PREP U ch 54: Caring for Clients with Breast Disorders

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor?

Medication adverse effects Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.

A client is considering use of chemoprevention because she is at high risk for developing breast cancer. What can the nurse do to assist the patient with her decision?

Provide the patient with information regarding the benefits, risks, and possible side effects.

A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis?

Tamoxifen Deep vein thrombosis, pulmonary embolism, and superficial phlebitis are all thromboembolic events that are adverse reactions to tamoxifen.

A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when she can take a shower. What should the nurse respond?

"Not until the drain is removed"

The nurse is caring for a 52-year-old woman 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?

"Tamoxifen is known to be a highly effective protective measure." Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.

A client who came to the clinic after finding a mass in her 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?

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?

Acute pain related to tissue manipulation and incision

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

Age at first pregnancy explained:::: Risk factors for breast cancer include an early menarche (before 12 years), nulliparity, late age at first full-term pregnancy, and an alcohol intake of 2 to 5 drinks daily.

A client is very concerned about possibly having breast cancer, especially after caring for a close family member who recently died from the disease. The nurse informs the client that the primary and most common sign of breast cancer is a:

painless mass in the breast, most often in the upper outer quadrant.

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:

should continue to perform breast self-examination on her right breast Explained::: 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 patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred?

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

A client has been diagnosed with stage II breast cancer. The client tells the nurse that the physician 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." What would be the nurse's best response?

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

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

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

A woman with a 3-cm breast tumor is scheduled for a lumpectomy followed by 5 to 7 weeks of radiation therapy. The patient asks the nurse if this procedure would cure her. What is the nurse's best response?

"Lumpectomy, followed by radiation, has the same predicted long-term survival rates as a mastectomy."

The nurse is educating a patient about the best time to perform breast self-examination (BSE). When does the nurse inform her is the best time after menses to perform BSE?

5 to 7 days Most women notice increased tenderness and lumpiness before their menstrual periods; therefore, BSE is best performed after menses (day 5 to day 7, counting the first day of menses as day 1).

The nurse working on a cancer treatment floor assesses her assigned clients. It is most important for the nurse to report which assessment finding?

Coolness and mottling of a newly constructed breast site

A patient is having a biopsy that will remove the entire mass, plus a margin of surrounding tissue. What type of biopsy will be documented on the operative permit?

Excisional biopsy Excisional biopsy is the standard procedure for complete pathologic assessment of a palpable breast mass. The entire mass, plus a margin of surrounding tissue, is removed. Incisional biopsy surgically removes a portion of a mass. Core needle biopsy is similar to FNA, except a larger-gauge needle is used (usually 14 gauge). A local anesthetic is applied, and tissue cores are removed via a spring-loaded device. The principles for ultrasound-guided core biopsy are similar to those of stereotactic core biopsy, but by using ultrasound guidance, computer coordination and mammographic compression are not necessary.

A nurse is reviewing a client's history for possible risk factors associated with breast cancer. Which of the following would the nurse identify as increasing the client's risk?

First full-term pregnancy at age 34 years

Which of the following is a teaching component for a patient who underwent surgery for fibroadenoma?

Follow label directions for administering mild non-narcotic analgesics. The nurse should also instruct the patient to wear a firm and supportive brassiere to reduce incisional discomfort. A loose brassiere would not support the breasts and would cause uneasiness. The surgeon should be contacted if there is exceptional incisional pain. To relieve minor pain, the patient should follow labeled directions for administering a mild nonnarcotic analgesic that may last 1 to 3 days. It is not essential to have a mammography done after surgery

A female patient comes to the clinic with the complaint that she is having a greenish-colored discharge from the nipple and the breast feels warm to touch. What does the nurse suspect these symptoms may indicate?

Infection

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?

Lobules and ducts

A client who has had a lumpectomy calls the clinic to talk to the nurse. The client tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone "drew a line with a red marker." What would the nurse suspect is the woman's problem?

Mondor disease Superficial thrombophlebitis of the breast (Mondor disease) is an uncommon condition that is usually associated with pregnancy, trauma, or breast surgery. Pain and redness occur as a result of a superficial thrombophlebitis in the vein that drains the outer part of the breast. The mass is usually linear, tender, and erythematous.

A patient has undergone surgery for breast cancer and the findings of the surgery are as follows: Invasive undifferentiated tumor Size 2.2 cm Axillary lymph nodes negative High ERBB2 expression Which of these findings would suggest a favorable prognosis?

Negative lymph nodes Explained::: The finding suggesting a favorable prognosis would be negative axillary lymph nodes. Other favorable factors would include noninvasive tumors or invasive tumors less than 1 cm in size, well-differentiated tumors, and low ERBB2 expression.

A 45-year-old woman comes into the health clinic for her annual checkup. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred over a few months. What assessment would be most appropriate for the nurse to make?

Palpate the area for a breast mass.

A nurse has assessed that a client is not yet willing to view her mastectomy site. How should the nurse best assist the client in developing a positive body image?

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

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this client knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this client's fears?

Provide the client with relevant information about expected recovery.

A nurse is assisting with obtaining a specimen of breast milk from a mother with suspected mastitis. What organism would the nurse most expect to be found in the milk that would be consistent with a diagnosis of mastitis?

Staphylococcus aureus

Which is one of the most important prognostic factors in breast cancer?

Status of lymph nodes

When planning discharge teaching with a client who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the client that she should report what sign or symptom to the health care provider immediately?

Sudden cessation of output from the drainage device

A group of students are reviewing the anatomy and physiology of the breasts. The students demonstrate understanding of breast structure when they identify the tail of Spence as an extension of which quadrant?

Upper outer

What is the most common location for breast cancer?

Upper outer quadrant of the breast

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

cyclical hormonal changes

A nurse is reviewing the organs most commonly affected by metastatic breast cancer. Which will not be included in this review?

kidneys The kidneys are not a common area of metastasis in patients with breast cancer. Lymph nodes most commonly are involved in metastasis, and the skeletal and pulmonary systems may also be involved (in that order). In addition, metastases may be found in the brain, adrenals, and liver.

A school nurse at a middle school finds that students are typically surprised to hear the role of women's breasts. What is their primary function?

lactation

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?

Assessing the vital signs and oxygen saturation levels.

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?

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

A breastfeeding client is reporting pain in her left breast and describes her breast as feeling "doughy." The client is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend?

Apply cold compresses as prescribed. treatment of mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. A broad-spectrum antibiotic agent may be prescribed for 7 to 10 days. The client should wear a snug bra and perform personal hygiene carefully. Massage is not recommended.

A client in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The client shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well overall to her diagnosis and surgery. What nursing intervention is most appropriate to support this client's coping?

Arrange a referral to a community-based support program.

A patient is told that she has a common form of breast cancer where the tumor arises from the duct system and invades the surrounding tissues, often forming a solid irregular mass. What type of cancer does the nurse prepare to discuss with the patient?

Infiltrating ductal carcinoma Infiltrating ductal carcinoma—the most common histologic type of breast cancer accounts for 80% of all cases. The tumors arise from the duct system and invade the surrounding tissues. They often form a solid irregular mass in the breast.

A client has been referred to the breast clinic after her 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?

Lumpectomy and radiation

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

Lymphedema