Female Problems
A 21-year-old woman with a family history of ovarian cancer is talking to the nurse about family planning. She is worried about ovarian cancer and asks the nurse if there is anything she can do to help decrease her risk for the disease. Which information should the nurse share with the patient? 1. "Having a family early in life could be helpful." 2. "Consider eating a diet that is high in different types of fats." 3. "You need to undergo screening because ovarian cancer is hereditary and the mortality rate is high." 4. "Avoid the use of oral contraceptives because they have been shown to increase the risk of ovarian cancer."
1. "Having a family early in life could be helpful." The patient is coming in to discuss family planning, so the suggestion that having a family early rather than later would be appropriate when discussing protective factors against ovarian cancer.
The nurse is caring for a patient who is starting treatment for breast cancer. The patient asks the nurse, "I don't understand why I need so many different drugs and surgery for my cancer!" How should the nurse respond? 1. "Targeting the cancer each way that it is susceptible is important. If you have concerns about your treatment, we can speak with your health care provider together." 2. "Surgery does not usually eliminate all of the cancer, so the drug therapies are used to ensure that all of the cancer cells are eliminated. This way you will have the best outcome." 3. "Cancers are unpredictable and respond in ways that we do not always understand. Multiple treatments are more likely to eliminate the cancer than one type of treatment alone." 4. "You need to adhere to the prescribed drugs and surgeries. Your health care provider has decided that these treatments give you the best chance for recovery from breast cancer. "
1. "Targeting the cancer each way that it is susceptible is important. If you have concerns about your treatment, we can speak with your health care provider together." It is important for the nurse to explain and reinforce how the different treatments for cancer work together and that the combination of treatments is usually better than one therapy alone. The nurse should be able to explain that that the chemotherapy and hormone therapy are meant to treat the cancer from different angles and that the surgery is meant to remove the cancer.
Which is an accurate statement about the risk factors for breast cancer? 1. Alcohol use can increase the risk of developing breast cancer. 2. Breast cancer development is not linked to estrogen exposure. 3. Being underweight increases the risk of breast cancer development. 4. Young age and female gender are risk factors for developing breast cancer.
1. Alcohol use can increase the risk of developing breast cancer. Alcohol consumption can increase the risk of developing breast cancer.
The nurse is caring for a patient with terminal cervical cancer. Which clinical manifestations would the nurse expect to observe based on this diagnosis? Select all that apply. 1. Anemia 2. Cachexia 3. Leukorrhea 4. Weight loss 5. Bleeding between periods
1. Anemia Anemia is a late sign of cervical cancer and would be consistent with a terminal cervical cancer diagnosis. 2. Cachexia Cachexia is a late sign of cervical cancer and would be consistent with a terminal cervical cancer diagnosis. 4. Weight loss Weight loss is a late sign of cervical cancer and would be consistent with a terminal cervical cancer diagnosis.
A patient with breast cancer asks the nurse what is meant by "in situ." How should the nurse respond? 1. "In situ means that a tumor responds to hormonal changes." 2. "In situ is a term that indicates a tumor has spread to other tissues." 3. "In situ means that the cancer arises from the epithelial lining of the ducts." 4. "The term, in situ, means that the cancer is currently noninvasive, within the duct."
4. "The term, in situ, means that the cancer is currently noninvasive, within the duct." In situ indicates that the cancer is currently noninvasive and has stayed within the area where initially detected.
The nurse is providing reproductive education to a group of healthy young women. What information regarding cancer prevention and early detection should the nurse provide to this group? Select all that apply. 1. Early detection can help improve the prognosis for reproductive cancers. 2. Routine cancer screening, such as a Pap test, is an important part of self-care. 3. Safer sex practices can decrease the risk for certain types of reproductive cancers. 4. A family history of cancer provides little information regarding reproductive types of cancer. 5. Healthy behaviors, such as regular physical activity and not smoking, can decrease the risk for some reproductive cancers.
1. Early detection can help improve the prognosis for reproductive cancers. The nurse should emphasize the need for early detection so that prognosis can be improved for these reproductive cancers. 2. Routine cancer screening, such as a Pap test, is an important part of self-care. The nurse should provide education on the importance of performing cancer screenings as a part of routine self-care to increase the likelihood of early detection. 3. Safer sex practices can decrease the risk for certain types of reproductive cancers. Safer sex practices, such limiting the number of sexual partners as well as using condoms during intercourse, can help to prevent certain types of cancers. 5. Healthy behaviors, such as regular physical activity and not smoking, can decrease the risk for some reproductive cancers. The nurse should emphasize that healthy activities, such as physical exercise and either never starting or cessation of smoking, can help to decrease the risk of the development of female reproductive cancers.
Which manifestations may be seen in a 55-year-old nulliparous, menopausal female patient with a suspected endometrial cancer? Select all that apply. 1. Pelvic pain 2. Leukorrhea 3. Vaginal bleeding 4. Pain with urination 5. Abdominal enlargement
1. Pelvic pain Pain in the pelvic area is a later sign of endometrial cancer. 3. Vaginal bleeding Abnormal uterine bleeding in a postmenopausal female is a classic clinical manifestation of endometrial cancer. 4. Pain with urination Pain with urination, or with intercourse, is a later sign of endometrial cancer.
A mother of an 11-year-old girl comes into the health clinical and speaks with the nurse about vaccinations. The mother asks, "Why should I give my little girl a vaccine for a sexually transmitted infection?" Which information should the nurse provide to the mother? Select all that apply. 1. The HPV vaccine can prevent infection when given before HPV exposure. The HPV vaccine can help prevent some of the most common forms of cervical cancer. 2. Your daughter should have received the vaccination a few years ago, so we need to catch her up. 3. Giving the vaccine before a person is sexually active can prevent the development of cervical cancer. 4. If your daughter gets exposed to HPV prior to being vaccinated, the vaccine will no longer be as effective.
1. The HPV vaccine can prevent infection when given before HPV exposure. Once the person is exposed to HPV, the vaccine is not as effective. It can still help prevent other strains of HPV and can still be given, though. 2. The HPV vaccine can help prevent some of the most common forms of cervical cancer. The primary prevention of cervical cancer is vaccination, and the vaccine does protect against most strains of HPV. 3. Giving the vaccine before a person is sexually active can prevent the development of cervical cancer. The vaccine is best given before any sexual contact, which is why the recommended age is so young. The vaccination takes six months to administer, so it should be started well in advance of any imminent sexual activity.
The nurse is preparing to care for a patient who is two days postoperative after a pelvic exenteration surgery. Which intervention should the nurse include in the patient's plan of care? 1. Encouragement for the patient to complete all self-care 2. Extra time to allow the patient to express feelings and concerns 3. Discussion of the discharge instructions with the patient and family 4. Education on the changes that the patient will need to apply into daily life
2. Extra time to allow the patient to express feelings and concerns The nurse should allow the time and space for the patient to express her feelings following a pelvic exenteration. The patient is trying to recover from a radical hysterectomy, an abdominal perineal resection, and an ileostomy or colostomy, so the social, physical, and emotional adjustment of the woman will require extra time.
The nurse is educating a patient about the manifestations of breast cancer. Which signs should the nurse include to help the patient detect a potentially cancerous lump in the breast? Select all that apply. 1. Mild asymmetry of the breasts 2. Nodule in the upper outer quadrant 3. Presence of a painless, nonmobile lump 4. Enlarged breast tissue during menstruation 5. Puckering or induration of the breast tissue
2. Nodule in the upper outer quadrant A nodule or mass in the upper outer quadrant of the breast should always be investigated further because this is the most common place for breast cancer tumors to develop. The tissues are very glandular in this area. 3. Presence of a painless, nonmobile lump A painless, nonmobile lump is characteristic of a cancerous lump. The lump is often nonmobile because of attachment to underlying muscle and is not tender like other breast changes that can result from hormonal changes. Additionally, the lump is often hard, irregularly shaped, and the borders may be difficult to define through palpation. 5. Puckering or induration of the breast tissue The puckering and dimpling or induration of the breast tissue when the woman is in different positions indicates the likelihood of a lump that is attached to the muscle underlying the breast tissue and therefore pulls the breast tissue into abnormal positions when the woman moves.
The nurse is working with a patient who is actively engaged in breast cancer treatment. The patient reports feeling distant from her family over the past few weeks. How can the nurse provide support to the patient in this situation? 1. Provide a safe place for her to express her emotions 2. Give her resources for obtaining mental health counseling 3. Help her identify other sources of strength, such as spirituality 4. Discuss ways she can increase her communication with her family
4. Discuss ways she can increase her communication with her family The patient states she is feeling distant from her family because of the cancer treatment. The nurse should promote communication among the family, friends, and the patient in order to directly address the patient's primary concern.
The nurse is caring for a patient newly diagnosed with breast cancer and working with the treatment team and her family. Which patient activities demonstrate that the patient is meeting the treatment goals at this time? Select all that apply. 1. The patient states, "I will do whatever you say." 2. The patient talks about the side effects of her chemotherapy. 3. The patient comes alone to her appointments until she is ready to tell her partner. 4. The patient brings a list of questions to her next appointment with the oncologist. 5. The patient discusses the need to continue treatment despite the difficulties that she is experiencing.
2. The patient talks about the side effects of her chemotherapy. The patient should discuss the side effects of the treatments so that the side effects are known by the treatment team, and ways to manage them can be discussed. This is a goal for a patient with breast cancer. 4. The patient brings a list of questions to her next appointment with the oncologist. The patient bringing a list of questions to the oncologist shows that the patient is taking an active role in her treatment and feels that she has access to the health care provider. This is a goal for a patient with breast cancer. 5. The patient discusses the need to continue treatment despite the difficulties that she is experiencing. The patient is discussing the importance of continuing treatment despite the fact that she is having difficulties, which indicates that she is committing to adhering to the therapeutic regimen while still wanting to discuss side effects or other issues. This is a goal for a patient with breast cancer.
The nurse is talking to a patient who is undergoing screening for ovarian cancer. The patient recently tested positive for BRCA-1. The patient has been prescribed an abdominal ultrasound and testing for CA-125. The patient states, "I know this is part of my screening now, but I don't remember why." Which information should the nurse provide? 1. "This testing will help prepare you for the exploratory laparoscopy and is crucial to complete." 2. "This testing will take the place of your annual bimanual pelvic exam and should be more comfortable." 3. "Your genetic history shows you are high risk for ovarian cancer, so adding this testing will enhance early detection." 4. "Your health care provider has determined this is the best screening for you because a bimanual exam is no longer indicated."
3. "Your genetic history shows you are high risk for ovarian cancer, so adding this testing will enhance early detection." The BRCA-1 indicates that the patient is at high risk for breast and ovarian cancer due to a genetic predisposition. The abdominal ultrasound and CA-125 marker are added to the yearly pelvic exam to increase the likelihood of early detection of ovarian cancer.
The nurse is providing education for a patient being discharged following a hysterectomy. Which information should the nurse emphasize to this patient? Select all that apply. 1. No heavy lifting for 4 weeks. 2. Menstruation should cease within a few months. 3. Intercourse should be avoided for 4-6 weeks. 4. Vaginal sensation should return within a few months. 5. Bathing in a tub should be avoided for at least 4 weeks.
3. Intercourse should be avoided for 4-6 weeks. Intercourse should be avoided for 4-6 weeks to help prevent trauma to the surgical site, so this information should be emphasized to the patient. 4. Vaginal sensation should return within a few months. Vaginal sensation is often lost temporarily and should return to the patient within a few months. This information should be emphasized to the patient because of the loss of sensation could be alarming if not expected and understood that the loss is temporary. 5. Bathing in a tub should be avoided for at least 4 weeks. Soaking in a tub should be avoided for 4-6 weeks to help prevent infection, so this information should be emphasized to the patient.
A patient was recently diagnosed with early-stage resectable breast cancer and tells the nurse, "I do not want to have my entire breast removed!" How should the nurse respond? 1. "Having your breast removed might save your life." 2. "Breast reconstruction is the best option after a mastectomy." 3. "You might be able just to have your lump removed, so try not to worry yet." 4. "Have you discussed your treatment options with your health care provider?"
4. "Have you discussed your treatment options with your health care provider?" The nurse should inquire whether the patient and health care provider have already discussed a breast-conserving surgery. Sometimes there is the misconception that everyone with breast cancer will have to have a mastectomy, and that is not always the case, especially when the cancer is diagnosed at an early stage.
A student nurse is caring for a patient diagnosed with breast cancer and inquires what is meant by a triple negative breast cancer finding in this patient. Which statement by the nursing instructor is correct? 1. "This test indicates that your patient has been tested for BRCA-1, BRCA-2, and genetic mutation. Therefore, the results mean her cancer is not hereditary." 2. "It means that the breast cancer is small, has not gotten into the lymph nodes, and is well differentiated. All of these findings indicate that the cancer will respond well to treatment." 3. "This test result indicates that the type of breast cancer that your patient has can be treated with chemotherapy, radiation, or hormone therapy. All treatment will be equally effective." 4. "It means that the cancer was tested for receptors to estrogen, progesterone, and HER-2. A negative finding will make the cancer harder to treat and, unfortunately, gives it a poorer prognosis."
4. "It means that the cancer was tested for receptors to estrogen, progesterone, and HER-2. A negative finding will make the cancer harder to treat and, unfortunately, gives it a poorer prognosis." A triple negative test indicates that all three receptors, estrogen, progesterone, and HER-2, are lacking in the tumor. The tumor is harder to treat, is more aggressive, and has a poorer prognosis.
A patient is diagnosed with endometrial cancer and her health care provider recommends a hysterectomy. The patient asks the nurse, "How will they perform the hysterectomy?" How should the nurse respond? 1. "Most hysterectomies are done laparoscopically, so there should be minimal or no complications." 2. "There are several ways a hysterectomy can be done when treating endometrial cancer, so the procedure will likely be minor and completed vaginally." 3. "The surgeon's expertise and preference will determine the type of hysterectomy that you will receive, so you will need to discuss your concerns with the surgeon." 4. "The surgeon will likely complete the hysterectomy through an incision in the abdomen due to the necessity to remove the fallopian tubes, ovaries, and biopsy the lymph nodes."
4. "The surgeon will likely complete the hysterectomy through an incision in the abdomen due to the necessity to remove the fallopian tubes, ovaries, and biopsy the lymph nodes." For endometrial cancer, the type of hysterectomy that is required is a total hysterectomy and bilateral salpingo-oophorectomy with lymph node biopsies. A surgery of this magnitude will require an abdominal incision and will not be able to be completed through either laparoscopic or vaginal routes.
The nurse is caring for a patient after a right mastectomy and lymph node removal. The nurse should intervene when she observes which actions by the patient? Select all that apply. 1. The patient wearing loose-fitting shirts on a regular basis 2. The patient's right arm in an elevated position for a few minutes 3. The patient stopping a phlebotomist from drawing blood from the right arm 4. The patient allowing a care technician to take a blood pressure on the right arm 5. The patient using only water to wash the right arm to help prevent skin irritation
4. The patient allowing a care technician to take a blood pressure on the right arm The nurse should intervene and provide instruction to both the patient and the care technician about the lymphedema precautions to ensure no procedures are performed on the right arm. Any constriction, even temporary like a blood pressure, can cause lymphedema. 5. The patient using only water to wash the right arm to help prevent skin irritation The patient does not need to limit washing the arm to only water. A mild soap can be used to wash the arm and should be encouraged if any trauma occurs to the arm. The patient needs to actively take measures to prevent infection, which could cause lymphedema.
Classification: Tissue type In general, breast cancer arises from the epithelial lining of the ducts (ductal carcinoma) or from the epithelium of the lobules (lobular carcinoma).
Ductal carcinoma (affects milk ducts): Medullary; Tubular; Colloid Lobular carcinoma (affects milk-producing glands) Other: Inflammatory; Paget's disease; Phyllodes tumor
Classification: Invasiveness Breast malignancy may be in situ (within the duct) or invasive (arising from the duct and invading through the wall of the duct).
Noninvasive (In Situ): Ductal carcinoma in situ; Lobular carcinoma in situ Invasive: Invasive ductal carcinoma; Invasive lobular carcinoma
Classification: Hormone Receptor and Genetic Status Some cancers respond to the presence of estrogen or progesterone. HER-2 (human epidermal growth factor receptor 2) is a protein that regulates cell growth.
Receptor: Can be estrogen receptor positive or negative; Can be progesterone receptor positive or negative HER-2: HER-2 positive or HER-2 negative
