Chapter 52: Assessment and Management of Patients with Breast Disorders

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

A. "An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation."

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

A. "Not until the drain is removed"

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

A. Acknowledge the fear the client is likely experiencing.

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

A. Acute pain related to tissue manipulation and incision

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

A. Adherence to the exercise plan B. Overall psychological functioning C. Integrity of surgical drains

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

A. Apply cold compresses as prescribed.

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

A. By encouraging the client to verbalize questions and concerns

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

A. Lumpectomy and radiation

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

A. Mondor disease

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

A. Non-tender on palpation

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

A. Women's knowledge of how their breasts normally look and feel

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

C. Sudden cessation of output from the drainage device

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

B. "An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment."

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

B. A nonmobile mass with irregular edges

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

B. Client must have someone to accompany them home. C. Client must understand activity restrictions. D. Client must understand care of the biopsy site.

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 breast self-examination (BSE)

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

B. Palpate the area for a breast mass.

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

B. The client gave birth to their first child at age 40.

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

B. The client might be referred for a biopsy.

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

C. "Is there someone you trust to help you make treatment choices?"

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

C. "It will help to observe for dimpling more closely."

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

C. 45 years old

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

C. Age 38

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

C. Avoid lifting objects heavier than 10 pounds (4.5 kg).

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

C. Fine-needle aspiration

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

C. Lobules and ducts

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

C. Paget disease

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

C. Stop taking aspirin.

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

D. "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy."

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

D. "Tamoxifen is known to be a highly effective protective measure."

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

D. Arrange a referral to a community-based support program.

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

D. Decreased nipple sensation

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

D. Galactography

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

D. Provide the client with encouragement in an empathic and thoughtful manner.

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

D. The client has a 15% chance of 5-year survival.

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. between days 5 and 7 after menses.