Breast Cancer ch.51 Med Surg (EXAM#2)

14. Which information will the nurse include in patient teaching for a 36-year-old patient who is scheduled for stereotactic core biopsy of the breast? a.A local anesthetic will be given before the biopsy specimen is obtained. b.You will need to lie flat on your back and lie very still during the biopsy. c.A thin needle will be inserted into the lump and aspirated to remove tissue. d.You should not have anything to eat or drink for 6 hours before the procedure.

ANS: A

15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing? a.CA 15-3 level testing b.HER-2 receptor testing c.Estrogen receptor testing d.Oncotype DX assay testing

ANS: A

28. When using the accompanying illustration to teach a patient about breast self-examination, the nurse will include the information that most breast cancers are located in which part of the breast? a.1 b.2 c.3 d.4 e.5

ANS: A The upper outer quadrant is the location of most of the glandular tissue of the breast.

10. The nurse provides discharge teaching for a 61-year-old 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.

ANS: B

11. A 33-year-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a.Take aspirin every 4 hours to reduce inflammation. b.Check wound drains for excessive blood or a foul odor. c.Wear a loose-fitting bra to decrease irritation of the sutures. d.Resume normal activities 2 to 3 days after the mammoplasty.

ANS: B

12. The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? a.Saline-filled implants are placed under the pectoral muscles. b.Recovery from the TRAM surgery takes at least 6 to 8 weeks. c.Muscle tissue removed from the back is used to form a breast. d.TRAM flap procedures may be done in outpatient surgery centers.

ANS: B

17. Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? 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

ANS: B

18. Which patient statement indicates that the nurses teaching about tamoxifen (Nolvadex) has been effective? a.I can expect to have leg cramps. b.I will call if I have any eye problems. c.I should contact you if I have hot flashes. d.I will be taking the medication for 6 to 12 months.

ANS: B

22. A 36-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with symptoms. Which is most important to report to the health care provider? a.There is yellow-green discharge from the patients right nipple. b.There is an area on the breast that is hot, pink, and tender to touch. c.The lumps are firm and most are in the upper outer breast quadrants. d.The lumps are larger and painful before the patients menstrual period.

ANS: B

23. The nurse notes bilateral enlargement of the breasts during examination of a 62-year-old man. Which action should the nurse take first? a.Teach the patient how to palpate the breast tissue for lumps. b.Question the patient about medications being currently used. c.Refer the patient for mammography and biopsy of the breast tissue. d.Explain that this is a temporary condition due to hormonal changes.

ANS: B

24. The nurse will plan to teach a 34-year-old patient diagnosed with stage 0 cervical cancer about a.radiation. b.conization. c.chemotherapy. d.radical hysterectomy.

ANS: B

25. The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a.The patient complains of fatigue. b.The patient eats only 25% of meals. c.The patients apical pulse is irregular. d.The patients white blood cell (WBC) count is 5000/L.

ANS: C

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

ANS: C

2. During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a.Do you currently smoke tobacco? b.Have you ever had a breast injury? c.At what age did you start having menstrual periods? d.Is there a family history of fibrocystic breast changes?

ANS: C

21. A nursing diagnosis that is likely to be appropriate for a 67-year-old woman who has just been diagnosed with stage III ovarian cancer is a.sexual dysfunction related to loss of vaginal sensation. b.risk for infection related to impaired immune function. c.anxiety related to cancer diagnosis and need for treatment decisions. d.situational low self-esteem related to guilt about delaying medical care.

ANS: C

21. Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a.Check blood pressure (BP) on both right and left arms. b.Avoid isometric exercise on the right arm. c.Assist with application of a compression sleeve. d.Keep the right arm at or below the level of the heart

ANS: C

5. A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a.HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b.HT does not appear to increase the risk for breast cancer unless there are other risk factors. c.The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d.Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

ANS: C

8. After a 48-year-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about a.estradiol (Estrace). b.raloxifene (Evista). c.tamoxifen (Nolvadex). d.trastuzumab (Herceptin).

ANS: C

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

ANS: C

1. The nurse teaching a young womens community service group about breast self-examination (BSE) will include that a.BSE will reduce the risk of dying from breast cancer. b.BSE should be done daily while taking a bath or shower. c.annual mammograms should be scheduled in addition to BSE. d.performing BSE after the menstrual period is more comfortable.

ANS: D

16. The nurse will anticipate teaching a 56-year-old patient who is diagnosed with lobular carcinoma in situ (LCIS) about a.lumpectomy. b.lymphatic mapping. c.MammaPrint testing. d.tamoxifen (Nolvadex)

ANS: D

19. The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? a.Teach the patient how to deep breathe and cough. b.Discuss options for postoperative pain management. c.Explain the postdischarge care of the axillary drains. d.Ask the patient to describe what she knows about the surgery.

ANS: D

20. When the nurse is working in the womens health care clinic, which action is appropriate to take? a.Teach a healthy 30-year-old about the need for an annual mammogram. b.Discuss scheduling an annual clinical breast examination with a 22-year-old. c.Explain to a 60-year-old that mammography frequency can be reduced to every 3 years. d.Teach a 28-year-old with a BRCA-1 mutation about magnetic resonance imaging (MRI).

ANS: D

24. A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? a.Teaching the patient how to avoid injury to the left arm b.Assessing the patients range of motion for the left arm c.Evaluating the patients understanding of instructions about drain care d.Administering an analgesic 30 minutes before scheduled arm exercises

ANS: D

27. The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? a.57-year-old with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching b.21-year-old with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene c.40-year-old who still has left side chest and arm pain 2 months after a left modified radical mastectomy d.50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin) and has ankle swelling and fatigue

ANS: D

7. The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a.hot flashes may occur with the medication. b.serum electrolyte levels will be drawn monthly. c.the patient will need frequent eye examinations. d.the patient should call if she notices ankle swelling.

ANS: D

6. A 58-year-old woman tells the nurse, I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do? Which response by the nurse is best? a.I would have a lumpectomy, but you need to decide what is best for you. b.Tell me what you understand about the surgical options that are available. c.It would not be appropriate for me to make a decision about your health. d.There is no need to make a decision rapidly; you have time to think about this.

ANS: B

26. A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, I would rather not know much about the surgery. Which response by the nurse is best? a.Tell me what you think is important to know about the surgery. b.It is essential that you know enough to provide informed consent. c.Many patients do better after surgery if they have more information. d.You can wait until after surgery for teaching about pain management.

ANS: A

3. A 51-year-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a.FNA is done in the outpatient clinic and results are available in 1 to 2 days. b.only a small incision is needed, resulting in minimal breast pain and scarring. c.if the biopsy results are negative, no further diagnostic testing will be needed. d.FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

ANS: A

39. A 58-year-old patient who has undergone a radical vulvectomy for vulvar carcinoma returns to the medical-surgical unit after the surgery. The priority nursing diagnosis for the patient at this time is a.risk for infection related to contact of the wound with urine and stool. b.self-care deficit: bathing/hygiene related to pain and difficulty moving. c.imbalanced nutrition: less than body requirements related to low-residue diet. d.risk for ineffective sexual pattern related to disfiguration caused by the surgery.

ANS: A

4. Which assessment finding in a 36-year-old patient is most indicative of a need for further evaluation? a.Bilateral breast nodules that are tender with palpation b.A breast nodule that is 1 cm in size, nontender, and fixed c.A breast lump that increases in size before the menstrual period d.A breast lump that is small, mobile, with a rubbery consistency

ANS: B

46. A healthy 28-year-old who has been vaccinated against human papillomavirus (HPV) has a normal Pap test. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? a.You can wait until age 30 before having another Pap test. b.Pap testing is recommended every 3 years for women your age. c.No further Pap testing is needed until you decide to become pregnant. d.Yearly Pap testing is suggested for women with multiple sexual partners.

ANS: B

23. Which patient in the womens health clinic will the nurse expect to teach about an endometrial biopsy? a.The 55-year-old patient who has 3 to 4 alcoholic drinks each day b.The 35-year-old patient who has used oral contraceptives for 15 years c.The 25-year-old patient who has a family history of hereditary nonpolyposis colorectal cancer d.The 45-year-old patient who has had 6 full-term pregnancies and 2 spontaneous abortion

ANS: C