patient b) Obesity c) Family history d) Status of lymph nodes
Status of lymph nodes Explanation: The two most important prognostic factor in breast cancer is the status of the lymph nodes and tumor size. Obesity, age of the patient, and family history are not the most important prognostic factors in breast cancer.
A client with a fibroadenoma is being scheduled for diagnostic testing. Which of the following would the nurse expect as most likely? a) Ultrasound b) Culture of discharge c) Excisional biopsy d) Mammogram
Ultrasound Explanation: Ultrasound can reveal physical characteristics unique to a fibroadenoma versus malignant mass with a higher degree of accuracy than mammography. In the case of very young women—an atypical age for breast cancer—an excisional biopsy is performed only if the mass changes or becomes larger. If the mass is detected in a woman with a higher risk for developing breast cancer, such as one with a family history or of an older age, a biopsy is performed to confirm that the tissue is indeed benign. There is no discharge to culture.
A nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: a) mammography. b) breast self-examination. c) fine needle aspiration. d) chest X-ray.
fine needle aspiration. Correct Explanation: Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
A nurse is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: a) on the same day each month. b) immediately after her menses. c) on the first day of the menstrual cycle. d) at the end of her menstrual cycle.
immediately after her menses. Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the first and last days of the cycle, the woman's breasts are still very tender. Postmenopausal women, because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.
Which of the following is a primary prevention modality that aims at preventing the disease before it starts? a) Prophylactic mastectomy b) Chemoprevention
Chemoprevention Explanation: Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts
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 level of pain first upon the clients return from the operating room. b) Assessing the vital signs and oxygen saturation levels. c) Checking for urinary retention and the need to void. d) Checking the dressing, drain, and amount of drainage.
Assessing the vital signs and oxygen saturation levels. The nurse prioritizes vital signs and breathing based on principles of ABCs.
During a breast examination, which finding most strongly suggests that a client has breast cancer? a) Slight asymmetry of the breasts b) A fixed nodular mass with dimpling of the overlying skin c) Multiple firm, round, freely movable masses that change with the menstrual cycle d) Bloody discharge from the nipple
A fixed nodular mass with dimpling of the overlying skin Correct Explanation: A fixed nodular mass with dimpling of the overlying skin is common during late stages of breast cancer. Many women have slightly asymmetrical breasts. Bloody nipple discharge is a sign of intraductal papilloma, a benign condition. Multiple firm, round, freely movable masses that change with the menstrual cycle indicate fibrocystic breasts, a benign condition.
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? a) Painless mass b) Peau d'orange skin c) Nipple retraction d) Breast symmetry
Breast symmetry The primary sign of breast cancer is a painless mass in the breast. Other signs of breast cancer include a bloody discharge from the nipple, a dimpling of the skin over the lesion, retraction of the nipple, peau d'orange (orange peel) appearance of the skin, and a difference in size between the breasts.
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? a) Breast symmetry b) Peau d'orange skin c) Painless mass d) Nipple retraction
Breast symmetry Correct Explanation: The primary sign of breast cancer is a painless mass in the breast. Other signs of breast cancer include a bloody discharge from the nipple, a dimpling of the skin over the lesion, retraction of the nipple, peau d'orange (orange peel) appearance of the skin, and a difference in size between the breasts.
A group of students is reviewing information about breast cancer and metastasis in preparation for an examination. The students demonstrate the need for additional study when they identify which of the following as a common site for metastasis? a) colon b) liver
Colon Explanation: Breast cancer typically does not metastasize to the colon. The four major sites of metastasis include the skeletal and pulmonary systems, brain, and liver.
A client has undergone a transverse rectus abdominis myocutaneous (TRAM) flap procedure for breast reconstruction immediately following a mastectomy. Which of the following would be most appropriate to include in the client's postoperative plan of care? a) Inspecting the breast site for expected mottling b) Maintaining the client in the supine position c) Monitoring the single incisional site at the breast d) Encouraging coughing and deep breathing exercises
Encouraging coughing and deep breathing exercises Explanation: A client who has undergone a TRAM flap procedure has incisions at both the mastectomy and abdominal donor sites. In addition, the breathing and leg exercises are essential because the client is more limited in her activity and is at greater risk for respiratory complications and deep vein thrombosis. Mottling at the newly created breast site must be reported to the surgeon immediately. Elevating the head of the bed 45 degrees and flexing the client's knees help to reduce tension on the abdominal incision during the first postoperative week.
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? a) Breast abscess b) Fibroadenoma c) Lymphedema d) Fibrocystic breast disease
Lymphedema Correct Explanation: Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing. Fibrocystic breast disease and fibroadenoma are two benign breast conditions that occur usually in premenopausal woman. Breast abscess is the infectious and inflammatory breast condition that is common among breast-feeding mothers.
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) Lower inner b) Upper inner c) Lower outer d) Upper outer
Upper outer 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.
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? a) The procedure allows for conservation of breast tissue. b) The procedure allows for an understanding of the spread of cancer cells. c) The procedure removes all cancer from the body. d) The procedure includes minimal surrounding tissue damage.
The procedure removes all cancer from the body. Explanation: Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.
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? a) Information regarding wigs from the American Cancer Society b) Information regarding depression from a mental health association c) Information regarding high caloric meals from a dietician d) Information about blood donation from the American Red Cross
Information regarding wigs from the American Cancer Society Alopecia is a common side effect from the use of doxorubicin (Adriamycin). It is best for the client to be proactive in planning for hair loss so that the client has a suitable plan. Also, the American Cancer Society in some areas offers financial support and guidance in obtaining a wig or head covering. Blood donation is not completed during chemotherapy because anemia is common. Due to recent antiemetic medications, nausea is less common not as prolonged. Client's rarely need a high-calorie diet. Emphasis is placed on nutrient dense, not calorie dense. Depression may be a concern, and a support group is an excellent resource. A mental health association may be more than what is needed.
The nursing is caring for a client who will be having artificial implants for breast reconstruction. The client is arriving at the physician's office for which procedure completed before the surgery can be done?
Tissue expansion Correct Explanation: Before an implant for breast reconstruction can produce an optimum cosmetic appearance, the skin and tissue on the chest wall are expanded to provide a large enough space to fill and approximate the size of the remaining breast. The other options are not correct.
Kara Carpenter is a 54-year-old woman who just had a left radical mastectomy. The nurse caring for her is providing information on complications that may arise due to removing the axillary lymph nodes. Which of the following would not be included? a) Reduced range of motion b) Infection c) Tissue necrosis d) All would be included in the discussion.
All would be included in the discussion. Impaired lymphatic circulation predisposes to disfigurement, reduced range of motion, heaviness of the limb, skin changes, infection, and, in severe cases, tissue necrosis that may require amputation of the limb. Reduced range of motion is a potential consequence from removing the axillary lymph nodes. Tissue necrosis that may require amputation of the limb is a potential consequence from removing the axillary lymph nodes. Infection is a potential consequence from removing the axillary lymph nodes.
A 37-year-old client has been diagnosed with breast cancer and is awaiting the cytology results of her biopsy. During your client education session, you discuss the possible types of breast malignancies. Which is the most common type? a) Medullary b) Infiltrating lobular c) Inflammatory d) Ductal
Ductal Explanation: 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 malignancy is ductal carcinoma (80%); inflammatory breast cancer (1% to 3%) is the rarest but most aggressive form of breast cancer. The most common malignancy is ductal carcinoma (80%). The most common malignancy is ductal carcinoma (80%) followed by infiltrating lobular carcinoma (10%).
The nurse recognizes which of the following statements as accurately reflecting a risk factor for breast cancer? a) Onset of menses before 14 years of age b) Multiparity c) Mother affected by cancer before 60 years of age d) No alcohol consumption
Mother affected by cancer before 60 years of age Correct Explanation: 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 for 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 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? a) "I need to use an electric shaver when shaving my right armpit." b) "I can lift with my right arm objects that weigh as much as 15 pounds." c) "I should tell my manucurist that it is okay to trim the cuticles on my right hand." d) "Anytime I need blood drawn, they should get the sample from my right arm."
"I need to use an electric shaver when shaving my right armpit." To prevent complications after a right modified radical mastectomy and axillary lymph node dissection, the client should shave her right axillary area with an electric razor rather than a straight razor to reduce the risk of trauma to or breaks in the skin. Blood sampling should be done with the client's left arm, not the right one. The client should not lift objects more than 5 to 10 pounds with the right arm, and cuticles on the affected hand should be pushed back, not cut.
The nurse is providing shift report related to a client newly received back to the unit from the post anesthesia care unit (PACU). The nurse is stating that the client had breast tissue removed with 7 of 14 lymph nodes, the lining of the chest muscles and pectoralis minor muscle removed. The oncoming nurse documents which procedure completed? a) A modified radical mastectomy b) A radical mastectomy c) A total mastectomy d) A segmental mastectomy
A modified radical mastectomy Explanation: A modified radical mastectomy is a procedure in which the breast, some lymph nodes, the lining over the chest muscles, and the pectoralis minor muscle is removed. A segmental mastectomy is where the tumor and some breast tissue and lymph nodes are removed. A total mastectomy includes only breast tissue. A radical mastectomy includes the breast axillary lymph nodes, and pectoralis major and minor muscles are removed. Sternal lymph nodes may also be removed with this procedure.
A 54-year-old woman presents to her healthcare provider's office where you practice nursing. She is very concerned that she might have breast cancer, especially after caring for her sister that recently died from the disease. Included in your discussion is the primary and most common sign of breast cancer. Which of the following would meet this criterion? a) A painless mass in the breast, most often in the upper outer quadrant b) A painful mass in the breast, most often in the lower quadrant near the nipple c) A painless mass in the breast, most often in the lower quadrant near the nipple d) A painful mass in the breast, most often in the upper outer quadrant
A painless mass in the breast, most often in the upper outer quadrant Correct Explanation: The primary sign of breast cancer is a painless mass in the breast, most often in the upper outer quadrant.
A 67-year-old client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which of the following are factors in the client's history that may have increased her risk of breast cancer? a) Not giving birth b) Obesity c) Increased age d) All options are correct.
All options are correct. The risk for breast cancer in women increases with age. Certain factors appear to increase the risk of breast cancer. Being female, being older than 50 years of age, and having a family history of breast cancer are the most common risk factors. Additional factors include obesity, and having no children or having children after 30 years of age. The risk for breast cancer in women increases with age. Certain factors appear to increase the risk of breast cancer including obesity and having no children or having children after 30 years of age.
The nurse has identified the following nursing diagnosis on the plan of care for a client who has undergone breast cancer surgery: Disturbed sensory perception related to nerve irritation in the affected breast area. Which of the following indicates that the outcome has been achieved? a) Client identifies appropriate measures to reduce the risk of lymphedema. b) Client demonstrates appropriate use of prescribed analgesic. c) Client reports a sensation of pulling in the breast area. d) Client states that feeling in her breast area will gradually subside with time.
Client states that feeling in her breast area will gradually subside with time. Correct Explanation: After breast surgery, the nerves in the skin and axilla are often cut or injured, leading the client to experience various sensations, including tenderness, soreness, numbness, tightness, pulling, and twinges. These sensations are normal and usually persist for several months and then subside. Therefore, acknowledging that the feeling in her breast area will gradually subside indicates that she understands why the sensation is occurring and that it is normal. The report of the sensation of pulling indicates that the client is feeling the sensation, but it does not indicate whether the nursing diagnosis was addressed. Analgesics usually would not be required for these sensations. These sensations are not associated with lymphedema.
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? a) Immediate postoperative reports of throat tenderness b) Coolness and mottling of a newly constructed breast site c) Temperature of 99.2°F, pulse 72, respirations 18, blood pressure 130/80 d) Small amount of bloody drainage on surgical dressing 12 hours postoperatively
Coolness and mottling of a newly constructed breast site Correct Explanation: Mottling or an obvious decrease in skin temperature may signify flap loss and needs to be reported to the surgeon immediately. Throat discomfort immediately following surgery is an expected effect of airway management during surgery. A small amount of bloody drainage is an expected finding 12 hours postoperatively. Vital signs are within acceptable range for a postoperative patient.
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? a) Radical mastectomy b) Total mastectomy c) Segmental mastectomy d) Modified radical mastectomy
Modified radical mastectomy Correct Explanation: A modified radical mastectomy leaves the pectoralis major and minor muscles intact. In a segmental mastectomy, varying amounts of breast tissue are removed, including the malignant tissue and some surrounding tissue to ensure clear margins. In a total mastectomy, breast tissue only is removed. Radical mastectomy includes removal of the pectoralis major and minor muscles in addition to breast tissue and axillary lymph node dissection.
The nurse is caring for a group of breast cancer survivors post mastectomy. When developing a list of instructions of points to avoid, which point is highlighted? a) Applying cream to breast b) Arm exercises on affected side c) Wearing loose fitting shirts d) No lifting greater than 15 lb
No lifting greater than 15 lb Correct Explanation: Of the list citing things to avoid, the correct option to avoid is lifting more than 15 lb. This fact is important and needs to be highlighted. Tight-fitting or constrictive clothing is to be avoided. The client is encouraged to place cream on any area of the breast which is dry. Arm exercises are routinely completed on the affected arm.
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? a) Back pain b) Skin irritation c) Low self-esteem d) Others disapprove
Others disapprove Correct Explanation: The rationale for a reduction mammoplasty most often comes from the client herself as she is experiencing a complication due to the size of the breast. Back pain, low self-esteem and a self-consciousness, and skin irritation are common rationales.
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? a) The lump is soft. b) The client reports tenderness during the palpation. c) The lump is irregularly shaped. d) The lump is mobile.
The lump is irregularly shaped. Correct Explanation: Generally, breast cancer lesions are nontender, fixed rather than mobile, and hard with irregular borders. Diffuse breast pain and tenderness with menstruation are usually associated with benign breast disease.
A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which of the following best reflects the rationale for using this group of drugs? a) They lower the level of estrogen in the body blocking the tumor's ability to use it. b) They stimulate the immune system to attack a protein common in many tumors. c) They block progesterone-dependent tumors from growing. d) They attach to endogenous protein receptors to slow the growth of cancerous cells.
They lower the level of estrogen in the body blocking the tumor's ability to use it. Explanation: Aromatase inhibitors lower the level of estrogen in the body thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogestin drug, such as mifepristone, blocks progesterone-dependent breast cancers. The monoclonal antibody, trastuzumab attaches to protein receptors to slow the growth of cancer cells. A breast cancer vaccine is under investigation in Italy. This vaccine stimulates the immune system to attack a protein called mammaglobin-A, which is found in 80% of breast cancer tumors.
A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following? a) Bathing frequency and living surroundings b) Client's workplace in relation to the surroundings c) Alcohol and caffeine consumption d) Timing of symptoms in relation to the menstrual cycle
Timing of symptoms in relation to the menstrual cycle Correct Explanation: Considering that the client has tender and painful breasts and that she often feels lumps within her breast tissue, it is most likely that she suffers from fibrocystic breast disease. To confirm these findings, the nurse should ask relevant questions about the characteristics and timing of symptoms in relation to the menstrual cycle. Symptoms of fibrocystic breast disease are noticeable before menstruation and usually abate during menstruation. The size of the cyst becomes larger before menstruation and often changes with the menstrual cycle. The nurse should further ask the client about her habits of smoking and consuming coffee, chocolate, and caffeinated soft drinks, not alcohol, because they aggravate the condition. Workplace surroundings or cleanliness habits do not matter because fibrocystic breast disease is not infectious.
Your patient is receiving adjuvant chemotherapy for breast cancer. Which of the following is most likely her node status and tumor size? a) node negative, tumor size 0.3 cm b) node negative, tumor size 1.2 cm c) node negative, tumor size 0.2 cm d) node negative, tumor size 0.5 cm
node negative, tumor size 1.2 cm Explanation: Adjuvant chemotherapy is recommended for patients who have positive lymph nodes or who have invasive tumors greater that 1 cm in size, regardless of nodal status.
A patient has been newly diagnosed with breast cancer. During her preoperative instructions the physician indicated that removal of the breast tissue and axillary lymph node dissection leaving the muscular structure intact was indicated as surgical treatment for her breast cancer. To which of the following procedures is the physician asking the patient to consent? a) Total mastectomy b) Radical mastectomy c) Segmental mastectomy d) Modified radical mastectomy
Modified radical mastectomy Correct Explanation: A modified radical mastectomy leaves the pectoralis major and minor muscles intact. In a segmental mastectomy, varying amounts of breast tissue are removed, including the malignant tissue and some surrounding tissue to ensure clear margins. In a total mastectomy, breast tissue only is removed. Radical mastectomy includes removal of the pectoralis major and minor muscles in addition to breast tissue and axillary lymph node dissection.
Which of the following would be inconsistent as a risk factor for breast cancer? a) Family history of breast cancer b) Increased age c) Late menopause d) Multiparity
Multiparity Correct Explanation: Nulliparity is a risk factor for breast cancer, along with late menopause, increased age, and family history of breast cancer.
An early sign of Paget's disease includes which of the following? a) Increased pulse b) Thickening of areola c) Fever d) Nipple erythema
Nipple erythema Explanation: Early signs of Paget's disease include nipple and areola erythema. Late signs include thickening, scaling, and erosion of the nipple and areola.
A client with breast cancer is receiving chemotherapy as part of the treatment plan. The client develops neutropenia and is scheduled to receive pegfilgrastim (Neulasta). The nurse would expect this drug to be given at which time? a) Once, approximately 24 hours after chemotherapy b) Weekly during chemotherapy administration c) Every 2 to 3 weeks after chemotherapy is given d) 7 to 10 days after chemotherapy administration
Once, approximately 24 hours after chemotherapy Explanation: Pegfilgrastim (Neulasta) is a long-acting granulocyte colony-stimulating factor(G-CSF) that is given via injection once, 24 hours after chemotherapy. Filgrastim (Neupogen), a short-acting G-CSF, is injected subcutaneously from 7 to 10 days after chemotherapy administration. Epoetin alfa, an erythropoietin growth factor, is administered weekly; darbepoetin alfa, a long-acting erythorpoietin growth factor, is administered every 2 to 3 weeks.
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? a) Recurrence within 2 years of the original diagnosis b) No maternal family history of breast cancer c) Aggressive treatment, including surgery, radiation, and hormonal therapy d) Previous therapeutic response to chemotherapy
Recurrence within 2 years of the original diagnosis Local recurrence may be an indicator that systemic disease will develop in the future, particularly if it occurs within 2 years of the original diagnosis. Local recurrence in the absence of systemic disease is treated aggressively with surgery, radiation, and hormonal therapy. Overall prognosis and optimal treatment are determined by a variety of factors such as the time to recurrence from the original diagnosis and history of prior treatments.
Which type of biopsy is used for nonpalpable lesions found on mammography? a) Tru-Cut core b) Incisional c) Stereotactic d) Excisional
Stereotactic Correct Explanation: Stereotactic biopsy utilizes computer location of the suspicious area found on biopsy, followed by core needle insertion and sampling of tissue for pathologic examination. An excisional biopsy is the usual procedure for any palpable breast mass. Incisional biopsy is performed on a palpable mass when tissue sampling alone is required. Tru-Cut core biopsy is used when a tumor is relatively large and close to the skin surface.
A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following? a) Client's workplace in relation to the surroundings b) Timing of symptoms in relation to the menstrual cycle c) Bathing frequency and living surroundings d) Alcohol and caffeine consumption
Timing of symptoms in relation to the menstrual cycle Considering that the client has tender and painful breasts and that she often feels lumps within her breast tissue, it is most likely that she suffers from fibrocystic breast disease. To confirm these findings, the nurse should ask relevant questions about the characteristics and timing of symptoms in relation to the menstrual cycle. Symptoms of fibrocystic breast disease are noticeable before menstruation and usually abate during menstruation. The size of the cyst becomes larger before menstruation and often changes with the menstrual cycle. The nurse should further ask the client about her habits of smoking and consuming coffee, chocolate, and caffeinated soft drinks, not alcohol, because they aggravate the condition. Workplace surroundings or cleanliness habits do not matter because fibrocystic breast disease is not infectious.
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? a) Mammogram b) Genetic counseling c) Pap testing d) Contacting the American Cancer Society
Genetic counseling Explanation: The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and three-generational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society will provide the client with information about cancer but the organization won't help assess the client's risk for developing 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? a) One breast is larger than the other. b) Nipple retractions are noted. c) The lump is round and movable. d) The lump is firm and nonmovable.
The lump is round and movable. When assessing a breast with fibrocystic disease, the lumps typically are different from cancerous lumps. The characteristic breast mass of fibrocystic disease is soft to firm, circular, movable, and unlikely to cause nipple retraction. A cancerous mass is typically irregular in shape, firm, and nonmovable. Lumps typically do not make one breast larger than the other. Nipple retractions are suggestive of cancerous masses.
A client is being discharged to home following a modified radical mastectomy. The nurse is providing discharge instructions and making arrangements for home care. Which of the following interventions will be included in her instructions? Select all that apply. a) Advise the client that blood pressure measurements, injections, blood donations, and IV infusions are lifelong restrictions on the side of the mastectomy. b) Encourage the client to wear restrictive clothing on the affected side. c) Recommend wearing gloves while doing yard or housework. d) Advise the client to use a disposable razor for shaving axillary hair.
• Advise the client that blood pressure measurements, injections, blood donations, and IV infusions are lifelong restrictions on the side of the mastectomy. • Recommend wearing gloves while doing yard or housework. Explanation: Because of impaired lymphatic flow, blood pressure measurements, injections, blood donations, and IV infusions in the affected arm are contraindicated. Gloves are worn to prevent injuries that may heal slowly or become infected. Advise the use of an electric razor for shaving axillary hair because it reduces the likelihood of cutting the skin, leading to infection. Discourage sleeping on the affected arm or wearing constrictive clothing that impairs circulation.
