Med Surg. Chapter 58

A client who has had a left total mastectomy is about to view her surgical site for the first time. Which of the following would be most appropriate for the nurse to say?

"Do you feel like you're ready to look at your incision now?"

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

Lymphedema

The nurse recognizes which of the following statements as accurately reflecting a risk factor for breast cancer?

Mother affected by cancer before 60 years of age

A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which of the following best reflects the rationale for using this group of drugs?

They lower the level of estrogen in the body blocking the tumor's ability to use it.

Breast cancers are usually found in which area of the breast?

Upper outer quadrant

What is the most common location for breast cancer?

Upper outer quadrant of the breast

During a breast examination, which finding most strongly suggests that a client has breast cancer?

A fixed nodular mass with dimpling of the overlying skin

On a follow-up visit, the patient is informed that her breast cancer has recurred. The nurse knows which of the following situations places the patient at risk for developing bone metastases?

Recurrence within 2 years of the original diagnosis

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer?

The lump is irregularly shaped.

The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease?

The lump is round and movable.

A nurse is describing the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which of the following?

Bone mineral density

How can breast cancer prevention programs best serve at-risk women from lower socioeconomic backgrounds?

Develop screening and educational programs.

The nurse is caring for a group of breast cancer survivors post mastectomy. Which teaching point should the nurse include?

Do not lift objects greater than 15 lb

A nurse is preparing a presentation for a local women's group about benign and malignant breast conditions. Which of the following would the nurse include as an example of a malignant breast condition?

Ductal carcinoma in situ

Which of the following would be inconsistent as a risk factor for breast cancer?

Multiparity

A patient 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 35-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?

She should eat a low-fat diet to further decrease her risk of breast cancer.

A health care provider tells a breast cancer patient that he is going to prescribe hormone therapy that has been found to significantly reduce mortality. Which of the following is the drug that would most likely be prescribed?

Tamoxifen

The nursing is caring for a client who will be having artificial implants for breast reconstruction. The client is arriving at the physician's office for which procedure completed before the surgery can be done?

Tissue expansion

The nurse is educating a group of women at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than BSE?

Breast self-awareness

A 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic?

Genetic counseling

Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon?

Gross swelling

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?

Tamoxifen

Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)?

Tamoxifen

A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred?

The mass may be cystic and was ruptured when the needle was inserted.

A patient has had a total mastectomy 12 hours ago and the nurse is assessing the surgical wound. The nurse observes ecchymosis, swelling, and tightness around the wound, and the patient states that it is painful. What does the nurse suspect has occurred?

The patient has developed a hematoma.

The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction?

The procedure removes all cancer from the body.

A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following?

Timing of symptoms in relation to the menstrual cycle

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

Upper, outer quadrant.

During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate?

Wear gloves and protective clothing to avoid any injuries.

Your patient is receiving adjuvant chemotherapy for breast cancer. Which of the following is most likely her node status and tumor size?

node negative, tumor size 1.2 cm

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.

A nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms:

yearly starting at age 40.

A client is being discharged to home following a modified radical mastectomy. The nurse is providing discharge instructions and making arrangements for home care. Which of the following interventions will be included in her instructions? Select all that apply.

• Advise the client that blood pressure measurements, injections, blood donations, and IV infusions are lifelong restrictions on the side of the mastectomy. • Recommend wearing gloves while doing yard or housework.

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 need to use an electric shaver when shaving my right armpit."

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

40

Kara Carpenter is a 54-year-old woman who just had a left radical mastectomy. The nurse caring for her is providing information on complications that may arise due to removing the axillary lymph nodes. Which of the following would not be included?

All would be included in the discussion.

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

Chemoprevention

A 32-year-old client is concerned with the lumps that have developed in her breasts and is fearful of cancer. She reports variability in the size of the lumps. What could be causing her condition?

Cyclical hormonal changes

The nurse advises a patient scheduled for external beam radiation that side effects are minimal and usually well tolerated. The most common and annoying side effect is:

Fatigue.

Which of the following is a characteristic of a breast cancer mass?

Firm, hard, embedded in surrounding tissue

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

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

The nurse is caring for a client who is beginning doxorubicin (Adriamycin) therapy for breast cancer. When preparing the client for probable side effects, which would the nurse include?

Information regarding wigs from the American Cancer Society

The nurse is assessing an older adult female who has not seen her 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, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer.

The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following?

Lymphedema

A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include?

Maintaining an ideal weight

A patient has been newly diagnosed with breast cancer. During her preoperative instructions the physician indicated that removal of the breast tissue and axillary lymph node dissection leaving the muscular structure intact was indicated as surgical treatment for her breast cancer. To which of the following procedures is the physician asking the patient to consent?

Modified radical mastectomy

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.

A nurse is meeting with a woman scheduled to have a modified radical mastectomy to remove an aggressive breast tumor. The woman tells the nurse that she agreed to have the surgery before considering alternative options. Which of the following statements is the nurse's best response?

"Tell me more about your fears and concerns."

The nurse is educating a patient about the best time to perform BSE. When does the nurse inform her is the best time after menses to perform BSE?

5 to 7 days

A 54-year-old woman presents to her healthcare provider's office where you practice nursing. She is very concerned that she might have breast cancer, especially after caring for her sister that recently died from the disease. Included in your discussion is the primary and most common sign of breast cancer. Which of the following would meet this criterion?

A painless mass in the breast, most often in the upper outer quadrant

A nurse is reviewing a female patient's history, which includes the following information:

Age at first pregnancy

A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation?

Assist the client to pump the breasts to remove breast milk.

The most common route of regional spread is to which area?

Axillary lymph nodes

After teaching a group of students about the signs and symptoms of breast cancer, the instructor determines that additional teaching is needed when the group identifies which of the following?

Breast symmetry

The nurse working on a woman's cancer treatment floor performs nursing assessments on her assigned patients. It is most important for the nurse to report which of the following assessment findings?

Coolness and mottling of a newly constructed breast site

A client is diagnosed with a palpable mass in her breast. The nurse would anticipate diagnostic testing using which of the following?

Core needle biopsy

A client has just been diagnosed with breast cancer and has been seen by the physician who has described the various options available to the client. The client tells the nurse, "I just don't know what to do. I'm so frightened. I don't know if surgery is the best thing. But I've heard such horror stories about chemotherapy, too." When developing this client's plan of care which nursing diagnosis would be most appropriate?

Decisional conflict related to the choice of treatment options

Which type of biopsy would the nurse tell the patient is a usual procedure for any palpable breast mass found on mammography?

Excisional

A 28-year-old woman is learning about breast self-examination. The nurse teaches the woman that the best time of each month to examine her breasts is during the:

First week after menstruation.

Which of the following options are available to women with an increased risk of developing breast cancer?

Long-term follow-up

A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies?

Mammogram

The nurse teaches the female patient who is premenopausal to perform breast self-examination (BSE) at which time frame?

On day 5 to day 7, counting the first day of menses as day 1

The nurse is completing the admission history for a client who is admitted for a reduction mammoplasty. Which of the following client statements is uncommon when explaining the rationale for the procedure?

Others disapprove

A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women

have a mammogram annually.

Nursing students are reviewing various procedures that can be used to obtain a tissue biopsy of the breast. They demonstrate understanding of the material when they identify which of the following as being done using local anesthesia and intravenous (IV) sedation? Select all that apply.

• Excisional biopsy • Wire needle localization

A client diagnosed with breast cancer has developed neutropenia secondary to chemotherapy. Which of the following would the nurse anticipate as being ordered to address the neutropenia? Select all that apply.

• Filgrastim • Pegfilgrastim

Which of the following are nursing interventions related to a patient with breast cancer? Select all that apply.

• Patient education and preparation for treatment • Promotion of positive body image • Relieving fear • Management of complications