Exam 1: Breast Cancer

Ductal Lobular

A ___________ carcinoma and __________ carcinoma are two types of noninvasive breast cancer

Phyllodes

A _____________ tumor is a type of breast cancer that develops in the breast's connective tissue

Abscess

A lactational breast ____________ is a palpable mass with red, edematous skin over involved breast

Modifiable

-Excess weight gain -Sedentary lifestyle -Dietary fat -Obesity -Alcohol -Smoking These are all _____________ risk factors of breast cancer

Non-Modifiable

-Family History -Early menarche -Advanced Age -Gender -Genetic Link These are all ________________ risk factors of breast cancer

a c d e f

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. Alcohol consumption f. Personal history of colon cancer

c

The nurse performs a breast examination on a 68-yr-old female patient. Which clinical manifestation indicates further evaluation for breast cancer is needed? a. Bilateral pendulous breasts b. Right breast is warm, painful to touch c. Irregular, nontender lump with induration d. Palpable lump that is tender and movable

c

A 29-yr-old primiparous patient is breastfeeding a 3-wk-old infant. She complains of recent breast tenderness, redness, and fever. Which teaching point should the nurse reinforce when following up on 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 while explaining the self-limiting nature of illness.

b

A 33-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which is most important to report to the health care provider? a. There is yellow-green discharge from one of the patients nipples. b. There is an area on the breast that is hot, pink, and tender to touch. c. The lumps are firm feeling and most are in the upper outer breast quadrants. d. The lumps are larger and more painful before the patients menstrual period.

d

A 51-yr-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 postoperative 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.

b

A 56 year old patient is undergoing a mammoplasty for breast reconstruction following a mastectomy 1 year ago. During the preoperative preparation of the patient, what is important for the nurse to do? a. determine why the patient is choosing reconstruction surgery rather than the use of an external prosthesis b. ensure that the patient has realistic expectations about the outcome and possible complications of the surgery c. inform the patient that implants used for breast reconstruction have been shown to cause immune-related diseases d. let the patient know that, although the shape will be different from the other breasts, the nipple can be reconstructed from other erectile tissue

a

A 72-yr-old patient had a mastectomy for breast cancer 6 months ago and wants to have breast reconstructive surgery. Which motivation for surgery would be most likely? a. Improve the woman's self-image b. Be able to experience sexual arousal c. To get a tummy tuck as well as the breast mound d. Restore the premastectomy appearance of the breast

c

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

A patient has fibrocystic changes in her breast. The nurse explains to the patient that this condition is significant because it a. commonly becomes malignant over time b. can be controlled with hormone therapy c. makes it more difficult to examine the breasts d. will eventually cause atrophy of normal breast tissue

c

A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. Which nursing action should be included in the plan of care? a. Insist that the patient examine the surgical incision when the dressings are removed. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Post a sign at the bedside warning against blood pressures or venipunctures in the right arm. d. Obtain a permanent breast prosthesis for the patient before she is discharged from the hospital.

a

A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. What should the nurse teach the patient about tissue expansion? a. weekly injections of sterile saline into the expander will be required b. the expander cannot be placed until healing from the mastectomy is complete c. this method of breast reconstruction uses the patient's own tissue to replace breast tissue d. the nipple from the affected breast will be saved to be grafted onto the reconstructed breast

d

A patient undergoing either a mastectomy or a lumpectomy for treatment of breast cancer can also usually expect to undergo what other treatment? a. chemotherapy b. radiation therapy c. hormonal therapy d. sentinel lymph node dissection

c

A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absence of breast. What is an appropriate nursing intervention for this patient? a. provide the patient with information about surgical breast reconstruction b. restrict visitors and phone calls until the patient feels better about herself c. arrange for a Reach to Recovery visitor or similar source available in the community d. encourage the patient to obtain a permanent breast prosthesis as soon as she is discharged

a

A patient with a positive breast biopsy tells the nurse that she read about tamoxifen on the internet and asks about its use. The best response by the nurse includes what information? a. tamoxifen is the treatment of choice if the tumor has receptors for estrogen on its cells b. tamoxifen is the primary treatment for breast cancer if axillary lymph nodes are positive for cancer c. tamoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer d. because tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment methods have not been successful

d

A simple 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 exercise for the affected shoulder to increase range of motion

Vacuum-assisted biopsy

A version of core biopsy that uses a vacuum technique to help collect the tissue sample. needle is inserted only once into the breast, and the needle can be rotated, which allows for multiple samples through a simple needle insertion.

b

After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that teaching has been successful? a. I will need to use my right arm and to rest the left one. b. I will avoid reaching over the stove with my left hand. c. I will keep my left arm in a sling until the incision is healed. d. I will stop the left arm exercises if moving the arm is painful.

c

The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer? a. A 25-yr-old female patient with fibrocystic breast disease b. A 59-yr-old male patient who has inherited the APC gene c. A 72-yr-old female patient with a family history of breast cancer d. A 43-yr-old male patient who is obese and leads a sedentary lifestyle

c

The nurse is caring for a 52-yr-old woman with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make? a. Observe for alopecia. b. Determine visual acuity. c. Monitor cardiac rhythm. d. Assess mouth and throat.

d

Which diagnostic test is most accurate and advantageous in terms of time and expense in diagnosis of malignant breast disorders? a. mammography b. excisional biopsy c. fine-needle aspiration d. core (core needle) biopsy

Upper outer quadrant

Breast cancer is most commonly found in which quadrant?

c

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? a. Keep affected arm flat at the patient's side. b. Apply an elastic bandage on the affected arm. c. Assess blood pressure only on unaffected arm. d. Restrict exercise of the affected arm for 1 week.

3-6 Months

Chemotherapy in breast cancer is usually given for about ___ to ____ months

c

The nurse is caring for an obese 67-yr-old woman after a right mastectomy with axillary lymph node dissection. Which discharge instruction should the nurse include? a. "Arm exercises should not be started for 4 to 6 weeks." b. "Discontinue arm exercises if you have discomfort or pain." c. "Special massage therapy can decrease swelling in your arm." d. "Keep your right arm in a sling to decrease pain and swelling."

b

The health care provider of a patient with a positive biopsy of a 2cm breast tumor has recommended a lumpectomy with radiation therapy or a modified radical mastectomy as treatment. The patient says that she does not know how to choose and asks the female nurse what she would do if she had to make the choice. What is the best response by the nurse to this patient? a. "it doesnt matter what I would do. It is a decision you have to make for yourself" b. "there are advantages and disadvantages of both procedures. what do you know about these procedures?" c. "i would choose the modified radical mastectomy because it would ensure that the entire tumor was removed" d. "the lumpectomy maintains a nearly normal breast, but the survival rate is not as good as it is with a mastectomy"

B

During a routine health examination, a 32-year-old patient tells the nurse she does not perform breast self-examinations. What is the most appropriate statement for the nurse to make? a. "Breast self-examination has little or no value." b."Breast self-examination is an option for all women." c. "It is important for you to do monthly breast examinations." d. "Yearly breast examinations are not frequent enough."

c

During the immediate postoperative period following a modified radical mastectomy, the nurse initially institutes which exercises for the affected arm? a. have the patient brush or comb her hair with the affected arm b. perform full passive range-of-motion exercises to the affected arm c. ask the patient to flex and extend the fingers and wrist of the operative side d. have the patient crawl her fingers up the wall, raising her arm above her head

Aspiration

Fine needle __________ is done when a needle is inserted into a lesion to sample breast cyst fluid, remove cells from intracellular places, or sample cells from a solid mass

b

Following a lumpectomy, a patient is scheduled for external beam radiation to the right breast. Which information should the nurse include in patient teaching? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be necessary. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.

b

Following a mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do? a. avoid skin-softening agents on the arm b. protect the arm from any type of trauma c. abduct and adduct the arm at the shoulder hourly d. keep the arm positioned so that it is in straight and dependent alignment

Men

Hypoestrogenism Family history Radiation exposure These are 3 risk factors breast cancer for what gender?

Prior

If a patient is receiving chemotherapy treatment for breast cancer, and they become nauseous, it is important for the nurse to administer an anti-nausea medication _________ to treatment

Ductal

Invasive _________ carcinomas are breast cancers that starts in the milk ducts and breaks through the ductal walls into the surrounding tissues, where they can then metastasize

Lobular

Invasive __________ carcinomas are breast cancers that begin in the lobules of the breast and can break free to metastasize

65

More than half of all breast cancers are diagnosed in women aged ____ or older. Older women are less likely to have mammograms, which is due to the fact that screening and treatment decisions are based on health status, not age

Recurrence

One of the major complications associated with breast cancer is ______________.

c

Postoperatively, to meet the psychologic needs of a woman scheduled for a simple 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-up screening

Digital Mammography

Process by which x-ray images are digitally coded and stored on to a computer

c

Sentinel lymph nodes biopsy (SLNB) is planned for a patient undergoing a modified radical mastectomy for breast cancer. What does the nurse teach the patient and her family about the purpose of this specific procedure? a. SLNB provides metastatic lymph nodes to test for responsiveness to chemotherapy b. if one sentinel lymph node is positive for malignant cells, all of the sentinel lymph nodes will be removed c. a radioisotope indicates which lymph nodes are most likely to have metastasis, and all of those nodes are removed d. if malignant cells are found in any sentinel nodes, a complete axillary lymph node dissection (ALND) will be done

Poorer

The larger the tumor, the ________ the prognosis

d

The nurse teaches a 53-yr-old patient about screening for early detection of breast cancer. Which statement by the patient requires clarification by the nurse? a. "I should plan to have a mammogram every year." b. "I will see a health care provider every year for a breast examination." c. "A breast examination should be done right after my menstrual period." d. "Self-breast examination is a reliable way to detect breast cancer early."

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. Which nursing intervention would be most effective 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.

BRCA1 BRCA2

These two genes are tumor suppression genes that work as such when functioning normally. When there is a mutation, a 40%-80% greater chance of breast cancer is evident

Paget's Disease

This is a breast disease that starts in the breast ducts and spreads to the areola and nipple. It can cause itching, burning, and bloody discharge

Galactorrhea

This is a milky secretion due to inappropriate lactation that can occur from drug therapy, and endocrine and neurologic disorders

Phantom Breast Pain

This issue is defined as pain felt in the breast after a mastectomy. It happens because the brain continues to send pain signals to the nerves in the breast that were cut during surgey

Post-Breast therapy pain syndrome

This syndrome with the acronym (PBTPS) occurs in some people who have had procedure for breast cancer done. It is most commonly caused by injury to nerves during surgery, or it can be done by radiation and chemotherapy

c

To determine the risk for breast cancer in a 52-year-old patient who has found a small lump in her breast, which question is most pertinent for the nurse to ask? a. Do you currently smoke cigarettes? b. Have you ever had any breast injuries? c. At what age did you start having menstrual periods? d. Is there any family history of fibrocystic breast changes?

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

Surgical Therapy

Treatments for Breast Cancer: The most common treatment for breast cancer. It includes breast conservation surgery (lumpectomy), mastectomy, modified radical mastectomy, and reconstructive surgery

External Radiation Therapy

Treatments for Breast Cancer: This radiation therapy choice is usually done after the surgery for primary treatment. It is considered whole breast radiation therapy

Brachytherapy

Treatments for Breast Cancer: This radiation therapy is used for partial-breast radiation as an alternative to traditional external radiation treatment

Immunotherapy

Treatments for Breast Cancer: This therapy is also known as targeted therapy. It uses drugs that specifically target cells that have altered gene expression

Palliative Radiation Therapy

Treatments for Breast Cancer: This type of radiation therapy is used to relieve pain, and is successful in controlling recurrent or metastatic disease

Hormone Therapy

Treatments for Breast Cancer: This type of therapy blocks the effect and source of estrogen, thus promoting tumor regression

Chemo

Trouble concentrating, difficulties with memory, focus, and attention are characteristics of _______ brain

Less

Tumors that are more well differentiated are typically _____ aggressive

2

Upon turning 55, women should start getting regular mammographies every ___ years

45

What age should regular mammographies begin?

a c

What describes the use of high-dose brachytherapy radiation? (select all that apply) a. may be completed in 5 days b. a primary treatment after mastectomy of the breast c. alternative to traditional radiation therapy for early stage breast cancer d. used to treat possible local residual cancer cells following a mastectomy e. used to reduce tumor size and stabilize metastatic lesions for pain relief

Tamoxifen

What is the hormone therapy drug of choice in estrogen receptor-positive women with all stages of breast cancer over the past 30 years?

Zofran

What medication is given to patients when they feel nauseated during chemotherapy?

-Pain level -Nipple Discharge -Symmetry of breasts -menstrual cycle -anxiety and fear

What type of information would be gained from a nursing assessment on a breast cancer patient?

Lymphedema

When a surgery is done on a patient with breast cancer, it is important to not use the affected arm for venipuncture. The lymph nodes were most likely taken out, which means that the drainage of the lymphatic system is altered. This can lead to ______________.

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.

c

When doing breast self-examination, the female patient should report which findings to her health care provider? a. Palpable rib margins b. Denser breast tissue c. Left nipple deviation d. Different sized breasts

c

When the nurse is caring for a patient with left arm lymphedema, which action will be included in the plan of care? a. Check BP on both right and left arms. b. Avoid isometric exercise on the left arm. c. Assist with application of compression dressings. d. Keep the left arm at or below the level of the heart.

d

Which statement by a 52-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that patient teaching may be needed? a. There are several options available for treating the cancer. b. I will probably need radiation to the breast after having the surgery. c. I can probably have reconstructive surgery at the same time as a mastectomy. d. Mastectomy will be the best choice to decrease the chance of cancer recurrence.

d

While examining a patient's breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate question by the nurse? a. "do you have a high caffeine intake?" b. "when did you last have a mammogram?" c. "is there a history of breast cancer in your mother or sisters?" d. "do the size and tenderness of the lumps change with your menstrual cycle?"

c d

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. To best promote the participant's 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.

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.

Neoadjuvant Adjuvant

___________ therapy is given before surgery to shrink the size of the tumor, while ___________ therapy is given after surgery to decrease the rate of recurrence and increase the length of survival

Inflammatory

_____________ breast cancer is described as lymph channels in the skin of the breast becoming blocked by cancer cells. This leaves the breast red, thickened, and feeling warm

Mammography

a radiographic examination of the breasts to detect the presence of tumors or precancerous cells

Lumpectomy

removal of a lesion with preservation of surrounding tissue

Modified Radical Mastectomy

removal of breast tissue, nipple, and lymph nodes, but preserves the pectoralis major