Breast Cancer
A client has a mass that has been identified by a mammogram. Which test may be ordered to further differentiate the mammogram results? A) Chest x-ray B) HER2/neu testing C) PET scan D) Breast biopsy
D) Breast biopsy Rationale: A breast biopsy may be used to further assess the tumor identified in the mammogram. A PET scan would not be used to further confirm the diagnosis of breast cancer. Rather, this test is used to assess for metastasis. A chest x-ray will not further differentiate mammogram results. HER2/neu testing is used to guide prognosis and treatment.
Why should the nurse tell a client who has undergone surgery for breast cancer to avoid wearing deodorant on the affected side? A) Deodorant can stimulate tumor growth in the remaining cancer cells B) Deodorant can inhibit the production of sweat, which stimulates healing C) Deodorant can harbor bacteria and increase the client's risk for infection D) Deodorant can irritate the skin and slow the healing process
D) Deodorant can irritate the skin and slow the healing process. Rationale: Substances like deodorant and talcum powder can irritate the skin and impede healing. Deodorant does not harbor bacteria or stimulate tumor growth, and although deodorant with an antiperspirant may inhibit sweat production, sweat does not contribute to the healing process.
A client with breast cancer asks how a modified radical mastectomy differs from a radical mastectomy. What should the nurse respond to this client? A) "A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact." B) "A modified radical mastectomy includes removal of the breast followed by immediate breast reconstruction." C) "A modified radical mastectomy removes the complete breast only." D) "A modified radical mastectomy removes just the tumor and the surrounding margins."
A) "A modified radical mastectomy removes the breast tissue and lymph nodes but leave the chest wall intact." Rationale: A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact, whereas a radical mastectomy also removes the chest wall muscles. Removal of only the complete breast is a simple mastectomy. Removal of the tumor and surrounding margins only is a segmental mastectomy. A modified radical mastectomy does not include breast reconstruction.
The nurse assesses a client with dimpling of skin in the left upper outer quadrant of the right breast and nipple discharge. Which question should the nurse ask to learn if the client is experiencing other clinical manifestations of breast cancer? A) "Have you noticed a rash or skin irritation around the nipple area?" B) "Does the skin in the left upper outer quadrant of the right breast feel warm to touch?" C) "Have you been experiencing any night sweats or low-grade fevers?" D) "Have you noticed any itching around the nipple or in the area affected by dimpling?"
A) "Have you noticed a rash or skin irritation around the nipple area?" Rationale: A persistent rash near the nipple area and skin irritation can both be clinical manifestations of breast cancer. Night sweats, low-grade fevers, itching of the breast and warmth in the affected area are not common manifestations of breast cancer.
The nurse instructs a client recovering from a mastectomy on ways to prevent lymphedema. Which client statement indicates that teaching has been successful? A) "I should do the exercises on my affected arm every day." B) "I have to take no special precautions." C) "I should avoid cleansing my skin with soap." D) "Eating fresh fruits and vegetables will prevent my arm from swelling."
A) "I should do the exercises on my affected arm every day." Rationale: Range-of-motion exercises in the affected arm help develop collateral drainage and prevent the development of lymphedema. The client should be instructed to protect the affected limb by not permitting blood pressure measurement and avoiding tight jewelry and clothing on the limb. There is no reason for the client to avoid cleansing the skin of the affected arm with soap. Consuming fresh fruits and vegetables will not prevent the development of lymphedema.
The nurse is caring for a client who is scheduled for a biopsy of a suspicious mass in the breast. The client is crying and is tachycardic and tachypneic. Based on this assessment data, which problem is a priority? A) Anxiety B) Body image disturbance C) Impairment of gas exchange D) Risk for infection
A) Anxiety Rationale: The client is exhibiting signs and symptoms of anxiety, which is a common nursing problem in clients with a breast disorder. The data provided do not support the nursing problems of risk for infection, body image disturbance, or impaired gas exchange.
A client with metastatic breast cancer asks where the cancer has spread. Which site should the nurse include in the response? SATA A) Bone B) Liver C) Brain D) Lungs E) Kidney
A, B, C, D Bone Liver Brain Lungs Rationale: Common sites for metastasis from breast cancer include the brain, liver, bone, and lungs. The kidney is not considered a common site for metastasis from breast cancer
The nurse prepares to visit the home of a client recovering from a mastectomy for breast cancer. Which should be included in the ongoing care of this client? SATA A) Post-mastectomy exercises B) Signs and symptoms of infection C) Importance of adequate rest periods D) Possible participation in a support group E) Keeping the affected limb immobile as much as possible
A, B, C, D Rationale: The ongoing care of the client who has undergone surgical interventions for breast cancer include telling about the importance of adequate rest, talking about signs and symptoms of infection, teaching postmastectomy exercises, and possibly participating in a support group. The client should be encouraged to use the affected limb for daily needs to maintain function and strength; the client should not keep it immobile.
The nurse is providing care to a client who was recently diagnosed with breast cancer. The nurse is providing education regarding the possible treatment options. Which options will the nurse include in the teaching session? SATA A) Mastectomy B) Hormone therapy C) Lumpectomy D) Palliative care E) Radiation
A, B, C, E Rationale: Treatment options appropriate for a client newly diagnosed with breast cancer may include mastectomy, hormone therapy, lumpectomy, and radiation. Palliative care will only be implemented once the client's cancer is considered to be terminal in nature.
The nurse evaluates teaching provided to a group of community members on breast cancer awareness. Which statement indicates that teaching on risk factors has been effective? SATA A) "Not breastfeeding increases the risk of breast cancer." B) "Having children after 30 increases the risk of breast cancer." C) "Having previous irradiation of the chest increases the risk of breast cancer." D) "Experiencing menopause after 50 increases the risk of breast cancer." E) "Having a first or second degree relative w/breast cancer increases the risk." F) "Having harmful mutations in BRCA1 or BRCA2 suppression increases the risk of breast cancer."
A, B, C, F Rationale: Not breastfeeding, having children after age 30, previous irradiation of the chest, and presence of harmful mutations in BRCA1 or BRCA2 suppression all increase the risk for breast cancer. Experiencing menopause after age 55, not 50, increases risk. Having a first-degree relative, but not having a second-degree relative, with breast cancer increases risk. Next Question
The nurse prepares a teaching poster for placement in a women's health clinic. Which activity should the nurse identify to help prevent breast cancer? SATA A) Refraining from smoking B) Engaging in physical activity C) Completing monthly self breast exams D) Limiting hormone therapy in duration and dose E) Avoiding exposure to environmental pollution and radiationA,
A, B, D, E Rationale: Refraining from smoking, engaging in physical activity, limiting hormone therapy in duration and dose, and avoiding exposure to environmental pollution and radiation can all help prevent the development of breast cancer. Completing monthly self-breast exams can help detect breast cancer early but does not prevent breast cancer.
The nurse is caring for a client with breast cancer who is having chemotherapy treatments. The client tells the nurse, "I am always tired, can't concentrate, and am so forgetful." Which statement made by the nurse in response to the client is true? SATA A) "This is also called chemo-brain." B) "This may occur with chemotherapy; however, it's rare." C) "You might want to make notes if needed as a memory aid." D) "This may last up to 2 years after completion of chemotherapy." E) "This is an abnormal side effect of chemotherapy and is very concerning."
A, C, D Rationale: The client is experiencing a normal side effect of chemotherapy, also called chemo-brain. The nurse should suggest that the client make notes or use other memory aids as needed. These side effects may last up to 2 years after completion of chemotherapy.
The nurse is updating the care plan for a client recovering from a mastectomy. Which should the nurse include to prevent infection? SATA A) Change dressings and IV tubing using aseptic technique B) Encourage ROM exercises in the affected arm shift C) Observe incision and IV sites for pain, redness, swelling, and drainage D) Assess surgical dressings for bleeding, drainage, color, and odor every 4 hr for 24 hrs E) Tell the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed.
A, C, D, E Rationale: The care plan would include changing dressings and IV tubing using aseptic technique; observing incision and IV sites for pain, redness, swelling, and drainage; and assessing surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. Telling the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed will also help to prevent infection. Encouraging range-of-motion exercises in the affected arm will help to promote optimal circulation
The nurse is reviewing data collected during a health history and physical assessment and determines that a client is at risk for developing breast cancer. Which data supports this client's risk for developing breast cancer? SATA A) Age 60 B) Breastfed both children C) Sister had breast cancer D) BMI 22 E) Menopause at age 58
A, C, E Rationale: The risk for developing breast cancer increases with age. Having a first-degree relative with breast cancer increases the risk. Menopause after the age of 55 also increases the risk for developing breast cancer. Breastfeeding and maintaining a normal body weight lower a person's risk for developing breast cancer.
The nurse is reviewing care instructions for a client who had a radical mastectomy of the right breast. Which instruction is appropriate for the nurse to include in the teaching session? SATA A) "Sleep with the right arm elevated on a pillow." B) "You will be able to resume playing golf with your friends." C) "You should apply hot compresses to the right arm if it is aching." D) "Don't allow anyone to take your BP in the right arm." E) "It's okay to carry your purse on your right arm as long as it's not heavy."
A, D Rationale: Elevation of the affected extremity after lymph node removal will allow drainage of fluid, prevent swelling, and promote circulation. Compression of the arm on the surgical side may increase the risk of developing lymphedema. The client should avoid carrying a purse or a briefcase on the affected arm. The client should avoid hot water contact on the affected extremity. Heat promotes vasodilation and fluid accumulation. Sports such as golf should be avoided in a client with a radical mastectomy
A client prescribed tamoxifen for breast cancer treatment asks the nurse how the medication works. What is the best response by the nurse? A) "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." B) "Tamoxifen works by blocking estrogen receptors of breast tissue." C) "Tamoxifen works by binding to the DNA of breast cancer cells." D) "Tamoxifen works by inhibiting the metabolism of breast cancer cells."
B) "Tamoxifen works by blocking estrogen receptors of breast tissue." Rationale: Breast cancer is dependent on estrogen for growth. Tamoxifen (Nolvadex) acts by blocking estrogen receptors; the tumor is deprived of estrogen. Tamoxifen does not inhibit the metabolism of breast cancer cells. Tamoxifen does not inhibit the cellular mitosis of breast cancer. Tamoxifen does not bind to the DNA of breast cancer cells.
The nurse is providing community teaching related to risk factors for breast cancer for a group of young women. Which woman might the nurse identify as being at a higher risk for developing breast cancer at a young age? A) A 28 year old woman who received radiation for a spinal cord tumor a L3 during childhood B) A 26 year old woman who had a 32 year old brother with breast cancer C) A 34 year old woman who has breastfed four children D) A 42 year old woman who has a second cousin diagnosed with breast cancer at age 58.
B) A 26 year old woman who had a 32 year old brother with breast cancer Rationale: The risk factors include having a close relative, such as a parent or sibling, or a male relative who has had breast cancer or having radiation therapy to the breast or chest during childhood. The 28-year-old woman had radiation therapy, but not to the breast or chest. The 42-year-old woman had a relative, but not a close relative, with breast cancer. Breastfeeding is a protective factor for developing breast cancer.
The nurse is caring for a 78-year-old woman who was recently diagnosed with breast cancer. What consideration may the nurse need to make for this woman that she may not need to make for younger women with breast cancer? A) Discussing the woman's life expectancy B) Arranging transportation to appointments C) Ensuring the woman has adequate emotional support D) Providing teaching related to breast-conservation treatments.
B) Arranging transportation to appointments Rationale: Older women may not have access to transportation if they or their partner do not drive. The nurse may need to help arrange transportation to appointments for these women. Older women are less likely to show emotional distress compared to younger women, and all clients with breast cancer should receive information related to life expectancy and breast-conservation techniques.
Which form of breast cancer is the most malignant form? A) Infiltrating ductal carcinoma B) Inflammatory carcinoma of the breast C) Carcinoma of the mammary ducts D) Page disease
B) Inflammatory carcinoma of the breast Rationale: The most malignant form of breast cancer is inflammatory carcinoma of the breast, which is a systemic disease. Infiltrating ductal carcinoma is the most common type of breast cancer. Paget disease is an atypical breast cancer. Carcinoma of the mammary ducts is a category of breast cancer.
A client with breast cancer is scheduled for radiation prior to surgery. Which situation supports the use of radiation prior to surgery? A) The tumor is expressing the HER2/neu receptor B) The tumor is unusually large C) The cancer has already metastasized D) Pain from the tumor is severe
B) The tumor is unusually large Rationale: Radiation may be done to shrink an unusually large tumor prior to surgery. Palliative radiation may be used to treat chest wall recurrences and some bone metastases to help control pain and prevent fractures. Radiation is not necessarily indicated if the tumor has already metastasized. Herceptin, not radiation, may be used to stop the growth of tumors that express the HER2/neu receptor.
While completing a physical examination, the nurse suspects a client has breast cancer. What did the nurse assess in this client? SATA A) Rash along the inside of the right arm B) Left nipple retraction C) Palpable lump in the upper outer right quadrant D) Scaliness near the right nipple E) Pain when extending the left arm
B, C, D Rationale: Manifestations of breast cancer include nipple retraction; a palpable lump, usually in the upper outer quadrant; and scaliness of the skin. A rash on the arm and arm pain upon extension are not manifestations of breast cancer.
The nurse reviews a list of clients scheduled for women's health visits. For which age range should the nurse emphasize the importance of early detection and treatment of breast cancer? A) 60-64 B) 50-54 C) 75-79 D) 45-49
C) 75-79 Rationale: The incidence of breast cancer is highest in women between the ages of 75 and 79 years in the United States. Even so, all women should be counseled on actions for prevention and early detection of breast cancer.
The nurse is discussing early detection of breast cancer with a group of teenage women. Which information should the nurse include to decrease the risk for mortality and promote positive client outcomes? A) Encourage annual mammograms beginning at age 30 B) Encourage annual laboratory tests including RBC, WBC, and platelets C) Encourage monthly self-breast exams D) Encourage genetic testing for BRCA1 and BRCA2
C) Encourage monthly self-breast exams. Rationale: Early detection does not prevent breast cancer but it can reduce risk for mortality and promote better outcomes. Because of this, clients should be encouraged to do monthly breast self-examinations. Genetic testing, annual mammograms beginning at age 30, and annual laboratory tests would not be recommended to detect early breast cancer.
The nurse is instructing a group of women between the ages of 40 and 50 about early detection of breast cancer. What should the nurse include in this teaching? A) Perform monthly self-exams B) See a healthcare provider if there is a strong family history of breast cancer C) Have a yearly mammogram D) Have a clinical breast exam performed by a healthcare provider every 5 years
C) Have a yearly mammogram Rationale: Yearly mammography for all women over the age of 45 is encouraged, as it decreases the mortality from breast cancer, and women between ages 40 and 45 can choose to have a mammogram annually. Breast self-exam is no longer recommended for all women. Discussing a family history of breast cancer would be part of the annual breast exam performed by a healthcare provider. It is inappropriate for women in this age group to have a clinical breast exam every 5 years.
A client with breast cancer receives diagnostic testing and scan results that indicate a tumor that is 4.2 cm in size with evidence of metastasis to movable ipsilateral axillary nodes only. According to the TNM staging system, how should this client's breast cancer be staged? A) T1 N0 M0 B) Tis N1 M0 C) T2 N1 M0 D) T3 N2 M1
C) T2 N1 M0 Rationale: This client's breast cancer would be staged as T2 N1 M0. T2 indicates a tumor no larger than 5 cm, N1 indicates metastasis to movable ipsilateral axillary nodes, and M0 indicates no distant metastasis. T1 indicates a tumor no larger than 2 cm. This indicates a tumor in situ. T3 indicates a tumor larger than 5 cm. N0 indicates no regional lymph node metastasis. N2 indicates metastasis to ipsilateral fixed axillary nodes. M1 indicates distant metastasis.
A woman has a family history of breast cancer, and genetic testing has revealed a mutation in BRCA2. If this woman develops breast cancer, what is the most likely mechanism for why the cancer developed? A) The cells' ability to accurately translate the RNA was impaired B) The cells underwent mitosis rather than meiosis C) The cells ability to suppress tumor growth was impaired D) The cells were stimulated to undergo rapid cell division
C) The cells' ability to suppress tumor growth was impaired. Rationale: Both BRCA1 and BRCA2 are tumor suppressor genes that help prevent the overstimulation of cell growth. If one or both are mutated, the cell's ability to suppress tumor growth is impaired. BRCA1 and BRCA2 do not stimulate cells to undergo rapid cell division or impair translation of RNA to protein. Only germ cells undergo meiosis, not cancer cells.
Which intervention promotes optimal circulation after a surgical invention for breast cancer? A) Monitoring surgical drains for amount and color of drainage. B) Observing the surgical site for redness and swelling C) Assessing for manifestations of lymphedema D) Encouraging ROM exercises in the affected arm.
D) Encouraging ROM exercises in the affected arm Rationale: Encouraging range-of-motion exercises in the affected arm will help promote optimal circulation. Assessing for manifestations of lymphedema, observing the surgical site for redness and swelling, and monitoring surgical drains for amount and color of drainage do not help promote optimal circulation.
A client with breast cancer asks which medication will most likely be used for chemotherapy before having surgery. Which medication should the nurse explain as the most common hormone therapy used to treat breast cancer? A) Anastrozole B) Letrozole C) Trastuzumab D) Tamoxifen
D) Tamoxifen Rationale: Tamoxifen is the most common hormone therapy drug used to treat breast cancer. It works by preventing estrogen from attaching to estrogen receptors on the cancer cells, which inhibits tumor growth and ultimately kills tumor cells. Letrozole (an aromatase inhibitor) has Trastuzumab (Herceptin) is used to stop the growth of breast tumors that express the HER2/neu receptor. Anastrozole (Arimidex) is the aromatase inhibitor used as first line treatment in postmenopausal women.
A client is diagnosed with adenocarcinoma of the breast. Based upon this diagnosis, where should the nurse expect the source of the cancer to be? A) Mammary layer fatty tissue B) Nipple epithelium C) Subcutaneous fat D) Terminal section of the breast ductal tissue.
D) Terminal section of the breast ductal tissue Rationale: Most breast cancers are adenocarcinomas and arise out of the terminal section of the breast ductal tissue.
The nurse is providing health counseling to a 32 year old woman whose mammogram indicates that she has dense breast tissue. Which information should the nurse provide to this client concerning this finding and breast health? A) Pre-cancerous cells are found in dense breast tissue; thus, she would have further screening done for breast cancer. B) Dense breast tissue is very common at this age and doesn't affect breast health. C) Dense breast tissue is a protective effect for breast cancer, and rates of breast cancer in women with dense breast tissue are very low. D) The presence of dense breast tissue increases the risk of breast cancer before the age of 45.
D) The presence of dense breast tissue increases the risk of breast cancer before the age of 45. Rationale: The presence of dense breast tissue increases the risk of breast cancer before the age of 45. The statement that dense breast tissue is not necessarily common at this age and increases the risk for breast cancer is not valid. Precancerous cells are not necessarily found in dense breast tissue, nor does dense breast tissue provide a protective effect against cancer.
A college-age client asks the nurse about the relationship between breast cancer and alcohol use. Which response by the nurse provides the most accurate information for this client? A) "The amount of alcohol that increases risk varies from person to person due to differences in metabolism and alcohol intolerance." B) "They have not established a firm link between alcohol use and breast cancer. Thus I wouldn't be too concerned." C) "If you are drinking hard liquor, you should limit it to one/day, but if you are drinking beer or wine, you can have more than one drink/day." D) "Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to one drink/day."
D)"Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to 1 drink/day." Rationale: Alcohol is a known risk factor for breast cancer. Recommendations include limiting alcohol intake to a maximum of one drink per day. The other statements are not valid.
