Chapter 54: Caring for Clients with Breast Disorders
A client that is Assigned Female at Birth (AFAB) is diagnosed with stage II breast cancer and informed breast conservation surgery followed by radiation is the best option. The client asks why a modified radical mastectomy wouldn't be done. Which is the nurse's best response? "According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial." "Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence." "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy." "Modified radical mastectomies are very hard on a client, both physically and emotionally, and they really aren't necessary anymore."
"According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy." Explanation: Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence.
A client is to undergo an ultrasound-guided core biopsy. The client tells the nurse that a friend of theirs had a stereotactic core biopsy. The client wants to understand the differences between the two procedures. What would be the nurse's best response? "An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster." "An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive." "An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster." "An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation."
"An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation." Explanation: Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.
At which age should a healthy client begin annual mammograms? -45 years old -20 years old -30 years old -55 years old
45 years old Explanation: The ACS has changed the mammography recommendations to state that healthy women should have mammography every year beginning at age 45.
The nurse is providing care to a client with a suspected malignant breast tumor. The nurse knows that the mass likely had which characteristic upon palpation? Soft on palpation Mobile Less than or equal to 5 mm Non-tender on palpation
Non-tender on palpation Explanation: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.
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: painful mass in the breast, most often in the upper outer quadrant. painful mass in the breast, most often in the lower quadrant near the nipple. painless mass in the breast, most often in the lower quadrant near the nipple. painless mass in the breast, most often in the upper outer quadrant.
painless mass in the breast, most often in the upper outer quadrant. Explanation: The primary sign of breast cancer is a painless mass in the breast, most often in the upper outer quadrant.
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 lower quadrant near the nipple. painful mass in the breast, most often in the lower quadrant near the nipple. painless mass in the breast, most often in the upper outer quadrant. painful mass in the breast, most often in the upper outer quadrant.
painless mass in the breast, most often in the upper outer quadrant. Explanation: The primary sign of breast cancer is a painless mass in the breast, most often in the upper outer quadrant.
A client recovering from a breast abscess has decided to stop breast-feeding. Which of the following measures would the nurse employ to assist the client? -Use a binder. -Boost the healing arm and shoulder with pillows. -Apply a tight-fitting brassiere. -Apply zinc oxide to surrounding skin.
Apply a tight-fitting brassiere. Explanation: If the mother decides to terminate breastfeeding, the nurse applies a tight-fitting brassiere. To avoid irritating the skin from frequent removal of tape, the nurse uses a binder to hold the dressing in place. He or she applies zinc oxide to the surrounding skin to avoid maceration from irritating drainage or wound compresses. To reduce swelling, the nurse supports the arm and shoulder with pillows.
A breastfeeding client is reporting pain in the left breast and describes the breast as feeling "doughy." The client is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend? -Avoid wearing a bra until the infection clears. -Perform gentle massage to stimulate neutrophil migration. -Apply cold compresses as prescribed. -Avoid washing the breasts.
Apply cold compresses as prescribed. Explanation: 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 their 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The client shares with the nurse being somewhat worried about the future, but the client appears to be adjusting well overall to the diagnosis and surgery. What nursing intervention is most appropriate to support this client's coping? Arrange a referral to a community-based support program. Recommend that the client remain optimistic for the sake of the children. Encourage the client to proceed with the next phase of treatment. Encourage the client's spouse or partner to be supportive during recovery.
Arrange a referral to a community-based support program. Explanation: The client is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach the client about talking with others who have had similar experiences. The nurse may educate the client's spouse or partner to listen for concerns, but the nurse should not tell the client's spouse what to do. The client must consult with their primary health care provider and make their own decisions about further treatment. The client needs to be able to express all feelings and should not be expected to be always optimistic.
A client who is assigned female at birth (AFAB) comes into the health clinic for an annual check-up. The client reports dimpling of the right breast that occurred recently. Which assessment(s) would be most appropriate for the nurse to make? Select all that apply. -Assess knowledge of normal age-related changes. -Assess for nipple retraction. -Assess knowledge of breast cancer. -Evaluate the client's milk production. -Palpate the area for a breast mass.
Assess for nipple retraction. Palpate the area for a breast mass. Explanation: It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the client to her primary care provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau d'orange); this and nipple retraction are classic signs of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The knowledge of breast cancer is relevant but is not a time-dependent priority. This finding is not an age-related change.
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. -Checking the dressing, drain, and amount of drainage. -Checking for urinary retention and the need to void. -Checking level of pain first upon the clients return from the operating room.
Assessing the vital signs and oxygen saturation levels. Explanation: The nurse prioritizes vital signs and breathing based on principles of ABCs.
The nurse is caring for a client who has just had a radical mastectomy and axillary node dissection. When providing education regarding rehabilitation, which intervention(s) will the nurse recommend? Select all that apply. -Avoid exercise of the arm for next 2 months. -Use a sling until healing is complete. -Keep cuticles clipped neatly. -Avoid lifting objects heavier than 10 pounds. -Use an electric razor for shaving underarm.
Avoid lifting objects heavier than 10 pounds. Use an electric razor for shaving underarm. Following an axillary dissection, the client should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, shaving underarm with a nonelectric razor, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged, and the use of a sling is not necessary.
The nurse is educating a group at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than breast self examination (BSE)? -Breast self-awareness -Mammography every year -Hormone replacement -Ultrasound with mammography
Breast self-awareness Explanation: Current practice is shifting from educating about BSE to promoting breast self-awareness, which is a client's attentiveness to the normal appearance and feel of their breasts.
The nurse is educating a group at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than breast self examination (BSE)? -Mammography every year -Breast self-awareness -Ultrasound with mammography -Hormone replacement
Breast self-awareness Explanation: Current practice is shifting from educating about BSE to promoting breast self-awareness, which is a client's attentiveness to the normal appearance and feel of their breasts.
Which is a characteristic of a breast cancer mass? -Tender upon palpation -Symmetrical mass -Firm, hard, embedded in surrounding tissue -Occurs as disseminated masses
Firm, hard, embedded in surrounding tissue Explanation: A characteristic of a breast cancer mass is a firm, hard, embedded lesion in surrounding tissue. It has an irregular shape, usually is not tender, and occurs as a single mass in one breast.
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 lobular carcinoma -Medullary carcinoma -Mucinous carcinoma
Infiltrating ductal carcinoma Explanation: 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 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? -progesterone -Cyclical hormonal changes -caffeine -nicotine
cyclical hormonal changes Explanation: The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.
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? -progesterone -caffeine -nicotine -cyclical hormonal changes
cyclical hormonal changes Explanation: The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.
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 -infiltrating lobular -inflammatory -medullary
ductal Explanation: The most common malignancy is ductal carcinoma (80%); followed by infiltrating lobular carcinoma (10%); medullary carcinoma, mucinous carcinoma, and tubular ductal carcinoma; and inflammatory breast cancer, the rarest but most aggressive form of breast cancer.
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 -sexual fulfillment -All options are correct. -sexual attraction
lactation Explanation: The breasts' primary function is the production of milk, a process referred to as lactation.
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? -sexual attraction -sexual fulfillment -lactation -All options are correct.
lactation Explanation: The breasts' primary function is the production of milk, a process referred to as lactation.
Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid? -lymphedema -fibroadenoma -breast cancer -mastalgia
lymphedema Explanation: Validating the lack of lymph node metastasis allows the surgeon to preserve more breast, axillary tissue, and chest muscle. Leaving more normal lymph nodes intact reduces the potential for complications such as lymphedema caused by the extensive disruption of lymphatic circulation.
For a cancerous tumor, a client must undergo modified radical mastectomy, which includes axillary node removal and immediate reconstruction. The nurse explains to the client that the axillary nodes will be removed to: -provide prognostic information. -facilitate breast reconstruction. -prevent metastasis. -facilitate postoperative recovery.
provide prognostic information. Explanation: Lymph node dissection provides prognostic information by helping to determine if chemotherapy is indicated. Although removal of lymph nodes may assist in prevention of metastasis, lymph node dissection isn't a guarantee that metastasis won't occur. This procedure doesn't affect breast reconstruction and may actually make postoperative recovery more difficult.
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 should tell my manicurist that it is okay to trim the cuticles on my right hand." "I need to use an electric shaver when shaving my right armpit." "Anytime I need blood drawn, they should get the sample from my right arm." "I can lift with my right arm objects that weigh as much as 15 pounds."
"I need to use an electric shaver when shaving my right armpit." Explanation: 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.
The nurse instructs a client on self-care after having a mastectomy with lymph node removal. Which client statement indicates that teaching has been effective? "I can resume all activities of daily living after the wound heals." "I will shave under my arms with an electric razor." "I will limit sun exposure to 15 minutes a day on the affected arm." "I can lift objects up to 25 pounds (11.4 kg) with my affected arm."
"I will shave under my arms with an electric razor." Explanation: After a mastectomy with lymph node removal, the client should be instructed to protect the entire extremity by using an electric razor for shaving. The weight of objects to be lifted should be limited to less than 5 to 10 lbs (11 to 22 kg). The client needs to alter some activities of daily living such as avoiding any pressure or invasive actions to the limb. The client should also wear insect repellent and wear gloves when gardening. Cooking mitts should be used when taking objects out of the oven. Cuticles should not be cut when having a manicure. Sunscreen should be used for extended exposure to the sun.
The nurse leading an educational session is describing self-examination of the breast. The nurse tells the group to raise their arms and inspect their breasts in a mirror. A member of the group asks the nurse why raising the arms is necessary. What is the nurse's best response? "It helps to spread out the fat that makes up your breast." "It allows you to simultaneously assess for pain." "This is what breast cancer experts recommend." "It will help to observe for dimpling more closely."
"It will help to observe for dimpling more closely." Explanation: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the client to raise both arms overhead. Citing expert opinion does not address the client's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.
The nurse leading an educational session is describing self-examination of the breast. The nurse tells the group to raise their arms and inspect their breasts in a mirror. A member of the group asks the nurse why raising the arms is necessary. What is the nurse's best response? "It helps to spread out the fat that makes up your breast." "It allows you to simultaneously assess for pain." "This is what breast cancer experts recommend." "It will help to observe for dimpling more closely."
"It will help to observe for dimpling more closely." Explanation: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the client to raise both arms overhead. Citing expert opinion does not address the client's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.
A client 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 will cure them. What is the nurse's best response? "Yes, without regional node involvement, lumpectomy, followed by radiation, is curative." "No, but recurrences can be treated with a mastectomy." "Lumpectomy, followed by radiation, has the same predicted long-term survival rates as a mastectomy." "No, but this combination of treatment has shown a 10-year remission rate."
"Lumpectomy, followed by radiation, has the same predicted long-term survival rates as a mastectomy." Explanation: The best response is to provide accurate information that won't increase anxiety. Choice "D" is also correct information but, according to limited research, less than 20% of clients have recurrences that require a mastectomy. Providing this information before surgery is not recommended.
A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when they can take a shower. What should the nurse respond? "Not until the drain is removed" "Now, if you wash gently with soap and water" "On the second postoperative day" "Seven days after your surgery"
"Not until the drain is removed" Explanation: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.
A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when they can take a shower. What should the nurse respond? -"Now, if you wash gently with soap and water" -"Seven days after your surgery" -"Not until the drain is removed" -"On the second postoperative day"
"Not until the drain is removed" Explanation: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.
A patient is scheduled to receive radiation therapy for 6 weeks after her lumpectomy. The patient states she is worried about the side effects of the radiation. What can the nurse inform her about the side effects of the radiation? "The radiation can cause musculoskeletal fatigue and you may not be able to continue to work while receiving the radiation." "The radiation can make you very nauseated, but something will be given for nausea." "The radiation can cause some skin breakdown in the axillary folds toward the end of treatment." "The radiation can cause you to lose your hair, but you can wear a wig or scarves."
"The radiation can cause some skin breakdown in the axillary folds toward the end of treatment." Explanation: Generally, radiation therapy is well tolerated. Acute side effects consist of mild to moderate erythema, breast edema, and fatigue. Occasionally, skin breakdown may occur in the inframammary fold or near the axilla toward the end of treatment. Fatigue can be depressing, as can the frequent trips to the radiation oncology unit for treatment. The patient needs to be reassured that the fatigue is normal and not a sign of recurrence.
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 Explanation: The nurse encourages the client to schedule a breast examination with a physician every 6 months or whenever a new or unusual lump develops.
A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous? A nonmobile mass with irregular edges Nonpalpable right axillary lymph nodes Eversion of the right nipple and mobile mass A mobile mass that is soft and easily delineated
A nonmobile mass with irregular edges Explanation: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.
A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous? -A mobile mass that is soft and easily delineated -Nonpalpable right axillary lymph nodes -Eversion of the right nipple and mobile mass -A nonmobile mass with irregular edges
A nonmobile mass with irregular edges Explanation: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.
A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous? -A nonmobile mass with irregular edges -Eversion of the right nipple and mobile mass -A mobile mass that is soft and easily delineated -Nonpalpable right axillary lymph nodes
A nonmobile mass with irregular edges Explanation: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.
A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous? -Eversion of the right nipple and mobile mass -A mobile mass that is soft and easily delineated -A nonmobile mass with irregular edges -Nonpalpable right axillary lymph nodes
A nonmobile mass with irregular edges Explanation: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.
A client who came to the clinic after finding a mass in the 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? -Describe the support groups that exist in the community. -Document a nursing diagnosis of ineffective coping. -Assess the client's stress management skills. -Acknowledge the fear the client is likely experiencing.
Acknowledge the fear the client is likely experiencing. Explanation: In the breast cancer diagnostic phase, it is appropriate to acknowledge the client's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills may be necessary, but the nurse should begin by acknowledging the client's feelings. Fear is not necessarily indicative of ineffective coping.
A client who came to the clinic after finding a mass in the 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? -Document a nursing diagnosis of ineffective coping. -Assess the client's stress management skills. -Describe the support groups that exist in the community. -Acknowledge the fear the client is likely experiencing.
Acknowledge the fear the client is likely experiencing. Explanation: In the breast cancer diagnostic phase, it is appropriate to acknowledge the client's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills may be necessary, but the nurse should begin by acknowledging the client's feelings. Fear is not necessarily indicative of ineffective coping.
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 -Chronic sorrow related to change in body image -Ineffective coping related to surgery -Risk for trauma related to postsurgical injury
Acute pain related to tissue manipulation and incision Explanation: Although many clients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.
A 33-year-old 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 -Long-term surveillance -Radiation therapy -Prophylactic mastectomy
Chemoprevention Explanation: Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts.
A 33-year-old 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? -Prophylactic mastectomy -Radiation therapy -Long-term surveillance -Chemoprevention
Chemoprevention Explanation: Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts.
A client who is 4 months postpartum reports significant left breast pain, edema, redness, and an elevated temperature. What would be an important client education topic for this client? -Complete all medication as prescribed. -Pump and save milk for later use. -Refrain from bathing until pain subsides. -Apply cool compresses to relieve pain.
Complete all medication as prescribed. Explanation: Take antibiotics as prescribed for the entire treatment period. Bathe or shower regularly and apply a medical grade lanolin ointment such as Lansinoh to dry or cracked nipples. Apply warm soaks to the breast or let warm water from a shower flow over the breast. Express milk with a breast pump until the infection is resolved sufficiently to resume breastfeeding.
Which type of biopsy would the nurse tell the client is a usual procedure for any palpable breast mass found on mammography? -Excisional -Stereotactic -Tru-Cut core -Incisional
Excisional Explanation: An excisional biopsy is the usual procedure for any palpable breast mass. Stereotactic biopsy uses computer location of the suspicious area found on biopsy, followed by core needle insertion and sampling of tissue for pathologic examination. Incisional biopsy is performed on a palpable mass when tissue sampling alone is required. A Tru-Cut core biopsy is used when a tumor is relatively large and close to the skin surface.
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? -Squeeze the nipple to check for drainage. -Put a heating pad on the area to reduce inflammation. -Inform the physician immediately. -Check the area after the next menses.
Inform the physician immediately. Explanation: The client should notify the physician immediately because a breast lump may be a sign of breast cancer. The client shouldn't squeeze the nipple to check for drainage until the physician examines the area. The client shouldn't wait until after the next menstrual period to inform the physician of the breast lump because prompt treatment may be necessary. Placing a heating pad on the area would have no effect on a breast lump.
The nurse is assessing an older adult who has not seen their physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding? It may result from a neoplasm blocking lymphatic drainage, indicating advanced breast cancer. It may result from inflammation due to mastitis while the patient is breastfeeding. This finding is not uncommon and is significant only when of recent origin. This finding is most likely related to benign cysts of the breast in the nipple area.
It may result from a neoplasm blocking lymphatic drainage, indicating advanced breast cancer. Explanation: Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange peel appearance (peau d'orange)—a classic sign of advanced breast cancer.
The nurse is assessing an older adult who has not seen their physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding? This finding is most likely related to benign cysts of the breast in the nipple area. This finding is not uncommon and is significant only when of recent origin. It may result from inflammation due to mastitis while the patient is breastfeeding. It may result from a neoplasm blocking lymphatic drainage, indicating advanced breast cancer.
It may result from a neoplasm blocking lymphatic drainage, indicating advanced breast cancer. Explanation: Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange peel appearance (peau d'orange)—a classic sign of advanced breast cancer.
A client with fibrocystic breast disease has been receiving treatment with danazol (Danocrine) therapy for the past 6 months. In anticipation of the drug being discontinued, the nurse instructs the client to inform the healthcare provider about which of the following? Inability to sleep after discontinuing the drug Lack of return of regular menses within 90 days after discontinuing the drug Nausea or vomiting occurring beyond 9 days after discontinuing the drug Constipation occurring 90 days after discontinuing the drug
Lack of return of regular menses within 90 days after discontinuing the drug Explanation: The nurse should tell the client to inform the healthcare provider if regular menses do not resume within 90 days after discontinuing the drug. Nausea, constipation, and sleep are not associated with danazol or its discontinuation.
A client with fibrocystic breast disease has been receiving treatment with danazol (Danocrine) therapy for the past 6 months. In anticipation of the drug being discontinued, the nurse instructs the client to inform the healthcare provider about which of the following? -Inability to sleep after discontinuing the drug -Constipation occurring 90 days after discontinuing the drug -Lack of return of regular menses within 90 days after discontinuing the drug -Nausea or vomiting occurring beyond 9 days after discontinuing the drug
Lack of return of regular menses within 90 days after discontinuing the drug Explanation: The nurse should tell the client to inform the healthcare provider if regular menses do not resume within 90 days after discontinuing the drug. Nausea, constipation, and sleep are not associated with danazol or its discontinuation.
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? -Connective tissue and smooth muscle -Modified tendons and ligaments -Endocrine glands and sebaceous glands -Lobules and ducts
Lobules and ducts Explanation: Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle.
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? -Age-related physiologic changes -Medication adverse effects -Fluid overload -Poor nutrition
Medication adverse effects Explanation: 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 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? -Fluid overload -Poor nutrition -Age-related physiologic changes -Medication adverse effects
Medication adverse effects Explanation: 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 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? -Poor nutrition -Age-related physiologic changes -Fluid overload -Medication adverse effects
Medication adverse effects Explanation: 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.
The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer?
Mother affected by cancer before 60 years of age Explanation: Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age). Nulliparity and later maternal age at first birth are associated with increased risk for breast cancer. Alcohol use remains controversial; however, a slightly increased risk is found in women who consume even one drink daily and doubles among women drinking three drinks daily.
The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer? -Onset of menses before 14 years of age -No alcohol consumption -Mother affected by cancer before 60 years of age -Multiparity
Mother affected by cancer before 60 years of age Explanation: Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age). Nulliparity and later maternal age at first birth are associated with increased risk for breast cancer. Alcohol use remains controversial; however, a slightly increased risk is found in women who consume even one drink daily and doubles among women drinking three drinks daily.
Which is inconsistent as a risk factor for breast cancer? -Multiparity -Late menopause -Older age -Family history of breast cancer
Multiparity Explanation: Nulliparity is a risk factor for breast cancer, along with late menopause, older age, and family history of breast cancer, among others.
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 -Undifferentiated tumor -High ERBB2 -Size
Negative lymph nodes Explanation: 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.
The nurse is providing care to a client with a suspected malignant breast tumor. The nurse knows that the mass likely had which characteristic upon palpation? -Mobile -Less than or equal to 5 mm -Soft on palpation -Non-tender on palpation
Non-tender on palpation Explanation: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.
The nurse is providing care to a client with a suspected malignant breast tumor. The nurse knows that the mass likely had which characteristic upon palpation? -Mobile -Non-tender on palpation -Soft on palpation -Less than or equal to 5 mm
Non-tender on palpation Explanation: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.
The nurse is providing care to a client with a suspected malignant breast tumor. The nurse knows that the mass likely had which characteristic upon palpation? -Non-tender on palpation -Mobile -Soft on palpation -Less than or equal to 5 mm
Non-tender on palpation Explanation: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.
A 49-year-old client reports their 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? Late menopause Family history of breast cancer Family history of hypertension Nulliparity
Nulliparity Explanation: There are a number of risk factors associated with breast cancer. This client's history indicates nulliparity, which is a risk factor for breast cancer. Late menopause (after 55 years of age) is also a risk for breast cancer, but this client experienced her last menstrual period at age 48, so this is not a risk factor for this client. Family history of breast cancer is a risk factor, but this client's history only indicates family histories of hypertension and diabetes. Other risk factors associated with breast cancer include increasing age, personal history of breast cancer, genetic mutations to BRCA1 and BRCA2, early menarche (before 12 years of age), late age at first full-term pregnancy (after 30 years of age), hormone therapy, exposure to ionizing radiation during adolescence or early adulthood, history of benign proliferative breast disease, obesity, and alcohol intake of more than one drink per day.
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? -Candida albicans -Protein -Chlamydia trachomatis -Staphylococcus aureus
Staphylococcus aureus Explanation: If a breast infection develops, the most common causative microorganism is Staphylococcus aureus, which often is resistant to antibiotic therapy. The other options are distracters for this question.
The nurse is caring for a client diagnosed with fibrocystic disease and prescribed danazol (Danocrine). Which is essential before drug therapy is initiated? -MUGA scan -Blood chemistry -Liver function test -Pregnancy test
Pregnancy test Explanation: Before initiating drug therapy, it is essential to confirm that the client is not pregnant. Ingesting danazol (Danocrine) may be teratogenic to the fetus. Liver function test, MUGA scan, and blood chemistry can provide relevant information of the status of the liver, heart, and general overall condition.
The nurse is caring for a client diagnosed with fibrocystic disease and prescribed danazol (Danocrine). Which is essential before drug therapy is initiated? -MUGA scan -Blood chemistry -Pregnancy test -Liver function test
Pregnancy test Explanation: Before initiating drug therapy, it is essential to confirm that the client is not pregnant. Ingesting danazol (Danocrine) may be teratogenic to the fetus. Liver function test, MUGA scan, and blood chemistry can provide relevant information of the status of the liver, heart, and general overall condition.
A 52-year-old client has just been told they have breast cancer and are scheduled for a modified mastectomy the following week. The nurse caring for this client knows that they are anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this client's fears? Offer the client alternative treatment options. Provide written material on the procedure that has been scheduled for the client. Provide the client with relevant information about expected recovery. Give the client current information on breast cancer survival rates.
Provide the client with relevant information about expected recovery. Explanation: Providing the client with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the client alternative treatment options is not within the nurse's normal scope of practice. Addressing survival rates may or may not be beneficial for the client. Written material is rarely sufficient to meet clients' needs.
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? Inform the patient that medication should not be used prophylactically due to the many side effects. Provide the patient with information regarding the benefits, risks, and possible side effects. Provide the patient with information about bilateral mastectomy for the prevention of this disease. Inform the patient that she should take every measure available to her to prevent this disease.
Provide the patient with information regarding the benefits, risks, and possible side effects. Explanation: Nurses can help women who are considering chemoprevention by providing them with information about the benefits, risks, and possible side effects of both tamoxifen and raloxifene.
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? Tell the client's spouse or partner to be supportive while she recovers. Recommend that the client remain cheerful for the sake of her children. Refer the client to the American Cancer Society's Reach for Recovery program or another support program. Encourage the client to proceed with the next phase of treatment.
Refer the client to the American Cancer Society's Reach for Recovery program or another support program. Explanation: The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, either through Reach for Recovery or another formal support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't tell the client's spouse what to do. The client must consult with her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She can't be expected to be cheerful at all times.
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? Tell the client's spouse or partner to be supportive while she recovers. Refer the client to the American Cancer Society's Reach for Recovery program or another support program. Encourage the client to proceed with the next phase of treatment. Recommend that the client remain cheerful for the sake of her children.
Refer the client to the American Cancer Society's Reach for Recovery program or another support program. Explanation: The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, either through Reach for Recovery or another formal support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't tell the client's spouse what to do. The client must consult with her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She can't be expected to be cheerful at all times.
A nurse is caring for a group of breast cancer survivors after mastectomy. Which teaching point should the nurse reinforce about activities 6 weeks after surgery? -Exercise only the unaffected side until seen by the healthcare provider. -Wear tight-fitting shirts for support. -Brisk walking and stretching exercises can be introduced. -Resume light household work.
Resume light household work. Explanation: The client is instructed about postoperative activity limitation. In general, heavy lifting (more than 5 to 10 pounds) is avoided for about 4 to 6 weeks, after which light household and work-related activities are promoted to maintain muscle tone. Brisk walking, the use of stationary bikes and stepping machines, and stretching exercises may begin as soon as the client feels comfortable. Once the drain is removed, the client may begin to drive if she has full arm range of motion and is no longer taking opioid analgesic agents. General guidelines for activity focus on the gradual introduction of previous activities (e.g., bowling, weight training) once fully healed.
A nurse is caring for a group of breast cancer survivors after mastectomy. Which teaching point should the nurse reinforce about activities 6 weeks after surgery? -Resume light household work. -Wear tight-fitting shirts for support. -Exercise only the unaffected side until seen by the healthcare provider. -Brisk walking and stretching exercises can be introduced.
Resume light household work. Explanation: The client is instructed about postoperative activity limitation. In general, heavy lifting (more than 5 to 10 pounds) is avoided for about 4 to 6 weeks, after which light household and work-related activities are promoted to maintain muscle tone. Brisk walking, the use of stationary bikes and stepping machines, and stretching exercises may begin as soon as the client feels comfortable. Once the drain is removed, the client may begin to drive if she has full arm range of motion and is no longer taking opioid analgesic agents. General guidelines for activity focus on the gradual introduction of previous activities (e.g., bowling, weight training) once fully healed.
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? -Exemestane -Letrozole -Tamoxifen -Anastrozole
Tamoxifen Explanation: Deep vein thrombosis, pulmonary embolism, and superficial phlebitis are all thromboembolic events that are adverse reactions to tamoxifen.
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 client will be scheduled for radiation therapy. -The client's diagnosis is likely related to use of oral contraceptives. -The client's breast mass is considered an age-related change.
The client might be referred for a biopsy. Explanation: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.
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 client will be scheduled for radiation therapy. -The client's diagnosis is likely related to use of oral contraceptives. -The client's breast mass is considered an age-related change.
The client might be referred for a biopsy. Explanation: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.
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 will be scheduled for radiation therapy. -The client's breast mass is considered an age-related change. -The client might be referred for a biopsy. -The client's diagnosis is likely related to use of oral contraceptives.
The client might be referred for a biopsy. Explanation: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.
The nurse is providing preoperative instruction for a patient who will be having an excisional breast biopsy. The patient asks the nurse what type of bra should be used after the procedure. What should the nurse inform the patient? The patient should wear a supportive bra after the procedure. The patient may wear a bra as long as it is an underwire bra. The patient should avoid the use of a bra for 24 hours after the procedure. The patient will not be able to wear a bra until the sutures are removed.
The patient should wear a supportive bra after the procedure. Explanation: The use of a supportive bra following surgery is encouraged to limit movement of the breast and reduce discomfort.
Most women diagnosed with breast cancer exhibit which risk factor? chronic alcohol consumption being older than 50 years old African American race early menarche
being older than 50 years old Explanation: Most women diagnosed with breast cancer have none of the identified risk factors except being female or being older than 50 (Mayo Clinic, 2007, National Cancer Institute, 2006).
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: -is lucky that the cancer was caught in time. -will have irregular menses. -should continue to perform breast self-examination on her right breast. -should schedule a follow-up appointment in 6 months.
should continue to perform breast self-examination on her right breast. Explanation: 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.
