Senior Med Surg - PrepU Ch 58: Assessment & Mgmt of Pts w/Breast Disorders

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 & oxygen saturation levels

The nurse 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 to be completed before the surgery can be done?

Tissue expansion

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

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

Modified radical mastectomy

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

The nurse is providing health education regarding disorders that affect breast tissue. Which symptom is least suggestive of a breast disorder?

differences in breast size

The nurse is caring for a client with breast cancer and removal of axillary lymph nodes. Which assessment finding is documented and brought to the physician's attention as potential lymphedema?

enlargement of the arm or hand

A nurse advises a client scheduled for external beam radiation that side effects are minimal and usually well tolerated. What are side effects should the nurse include in the teaching?

erythema, fatigue, breast edema

Which psychosocial nursing diagnoses are common in the client with breast cancer?

fear, body image disturbance, hopelessness

A client is concerned with lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What would the physician indicate is the client's condition?

fibrocystic breast disease

A nurse is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination

immediately after her menses

A nurse is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:

immediately after her menses

Atypical hyperplasia increases a women's risk for breast cancer about how many times compared with that of the general population?

increases a women's risk for breast cancer about four to five times

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

inform physician immediately

A nurse working in a gynecologist's office reviews breast self-examination (BSE) with a patient and explains the difference between a breast fibroadenoma and a malignancy. Which of the following characteristics associated with a malignancy are most descriptive of this type of mass?

irregular in shape, fixed to the skin, associated signs of retraction

A 45-year-old woman has a family history of breast cancer. She herself was diagnosed with breast cancer 2 months ago. During a routine visit, the physician informs her that she has to undergo radiation as soon as possible to avoid spreading of the cancer. Which symptom would prompt radiation therapy?

massive swelling in her arm

Which term refers to breast pain?

mastalgia

Which is an early sign of Paget disease?

nipple erythema

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

nulliparity

A 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?

patient has developed a hematoma

The nurse is providing shift report related to a client newly received back to the unit from the post anesthesia care unit (PACU). The nurse is stating that the client had breast tissue removed with 7 of 14 lymph nodes, the lining of the chest muscles and pectoralis major and minor muscles removed. The oncoming nurse documents which procedure completed?

radical mastectomy

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 ductal carcinoma in situ (DCIS) is considered to be which stage of breast cancer?

0

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

45

External beam radiation typically begins at approximately how many weeks after breast conservation surgery?

6

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

A 33-year-old female client is recovering from a modified radical mastectomy with immediate reconstruction. This is the client's fourth day postoperatively. Her vital signs are temperature 99°F, pulse 82, respirations 18, and blood pressure 152/90. She continues to complain of considerable pain, with a pain rating of 9 on a scale of 1 to 10, with 10 being the worst possible pain. The client was discharged home with a prescription for oxycodone and acetaminophen and has been taking the drugs as prescribed. Which assessment finding would cause the nurse to phone the physician?

A well-defined oval area near the incision site

When a female client demonstrates nipple cracks or abrasions along with reddened and warm breast skin and tenderness, the nurse recognizes that the client is exhibiting signs of which disease process?

Acute mastitis

A 43-year-old client is a single parent and has been admitted for a left mastectomy after confirmation of cancer from a node biopsy. She has a daughter who is 12 years old. What are primary issues for the nurse to discuss with this client?

Concerns regarding the cancer and how the surgery will affect her

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

The nurse is obtaining a history from a client who states recurrent breast tenderness. The client inquires if there is something wrong with her breasts. Which question by the nurse is a priority?

Does the tenderness occur around the same time each month?

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

When a female client demonstrates a wart-like growth near the nipple, causing bloody nipple discharge, the client is exhibiting signs of which disease process?

Intraductal papilloma

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 client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?

Nonmobile mass with irregular edges

When a female client demonstrates thickening, scaling, and erosion of the nipple and areola, the nurse recognizes that the client is exhibiting signs of which disease process?

Paget disease

Which is an inaccurate manifestation of a fibroadenoma?

Premenstrual changes do not occur

The nurse is caring for a client following breast reconstruction surgery using autogenous tissue. When assessing wounds from the surgical procedure, in which area would the nurse assess the wound from which tissue was taken?

Rectus abdominis

At a follow-up visit, the client is informed that her breast cancer has recurred. The nurse knows that which situation places the client at risk for developing bone metastases?

Recurrence within 2 years of the original diagnosis

A client who is to have breast conservation surgery is also to undergo a sentinel lymph node biopsy (SLNB). Which of the following would the nurse include in the client's preoperative teaching plan?

The client's urine may have a blue-green discoloration in the first 24 hours

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 some skin breakdown in the axillary folds toward the end of treatment

A health care provider recommends that a patient with breast cancer undergo a modified radical mastectomy. The nurse explains that this procedure involves removal of the entire breast

and the nipple-areola complex along with the axillary node dissection

A suspicious breast lump is noted on a mammogram. The client asks the nurse which diagnostic test confirms if the lump is cancerous or benign. Which response by the nurse is most correct?

biopsy

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

Why should pre-menopausal women do their breast self examination immediately after their period?

breasts are least tender & least lumpy

The client is receiving adjuvant chemotherapy for breast cancer. Who is adjuvant chemotherapy recommended for?

clients who have positive lymph nodes or who have invasive tumors greater that are 1 cm in size, regardless of nodal status

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

Which of the following would the nurse expect to find when assessing the breasts of a client with fibrocystic breast disease?

soft mass

Which is one of the most important prognostic factors in breast cancer?

status of lymph nodes

Which type of biopsy is used for nonpalpable lesions found on mammography?

stereotactic

What is the correct way to perform a breast self exam?

the entire surface of the breast and axillary tail is systematically palpated proceeding in a clockwise direction, following imaginary concentric circles from the outer limits of the breast toward the nipple

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 to limit movement of the breast and reduce discomfort

Which of the following are the two most important prognostic factors associated with breast cancer?

tumor size & axillary lymph node involvement

A nurse is giving preoperative instructions to a client who is scheduled for a breast biopsy. Which medication should the nurse instruct the client to stop 1 week before the procedure?

vitamin E - can increase risk of bleeding during surgery

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 & protective clothing to avoid any injuries