Chapter 54: Caring for Clients with Breast Disorders

A client has been diagnosed with breast cancer and is awaiting cytology results of a biopsy. During client education, the nurse discusses the possible types of breast malignancies. Which is the most common type?

ductal

A client has just been told she needs 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 she might have?

By encouraging her to verbalize her questions and concerns

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

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

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

lymphedema

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."

The nurse is discussing mammography with a female client at the clinic. The client asks at what age she should begin getting yearly mammograms. What answer should the nurse provide?

40

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

An older client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which factors in the client's history may have increased the risk of breast cancer

All options are correct.

A client has just had a left radical mastectomy, and the nurse is providing information on complications that may arise due to removing the axillary lymph nodes. Which would not be included?

All would be included in the discussion.

A 33-year-old female client with three children has had a follow-up mammogram after an abnormal BSE. Mammogram findings reveal incidental microscopic abnormal tissue growth in the left breast lobules. The physician orders tamoxifen for the client. The nurse understands that the physician is implementing which primary prevention modality to treat this client?

Chemoprevention

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 woman 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?

Decreased nipple sensation

A 23-year-old woman 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?

Fine-needle aspiration

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

The nurse is assessing the breast of a female patient and observes a prominent venous pattern on the left breast. What does the nurse understand that this can be indicative of?

Increased blood supply required by a tumor

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

Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do?

Inform the physician immediately.

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 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

Which term is used to describe removal of breast tissue and axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer?

Modified radical mastectomy

The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer?

Mother affected by cancer before 60 years of age

Which is inconsistent as a risk factor for breast cancer?

Multiparity

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

The nurse is reviewing the health care provider's notes from the client who has just left the clinic. The nurse learns that a malignant breast tumor is suspected. On palpation, the mass most likely had what characteristic?

Nontenderness

A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?

Refer the client to the American Cancer Society's Reach for Recovery program or another support program.

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

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 nurse is examining a client who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this client's diagnosis?

The client might be referred for a biopsy.

The nurse is performing a comprehensive health history of a client who is in her 50s. The nurse should identify what risk factor that may increase this client's risk for breast cancer?

The nurse is performing a comprehensive health history of a client who is in her 50s. The nurse should identify what risk factor that may increase this client's risk for breast cancer?

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

During a teaching demonstration on breast self-examination (BSE), the nurse should always explain that the majority of breast cancers are found in the:

Upper, outer quadrant.

For which of the following population groups would an annual clinical breast examination be recommended?

Women over age 40

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?

pply cold compresses as prescribed.

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE:

between days 5 and 7 after menses

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 client has fibrocystic breast disease. Assuming that there are no sudden or unusual changes, the nurse would suggest that the client have follow-up appointments with her physician every ____ months. Record your answer with a whole number.

6

A 49-year-old woman reports that her last known menstrual cycle occurred over 1 year ago. Her records indicate gravida 0, para 0. Upon further review of the chart, the nurse notes that the client has a positive maternal history of hypertension. Moreover, the client has a positive paternal history of diabetes. With no additional significant history noted, which of the nurse's findings is consistent as a risk factor for breast cancer for this client?

Nulliparity

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.