Breast Cancer and Disorders

A patient with breast cancer has been prescribed tamoxifen. What side effects should the nurse advise the patient to monitor for while taking this medication? Select all that apply. A. Chest pain B. Blurred vision C. Leg cramps D. Gastrointestinal disturbances E. Irregular vaginal bleeding

B. Blurred vision C. Leg cramps E. Irregular vaginal bleeding

Which action will the nurse include in the plan of care for a patient with right arm lymphedema? A. Assist with application of a compression sleeve. B. Keep the right arm at or below the level of the heart. C. Check blood pressure (BP) on both right and left arms. D. Avoid isometric exercise on the right arm.

A. Assist with application of a compression sleeve. Rationale: Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's left arm. The arm should not be placed in a dependent position.

Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? A. Careful skin care in the radiated area will be necessary. B. Visitors are restricted until the radiation therapy is completed. C. The radiation therapy will take a week to complete. D. Wigs may be used until the hair regrows after radiation therapy.

A. Careful skin care in the radiated area will be necessary. Rationale: Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Scalp hair loss does not occur with breast radiation therapy. Because the patient does not have radioactive implants, no visitor restrictions are necessary.

The nurse is examining a woman's breast and notes multiple small mobile lumps. Which question would be the most appropriate for the nurse to ask? A. "Do the small lumps seem to change with your menstrual period?" B. "How many cans of caffeinated soda do you drink in a day?" C. "When was your last mammogram at the clinic?" D. "Do you have a first-degree relative who has breast cancer?"

A. "Do the small lumps seem to change with your menstrual period?" Rationale: The most appropriate question would be one that relates to benign lesions that usually change in response to hormonal changes within a menstrual cycle. Reduction of caffeine in the diet has been shown to give relief in fibrocystic breast conditions, but research has not found that it has a significant impact. Questions related to the patient's last mammogram or breast cancer history are not related to the nurse's assessment.

A patient is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the patient would indicate that further teaching is needed? A. "I am glad that these tubes will fall out at home when I finally shower." B. "I should be careful how I lie in bed so that I will not kink the tubing." C. "I should measure the drainage each day to make sure it is less than an ounce (30 mL)." D. "If there is a foul odor from the drainage, I should contact my doctor."

A. "I am glad that these tubes will fall out at home when I finally shower." Rationale: The drainage tubes (such as a Jackson-Pratt drain) lie just under the skin but need to be removed by the healthcare professional in about 1 to 3 weeks at an office visit. Drainage should be less than 25 mL in a day's time. The patient should be aware of her positioning to prevent kinking of the tubing. A foul odor from the drainage may indicate an infection; the provider would be contacted immediately.

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? A. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue B. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching C. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene D. A 40-yr-old patient who still has left side chest and arm pain 2 months after a left modified radical mastectomy

A. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue Rationale: Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-yr-old patient, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

The nurse is providing postoperative teaching for a patient after a mastectomy. Which is the priority postoperative goal? A. Adhere to the therapeutic plan. B. Comply with follow-up appointments. C. Manage side effects of drug therapy. D. Participate in decisions regarding treatment.

A. Adhere to the therapeutic plan.

A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? A. Administering an analgesic 30 minutes before scheduled arm exercises B. Evaluating the patient's understanding of instructions about drain care C. Assessing the patient's range of motion for the left arm D. Teaching the patient how to avoid injury to the left arm

A. Administering an analgesic 30 minutes before scheduled arm exercises Rationale: LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice.

What comfort measure can only be performed by a nurse, as opposed to an unlicensed assistive personnel (UAP), for a patient who returned from a left modified radical mastectomy 4 hours ago? A. Administering morphine for pain at a "4" on a 0-to-10 scale B. Supporting the left arm while initially ambulating the patient C. Elevating the left arm on a pillow D. Placing the head of bed at 30 degrees

A. Administering morphine for pain at a "4" on a 0-to-10 scale Rationale: Only the nurse is authorized to administer medications, but the UAP could inform the nurse about the rating of pain by the patient. The UAP could position the bed to 30 degrees and elevate the patient's arm on a pillow to facilitate lymphatic fluid drainage return. The patient's arm should be supported while walking at first but then allowed to hang straight by the side. The UAP could support the arm while walking the patient.

A patient with breast cancer underwent a partial mastectomy with radiation therapy. For which symptoms should the nurse tell the patient to be observant? Select all that apply. A. Arm swelling B. Breast soreness C. Skin reactions D. Excessive hair loss E. Gastrointestinal disturbances

A. Arm swelling B. Breast soreness C. Skin reactions

The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? A. Ask the patient to describe what she knows about the surgery. B. Discuss options for postoperative pain management. C. Explain the postdischarge care of the axillary drains. D. Teach the patient how to deep breathe and cough.

A. Ask the patient to describe what she knows about the surgery. Rationale: Before teaching, the nurse should assess the patient's current knowledge level. The other teaching also may be appropriate, depending on the assessment findings.

A patient has been diagnosed with breast cancer and has been prescribed doxorubicin. Which assessments should the nurse make before administering the drug? Select all that apply. A. Check for signs and symptoms of infections. B. Check whether any recent live vaccinations have been received by the patient. C. Check whether the patient has high sugar levels. D. Check whether the patient is in contact with any person who has received live attenuated virus. E. Check the cholesterol levels of the patient.

A. Check for signs and symptoms of infections. B. Check whether any recent live vaccinations have been received by the patient. D. Check whether the patient is in contact with any person who has received live attenuated virus.

A 35-year-old woman is diagnosed with stage III breast cancer. She seems to be extremely anxious. What action by the nurse is best? A. Explore the idea of a referral to a breast cancer support group. B. Assess whether there has been any mental illness in her past. C. Encourage the patient to search the Internet for information tonight. D. Ask the patient if sexuality has been a problem with her partner.

A. Explore the idea of a referral to a breast cancer support group. Rationale: Support for the diagnosis would be best with a referral to a breast cancer support group. The Internet may be a good source of information, but the day of diagnosis would be too soon. The nurse could assess the frequency and satisfaction of sexual relations but would not assume that there is a problem in that area. Assessment of mental illness is not an appropriate action.

A patient is scheduled for a breast-conserving surgery (lumpectomy) with radiation therapy. What possible complications does the nurse monitor the patient for? Select all that apply. A. Hematoma B. Lymphedema C. Breast edema D. Breast soreness E. Chest wall tightness

A. Hematoma C. Breast edema D. Breast soreness

An older adult patient who had a mastectomy for breast cancer six months ago wants to have breast reconstructive surgery. The nurse knows that what is the most likely motivation for this patient seeking this surgery? A. Improvement of the woman's self-image B. Being able to experience sexual arousal C. Getting a tummy tuck as well as the breast mound D. Restoring the premastectomy appearance of the breast

A. Improvement of the woman's self-image

The nurse is caring for a patient who underwent a partial mastectomy with axillary lymph node dissection. For which signs and symptoms should the nurse monitor to detect lymphedema? Select all that apply. A. Inability to move the arm B. Heaviness and pain in the arm C. Tingling sensation in the fingers D. Unbearable itching along the suture line E. Decreased strength of the arm muscles

A. Inability to move the arm B. Heaviness and pain in the arm C. Tingling sensation in the fingers

A patient is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug? A. It selectively blocks estrogen in the breast. B. It interferes with cancer cell division. C. It blocks the release of luteinizing hormone. D. It inhibits DNA synthesis in rapidly dividing cells.

A. It selectively blocks estrogen in the breast. Rationale: Tamoxifen (Nolvadex) reduces the estrogen available to breast tumors to stop or prevent growth. This drug does not block the release of luteinizing hormone to prevent the ovaries from producing estrogen; leuprolide (Lupron) does this. Chemotherapy agents such as ixabepilone (Ixempra) interfere with cancer cell division, and doxorubicin (Adriamycin) inhibits DNA synthesis in susceptible cells.

What topics should the nurse include in discharge teaching for a patient who underwent an axillary lymph node dissection? Select all that apply. A. Management of drains B. Upper limb exercises C. Deep breathing exercises D. Self-monitoring of vital signs E. Self-administration of chemotherapy

A. Management of drains B. Upper limb exercises C. Deep breathing exercises

A patient who has undergone surgery for breast cancer reports muscle weakness and loss of sense of touch. Which surgery does the nurse understand the patient likely has undergone? A. Modified radical mastectomy B. Lumpectomy with radiation therapy C. Tissue expansion and breast implantation D. Breast reconstruction tissue flap procedure

A. Modified radical mastectomy

A patient's treatment plan includes a surgery that involves removal of the breast, preservation of the pectoralis muscles, sentinel lymph node dissection (SLND), and axillary lymph node dissection. The nurse expects that the surgical consent will list what procedure? A. Modified radical mastectomy B. Tissue expansion and breast implants C. Deep inferior epigastric artery perforator (DIEP) flap D. Transverse rectus abdominis musculocutaneous (TRAM) flap

A. Modified radical mastectomy

Which finding in a female patient by the nurse would receive the highest priority of further diagnostics? A. Nontender immobile mass in the upper outer quadrant of the breast B. A 3-cm firm, defined mobile mass in the lower quadrant of the breast C. Small, painful mass under warm reddened skin D. Tender moveable masses throughout the breast tissue

A. Nontender immobile mass in the upper outer quadrant of the breast Rationale: Malignant lesions are hard, nontender, and usually located in the upper outer quadrant of the breast and would be the priority for further diagnostic study. The other lesions are benign breast disorders. The tender moveable masses throughout the breast tissue could be a fibrocystic breast condition. A firm, defined mobile mass in the lower quadrant of the breast is a fibroadenoma, and a painful mass under warm reddened skin could be a local abscess or ductal ectasia.

Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes? A. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. B. Insist that the patient examine the surgical incision when the initial dressings are removed. C. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. D. Obtain a permanent breast prosthesis before the patient is discharged from the hospital.

A. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. Rationale: The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

The nurse is explaining the clinical manifestations of breast cancer to a group of young women. Which characteristics are true for breast cancer? Select all that apply. A. Presence of nipple retraction B. Presence of a lump in the breast that is highly mobile and tender C. Presence of peau d'orange in the skin of the involved breast D. Presence of a lump that is irregular in shape and poorly delineated E. Presence of a lump in the lower outer quadrant of the breast

A. Presence of nipple retraction C. Presence of peau d'orange in the skin of the involved breast D. Presence of a lump that is irregular in shape and poorly delineated

When teaching a patient about the prevention of breast cancer, what should be included as helpful in decreasing the risk of breast cancer? Select all that apply. A. Prevent smoking and alcohol intake. B. Prevent exposure to harmful radiation. C. Increase the use of oral contraceptives. D. Prevent gaining excess weight during adulthood. E. Use combined hormone therapy (progesterone and estrogen) after menopause.

A. Prevent smoking and alcohol intake. B. Prevent exposure to harmful radiation. D. Prevent gaining excess weight during adulthood.

The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? A. Question the patient about current medications. B. Refer the patient for mammography. C. Teach the patient how to palpate the breast tissue for lumps. D. Explain that this is temporary due to hormonal changes.

A. Question the patient about current medications. Rationale: The first action should be further assessment. Because gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.

The primary health care provider has performed an estrogen and progesterone receptor status test for a patient with breast cancer. The result of this test has revealed that the tumor is receptor positive. Which statements appropriately convey the meaning of the test results to the patient? Select all that apply. A. The tumor cells have a higher normal DNA content than do other types. B. The tumor has a low chance of recurrence. C. The tumor cells are poorly differentiated. D. The tumor will multiply at a very fast rate. E. The tumor will respond well to hormone therapy.

A. The tumor cells have a higher normal DNA content than do other types. B. The tumor has a low chance of recurrence. E. The tumor will respond well to hormone therapy.

A patient has been diagnosed as having breast cancer stage TNM IIIC. The nurse has to convey the meaning of TNM IIIC. Which points should the nurse include in the explanation? Select all that apply. A. The tumor size is more than 5 cm. B. The tumor will respond well to hormone therapy. C. The cancer has affected the bone and spinal cord. D. The cancer has spread to more than 10 adjacent lymph nodes. E. The cancer is unresponsive to therapy.

A. The tumor size is more than 5 cm. D. The cancer has spread to more than 10 adjacent lymph nodes.

A patient recently underwent a radical mastectomy and wishes to have breast reconstruction surgery. What information should the nurse give the patient before she gives the consent for surgery? Select all that apply. A. This surgery will not restore lactation. B. The surgery will not restore nipple sensation or erectility. C. This surgery would be useful in preserving self-image and regaining a sense of normalcy. D. The postsurgical look of the breast will fully resemble its pre-mastectomy appearance. E. The postsurgical treatment will require an external prosthesis to restore the contour of the breast.

A. This surgery will not restore lactation. B. The surgery will not restore nipple sensation or erectility. C. This surgery would be useful in preserving self-image and regaining a sense of normalcy.

A nurse is reviewing the record of a patient with breast cancer to determine the cancer stage according to the TNM system (tumor size, nodal involvement, presence of metastasis). Which parameters are taken into account in TNM staging of cancers? Select all that apply. A. Tumor size B. Metastasis C. Number of tumors D. Lymph node involvement E. Response to hormonal therapy

A. Tumor size B. Metastasis D. Lymph node involvement

When using the accompanying illustration to teach a patient about breast self-examination, the nurse will include the information that most breast cancers are located in which part of the breast? A. Upper Outer Quadrant B. Upper Inner Quadrant C. Nipple D. Lower Outer Quadrant E. Lower Inner Quadrant

A. Upper Outer Quadrant Rationale: The upper outer quadrant is the location of most of the glandular tissue of the breast.

The nurse is caring for a patient with breast cancer receiving trastuzumab therapy. What conditions could result as adverse effects of the drug that the nurse should monitor for? Select all that apply. A. Ventricular dysfunction B. Heart failure C. Deep vein thrombosis D. Gastroenteritis E. Retinopathy

A. Ventricular dysfunction B. Heart failure

The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that: A. the patient should call if she notices ankle swelling. B. the patient will need frequent eye examinations. C. hot flashes may occur with the medication. D. serum electrolyte levels will be drawn monthly.

A. the patient should call if she notices ankle swelling. Rationale: Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.

A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that: A. the tumor is not likely to be responsive to hormone therapy. B. HER-2 receptor testing was repeated for a total of three samples. C. estrogen receptor testing identified the three hormones causing the cancer. D. treatment with chemotherapy is not likely to be recommended.

A. the tumor is not likely to be responsive to hormone therapy. Rationale: A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected, with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care? A. Evaluate left arm lymphatic accumulation. B. Maintain joint flexibility and left arm function. C. Teach the patient about chemotherapy and radiation therapy. D. Assess the patient's response to the diagnosis of breast cancer.

D. Assess the patient's response to the diagnosis of breast cancer.

A patient has been diagnosed with a noninvasive form of breast cancer. What type of cancer should the nurse educate the patient about? A. Tubular carcinoma B. Mucinous carcinoma C. Medullary carcinoma D. Ductal carcinoma in situ

D. Ductal carcinoma in situ

During a well-woman physical examination, a 43-yr-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? A. "Do you currently smoke tobacco?" B. "At what age did you start having menstrual periods?" C. "Have you ever had a breast injury?" D. "Is there a family history of fibrocystic breast changes?"

B. "At what age did you start having menstrual periods?" Rationale: Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

The nurse provides discharge teaching for a 61-yr-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? A. "I will keep my left arm in a sling until the incision is healed." B. "I will avoid reaching over the stove with my left hand." C. "I will stop the left arm exercises if moving the arm is painful." D. "I will need to use my right arm and to rest the left one."

B. "I will avoid reaching over the stove with my left hand." Rationale: The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

A patient is preparing to begin breast cancer treatment with tamoxifen. What point should the nurse emphasize when teaching the patient about the new drug regimen? A. "You may find that your medication causes some breast sensitivity." B. "It's important that you let your health care provider know about any changes in your vision." C. "You'll find that this drug often alleviates some of the symptoms that accompany menopause." D. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."

B. "It's important that you let your health care provider know about any changes in your vision."

The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which guidelines should the nurse provide to the audience? A. "Mammograms are necessary if you have a family history of breast cancer." B. "It's recommended that you get a mammogram each year after you turn 40." C. "If you are not able to perform breast self-examination (BSE), you should go for regular mammograms." D. "You should ensure that your primary health care provider performs a breast examination each time you visit."

B. "It's recommended that you get a mammogram each year after you turn 40."

A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? A. "I will probably need radiation to the breast after having the surgery." B. "Mastectomy is the best choice to decrease the chance of cancer recurrence." C. "I can probably have reconstructive surgery at the same time as a mastectomy." D. "There are several options that I can consider for treating the cancer."

B. "Mastectomy is the best choice to decrease the chance of cancer recurrence." Rationale: The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the patient indicates a lack of understanding? A. "One cup of coffee in the morning should be enough for me." B. "This condition will become malignant over time." C. "I should refrain from using hormone replacement therapy." D. "This condition makes it more difficult to examine my breasts."

B. "This condition will become malignant over time." Rationale: Fibrocystic breast condition does not increase a woman's chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.

Which information will the nurse include in patient teaching for a 36-yr-old patient who is scheduled for stereotactic core biopsy of the breast? A. A thin needle will be inserted into the lump and aspirated to remove tissue. B. A local anesthetic will be given before the biopsy specimen is obtained. C. You will need to lie flat on your back and lie very still during the biopsy. D. You should not have anything to eat or drink for 6 hours before the procedure.

B. A local anesthetic will be given before the biopsy specimen is obtained. Rationale: A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to obtain the specimens.

A nurse is explaining the mammography procedure to a patient. Which statement best describes the procedure? A. A method of capturing ultrasonic images of the breast B. A method to visualize the breast's internal structure using x-rays C. A method that uses powerful magnetic and radio waves to create images of the breast D. A method that involves inserting a small needle into the breast tissue to obtain a tissue sample

B. A method to visualize the breast's internal structure using x-rays

A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? A. The lumps get more painful before the patient's menstrual period. B. An area on the breast is hot, pink, and tender to the touch. C. Firm, moveable lumps are in the upper outer breast quadrants. D. There is yellow discharge from the patient's right nipple.

B. An area on the breast is hot, pink, and tender to the touch. Rationale: An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. Manifestations of fibrocystic breast changes include one or more palpable lumps that are often round, well delineated, and freely movable within the breast. Discomfort ranging from tenderness to pain may also occur. The lump is usually observed to increase in size and perhaps in tenderness before menstruation. Nipple discharge associated with fibrocystic breasts is often milky, watery-milky, yellow, or green.

A patient who has undergone breast augmentation earlier in the day will be discharged home in the early evening. What instructions should the nurse provide to minimize the patient's risk of complications in the immediate recovery period? A. Avoid wearing a bra until postoperative day three. B. Ask the patient to avoid strenuous exercise during her recovery period. C. Sleep in a semi-Fowler's position until her scheduled follow-up appointment. D. Enlist a friend or family member to perform passive range-of-motion exercises.

B. Ask the patient to avoid strenuous exercise during her recovery period.

A patient is suspected of having Paget's disease. What clinical manifestation assed by the nurse would correlate with this diagnosis? A. Sticky nipple discharge B. Bloody nipple discharge C. Palpable fluid-filled mass D. Hard mass with irregular borders

B. Bloody nipple discharge

A patient who underwent a radical mastectomy expresses concern that she may not look the same. What options should the nurse mention to her that may aid in improving her body image? Select all that apply. A. Self-massaging of the area can be helpful. B. Breast reconstruction surgeries can be considered. C. Estrogen pills can be used to help in developing the breasts. D. Garments such as camisoles with soft breast prosthetic inserts can be used. E. Permanent weighted prosthesis and bra can be used at around four to eight weeks postoperatively.

B. Breast reconstruction surgeries can be considered. D. Garments such as camisoles with soft breast prosthetic inserts can be used. E. Permanent weighted prosthesis and bra can be used at around four to eight weeks postoperatively.

A nurse is teaching a group of teenagers about breast cancer prevention. What topics should the nurse include in the presentation? Select all that apply. A. Yearly regular mammograms starting at age 60 B. Breast self-examinations C. Identification of an at-risk population D. Breast self-examination before the onset of menstruation monthly E. Importance of clinical breast examination yearly after age 40

B. Breast self-examinations D. Breast self-examination before the onset of menstruation monthly E. Importance of clinical breast examination yearly after age 40

A 33-yr-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? A. Take aspirin every 4 hours to reduce inflammation. B. Check wound drains for excessive blood or a foul odor. C. Wear a loose-fitting bra to decrease irritation of the sutures. D. Resume normal activities 2 to 3 days after the mammoplasty.

B. Check wound drains for excessive blood or a foul odor. Rationale: The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

A young adult female patient is having screening for breast cancer but has dense breast tissues. What radiological procedure should the nurse prepare the patient for? A. Ultrasound B. Digital mammography C. Fine needle aspiration D. Sterotactic core needle biopsy

B. Digital mammography

During dressing changes, the nurse assesses a patient who has had breast reconstruction. Which finding would cause the nurse to take immediate action? A. Temperature of 99° F (37.2° C) B. Dusky color of the flap C. Blood pressure of 128/75 mm Hg D. Slightly reddened incisional area

B. Dusky color of the flap Rationale: A dusky color of the breast flap could indicate poor tissue perfusion and a decreased capillary refill. The nurse would notify the surgeon to preserve the tissue. It is normal to have a slightly reddened incision as the skin heals. The blood pressure is within normal limits and the temperature is slightly elevated but would be monitored.

A 51-yr-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that: A. if the biopsy results are negative, no further diagnostic testing will be needed. B. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. C. FNA is guided by a mammogram, ensuring that cells are taken from the lesion. D. only a small incision is needed, resulting in minimal breast pain and scarring.

B. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. Rationale: FNA is done in outpatient settings, and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound but not by mammogram. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA results are negative.

A patient with breast cancer chooses to undergo a radical mastectomy and take hormone therapy but is concerned about the effects of this treatment on her sex life. What information should the nurse provide the patient? Select all that apply. A. Mastectomy does decrease sexual satisfaction. B. Hormone therapy may cause a decreased sexual drive. C. Vaginal dryness may be present. D. Sex should be avoided for a few months after surgery. E. Lubrication may be used during sexual intercourse.

B. Hormone therapy may cause a decreased sexual drive. C. Vaginal dryness may be present. E. Lubrication may be used during sexual intercourse.

The nurse is assessing a patient with breast cancer for the presence of any metastasis. The nurse suspects that the patient may have brain involvement. Which signs and symptoms would have led the nurse to this conclusion? Select all that apply. A. Dyspnea B. Incoordination of movements C. Unilateral sensory loss D. Progressive radiating back pain E. Nausea and vomiting which are unrelated to medication

B. Incoordination of movements C. Unilateral sensory loss E. Nausea and vomiting which are unrelated to medication

A patient experiences post-breast therapy pain syndrome (PBTPS). What should the nurse explain to the patient is the cause of this syndrome? A. Accumulation of lymph in soft tissue B. Injury to the intercostobrachial nerves C. Deposition of calcium crystals in the breast D. Increase in estrogen and progesterone levels

B. Injury to the intercostobrachial nerves

A nurse is explaining the sentinel lymph node dissection for diagnosis of cancer to a patient suspected of having breast cancer. Which statements best describe the procedure? Select all that apply. A. It involves dissecting all of the axillary lymph nodes for testing. B. It helps the surgeon identify the lymph nodes that drain first from the tumor site. C. It involves injecting the radioisotope into the affected breast and intraoperatively identifying the sentinel node. D. It confirms that axillary lymph node dissection is more accurate than sentinel lymph node dissection. E. It ensures that if sentinel lymph node dissection is negative, then no further axillary surgery is required.

B. It helps the surgeon identify the lymph nodes that drain first from the tumor site. C. It involves injecting the radioisotope into the affected breast and intraoperatively identifying the sentinel node. E. It ensures that if sentinel lymph node dissection is negative, then no further axillary surgery is required.

When caring for a patient who underwent a mastectomy, what nursing interventions should be performed to prevent shoulder joint complications and restoration of arm movements? Select all that apply. A. Place the patient in a prone position. B. Keep the affected arm elevated on a pillow. C. Keep the affected shoulder immobile after surgery to prevent pain. D. Administer analgesics 30 minutes before the initiation of shoulder exercises. E. Pour warm water on the involved shoulder.

B. Keep the affected arm elevated on a pillow. D. Administer analgesics 30 minutes before the initiation of shoulder exercises. E. Pour warm water on the involved shoulder.

Which task could the registered nurse delegate to unlicensed assistive personnel (UAP) during the care of a patient who has had recent transverse rectus abdominis musculocutaneous (TRAM) flap surgery? A. Document the condition of the patient's incisions. B. Mobilize the patient in a slightly hunched position. C. Change the patient's abdominal and chest dressings. D. Change the parameters of the patient-controlled analgesic (PCA) pump.

B. Mobilize the patient in a slightly hunched position.

The nurse is caring for a patient with breast cancer who is receiving doxorubicin therapy. To prevent complications, which interventions should be included in the care plan? Select all that apply. A. Monitor estrogen levels. B. Monitor for signs of cardiotoxicity. C. Provide a low-protein diet to prevent food interactions. D. Recommend that the patient take aspirin to obtain pain relief. E. Instruct the patient to not receive any immunizations without the health care provider's approval.

B. Monitor for signs of cardiotoxicity. E. Instruct the patient to not receive any immunizations without the health care provider's approval.

The nurse is taking the history of a patient who is scheduled for breast augmentation surgery. The patient reveals that she took two aspirin this morning for a headache. Which action by nurse is best? A. Take the patient's vital signs and record them in the chart. B. Notify the surgeon about the aspirin ingestion by the patient. C. Warn the patient that health insurance may not pay for the procedure. D. Teach the patient about avoiding twisting above the waist after the operation.

B. Notify the surgeon about the aspirin ingestion by the patient. Rationale: The surgeon must be notified immediately since the aspirin could cause increased bleeding during the procedure. Vital signs would be recorded and postoperative teaching would be completed in the preoperative time frame, but these are not the priority since the procedure may be rescheduled. The warning about the patient's health insurance is not appropriate at this time.

A patient who underwent a radical mastectomy is depressed and not coping well. In what ways can the nurse help the patient cope with the depression? Select all that apply. A. Administer an antidepressant drug. B. Provide a comfortable environment to let her express all her feelings. C. Promote communication between the patient and family or friends. D. Teach and encourage the patient to use various coping techniques. E. Avoid the questions being asked by the patient, because talking about such topics may simply accentuate her depression. F. Explain various ways to improve her body image, such as breast reconstruction or use of external implants.

B. Provide a comfortable environment to let her express all her feelings. C. Promote communication between the patient and family or friends. D. Teach and encourage the patient to use various coping techniques. F. Explain various ways to improve her body image, such as breast reconstruction or use of external implants.

A nurse is explaining the procedures involved in modified radical mastectomy surgery to a patient with breast cancer. Which statements best describe the procedure? Select all that apply. A. Wide excision of the tumor B. Removal of the breast C. Removal of axillary lymph nodes D. Removal of pectoralis major muscle E. Insertion of implant under the musculofascial layer of the chest wall

B. Removal of the breast C. Removal of axillary lymph nodes

The nurse is caring for a patient who recently underwent a radical mastectomy. What nursing interventions are appropriate for this patient to manage post-breast therapy pain syndrome (PBTPS)? Select all that apply. A. Explain that the pain occurs due to injury to the motor nerves that supply shoulder and arm muscles. B. Suggest shoulder exercises that would be helpful in preventing frozen shoulder. C. Confirm that the symptoms would persist for not more than two weeks after surgery. D. Administer nonsteroidal antiinflammatory drugs and antidepressants to relieve pain. E. Check whether the patient has chest and upper arm pain, tingling down the arm, numbness, and unbearable itching.

B. Suggest shoulder exercises that would be helpful in preventing frozen shoulder. D. Administer nonsteroidal antiinflammatory drugs and antidepressants to relieve pain. E. Check whether the patient has chest and upper arm pain, tingling down the arm, numbness, and unbearable itching.

Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? A. "I will be taking the medication for 6 to 12 months." B. "I should contact you if I have hot flashes." C. "I will call if I have any eye problems." D. "I can expect to have leg cramps."

C. "I will call if I have any eye problems." Rationale: Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

When the nurse is working in the women's health care clinic, which action is appropriate to take? A. Discuss scheduling an annual clinical breast examination with a 22-year-old patient. B. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI). C. Explain to a 60-yr-old patient that mammography frequency can be reduced to every 3 years. D. Teach a healthy 30-yr-old patient about the need for an annual mammogram.

B. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI). Rationale: MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A woman should have a clinical breast examination about every 3 years for women in their 20s and 30s and every year for women age 40 years and older. Annual mammograms are recommended for women older than 40 years of age.

The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? A. The patient's white blood cell (WBC) count is 5000/μL. B. The patient's apical pulse is irregular. C. The patient eats only 25% of meals. D. The patient complains of fatigue.

B. The patient's apical pulse is irregular. Rationale: Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

The nurse is caring for a patient who is diagnosed with stage I breast cancer. Which assessment finding corresponds with this diagnosis? A. Metastasis is present. B. The size of the tumor is less than 2 cm. C. The axillary lymph nodes are involved. D. The internal mammary lymph nodes are affected.

B. The size of the tumor is less than 2 cm.

The nurse is teaching a female patient who has undergone lymph node excision about measures to reduce lymphedema in the arm. Which action of the patient indicates the need for further teaching? A. Pushing against the wall B. Wearing clothing with loose fitting sleeves C. Placing hands under the head while sleeping D. Applying antibiotic ointment to the injury on the arm

B. Wearing clothing with loose fitting sleeves

The nurse will anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS) about: A. lymphatic mapping. B. tamoxifen C. MammaPrint testing. D. lumpectomy.

B. tamoxifen Rationale: Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about: A. raloxifene (Evista). B. tamoxifen C. estradiol (Estrace). D. trastuzumab (Herceptin).

B. tamoxifen Rationale: Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

A patient is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? A. "Numbness, tingling, and swelling are common sensations after a mastectomy." B. "The risk for lymphedema is a real threat and can be very self-limiting." C. "A risk factor for lymphedema is infection, so wear gloves when gardening outside." D. "You do not need to worry about lymphedema since you did not have radiation therapy."

C. "A risk factor for lymphedema is infection, so wear gloves when gardening outside." Rationale: Infection can create lymphedema; therefore, the patient needs to be cautious with activities using the affected arm, such as gardening. Radiation therapy is just one of the factors that could cause lymphedema. Other risk factors include obesity and presence of axillary disease. The symptoms of lymphedema are heaviness, aching, fatigue, numbness, tingling, and swelling, and are not common after the surgery. Women with lymphedema live fulfilling lives.

A 68-year-old male patient is embarrassed about having bilateral breast enlargement. Which statement by the nurse is the most appropriate? A. "Gynecomastia usually comes from overeating." B. "Breast cancer in men is quite rare." C. "It is good that you came to be carefully evaluated." D. "When you get older, the male breast always enlarges."

C. "It is good that you came to be carefully evaluated." Rationale: The most appropriate statement is the one that is supportive of the patient. A breast mass should be carefully evaluated for breast cancer, even if it is not common. Gynecomastia as a symptom can be related to antiandrogen agents, aging, obesity, estrogen excess, or lack of androgens.

The nurse is preparing a plan of care for a patient to reduce postoperative edema after a mastectomy. Which nursing interventions are recommended? Select all that apply. A. "Elevate the affected arm at night." B. "Apply topical antibiotics and a sterile dressing." C. "Perform isometric exercises to the affected arm." D. "Take analgesics 30 minutes before your exercises." E. "Massage therapy of the lymph areas may be helpful." F. "Wear intermittent compression sleeves during the day."

C. "Perform isometric exercises to the affected arm." D. "Take analgesics 30 minutes before your exercises." E. "Massage therapy of the lymph areas may be helpful." F. "Wear intermittent compression sleeves during the day."

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? A. "Many patients do better after surgery if they have more information." B. "It is essential that you know enough to provide informed consent." C. "Tell me what you think is important to know about the surgery." D. "You can wait until after surgery for teaching about pain management."

C. "Tell me what you think is important to know about the surgery." Rationale: This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

A 58-yr-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? A. "It would not be appropriate for me to make a decision about your health." B. "I would have a lumpectomy, but you need to decide what is best for you." C. "Tell me what you understand about the surgical options that are available." D. "There is no need to make a decision rapidly; you have time to think about this."

C. "Tell me what you understand about the surgical options that are available." Rationale: Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication.

The nurse is providing preoperative teaching for a patient prior to a simple mastectomy. Which nursing statement is correct? A. "Only the breast mass will be removed." B. "The mammary glands will be removed." C. "The breast tissue and mammary glands will be removed." D. "The lymph nodes and mammary glands will be removed."

C. "The breast tissue and mammary glands will be removed."

Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? A. A breast lump that increases in size before the menstrual period B. A breast lump that is small, mobile, with a rubbery consistency C. A breast nodule that is 1 cm in size, nontender, and fixed D. Bilateral breast nodules that are tender with palpation

C. A breast nodule that is 1 cm in size, nontender, and fixed Rationale: Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.

A patient is suspected to have distant metastasis of breast cancer to the spinal cord. What clinical manifestation does the nurse anticipate assessing? A. Muscular weakness B. Swelling in the abdomen C. Change in bowel function D. Loss of sensation on one side

C. Change in bowel function

A man is determined to be at risk for breast cancer during a routine health screening by the nurse. The patient does not give any history of radiation exposure or genetic inheritance. Which other factor would have led the nurse to label the patient as high risk? A. History of on and off fever B. History of allergic rashes C. History of taking hormone replacement therapy for changing sex D. History of sudden excessive hair loss resulting in alopecia

C. History of taking hormone replacement therapy for changing sex

A patient who underwent a radical mastectomy has developed lymphedema. What measures should the nurse take to reduce lymphedema in this patient? Select all that apply. A. Regular blood pressure readings should be taken from the affected arm. B. Intravenous injections should be given on the affected arm. C. Isometric exercises of the affected side should be performed. D. The affected arm should not be placed in the dependent position for a long period of time. E. The affected side should be washed with soap and water if trauma occurs.

C. Isometric exercises of the affected side should be performed. D. The affected arm should not be placed in the dependent position for a long period of time. E. The affected side should be washed with soap and water if trauma occurs.

A nurse is educating a patient with breast cancer who is hesitant to undergo radiation therapy. Which statements best explain the advantages of radiation therapy to reassure the patient? Select all that apply. A. It helps to prevent the development of lymphedema. B. It ensures that there are no rashes or other skin changes associated with this surgery. C. It helps to relieve pain caused by local or distant recurrence. D. It helps to prevent local and nodal recurrences after mastectomy. E. It helps to prevent local breast cancer recurrences after a breast-conserving surgery.

C. It helps to relieve pain caused by local or distant recurrence. D. It helps to prevent local and nodal recurrences after mastectomy. E. It helps to prevent local breast cancer recurrences after a breast-conserving surgery.

A nurse is providing care for a patient who underwent a left modified radical mastectomy and is now in the immediate postoperative phase. To help prevent the development of lymphedema, what intervention should the nurse perform? A. Range-of-motion exercises on the patient's left arm B. Placing the left arm in an extended and dependent position C. Keeping the left arm elevated on pillows higher than the axilla D. Encouraging the patient to perform isometric exercises with the left arm

C. Keeping the left arm elevated on pillows higher than the axilla

A patient with breast cancer reports shortness of breath, weakness, and lightheadedness. The laboratory reports reveal a count of 2.2 million red blood cells/μL and a hemoglobin value of 8.4 g/dL. Which condition does the primary health care provider suspect? A. Metastasis to the brain B. Metastasis to the spinal cord C. Metastasis to the bone marrow D. Metastasis to the skeletal muscle

C. Metastasis to the bone marrow

Which nursing intervention is most appropriate for a patient who has undergone breast reconstruction surgery? A. Positioning the patient on the affected side B. Maintaining even pressure on the patient's wound C. Preventing the patient from having chills and shivering D. Raising the patient's arm over her head four times a day

C. Preventing the patient from having chills and shivering

The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? A. Saline-filled implants are placed under the pectoral muscles. B. Muscle tissue removed from the back is used to form a breast C. Recovery from the TRAM surgery takes at least 6 to 8 weeks. D. TRAM flap procedures may be done in outpatient surgery centers.

C. Recovery from the TRAM surgery takes at least 6 to 8 weeks. Rationale: Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.

A patient is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and fluorouracil (5-FU) for breast cancer. Which side effect seen in the patient would the nurse report to the provider immediately? A. Mucositis B. Nausea and vomiting C. Shortness of breath D. Hair loss

C. Shortness of breath Rationale: Doxorubicin (Adriamycin) can cause cardiac problems with symptoms of extreme fatigue, shortness of breath, chronic cough, and edema. These need to be reported as soon as possible to the provider. Nausea, vomiting, hair loss, and mucositis are common problems associated with chemotherapy regimens.

A patient reports tenderness and a lump in the breast. The primary health care provider records the size of the tumor to be 7 cm. The pathology report reveals two lymph nodes to be cancerous. Which stage of cancer is described? A. Stage 0 B. Stage 1 C. Stage 2 D. Stage 3

C. Stage 2

A patient has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe? A. Elevating the right arm on a pillow B. Checking the amount of urine in the urine catheter collection bag C. Taking the blood pressure on the right arm D. Encouraging the patient to squeeze a rolled washcloth

C. Taking the blood pressure on the right arm Rationale: Healthcare professionals need to avoid the arm on the side of the surgery for blood pressure measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage would be compromised. The pressure from the blood pressure cuff could promote swelling. Infection could occur with injections and blood draws. Checking urine output, elevation of the affected arm on a pillow, and encouraging beginning exercises are all safe postoperative interventions.

A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? A. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. B. HT does not appear to increase the risk for breast cancer unless there are other risk factors. C. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. D. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

C. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. Rationale: Because HT has been linked to increased risk for breast cancer, the patient and health care provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants? A. Inappropriate lactation necessitates breast biopsy. B. Nipple discharge of any type is considered a precursor to cancer. C. Unexpected nipple discharge of any type warrants medical follow-up. D. Galactorrhea is a normal age-related change and a frequent perimenopausal symptom.

C. Unexpected nipple discharge of any type warrants medical follow-up.

With a history of breast cancer in the family, a 48-year-old female patient is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the patient indicates that more teaching is needed? A. "I am fortunate that I breast-fed each of my three children for 12 months." B. "It looks as though I need to start working out at the gym more often." C. "When I have menopausal symptoms, I must avoid hormone replacement therapy." D. "I am glad that we can still have wine with every evening meal."

D. "I am glad that we can still have wine with every evening meal." Rationale: Modifiable risk factors can help prevent breast cancer. The patient should lessen alcohol intake and not have wine 7 days a week. Breast-feeding, regular exercise, and avoiding hormone replacement are also strategies for breast cancer prevention.

A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase: 125 U/L (2.2 mckat/L) Total calcium: 12 mg/dL (3 mmol/L) Hematocrit: 39% (0.39) Hemoglobin: 14 g/dL (140 mmol/L) Which test results indicate to the nurse that some further diagnostics are needed? A. The elevated hematocrit and hemoglobin indicate dehydration. B. Only alkaline phosphatase is decreased, suggesting liver metastasis. C. Hematocrit and hemoglobin are decreased, indicating anemia. D. Elevated alkaline phosphatase and calcium suggests bone involvement.

D. Elevated alkaline phosphatase and calcium suggests bone involvement. Rationale: The alkaline phosphatase (normal value 30 to 120 U/L [0.5 to 2.0 mckat/L)) and total calcium (normal value 9 to 10.5 mg/dL [2.25 to 2.63 mmol/L) levels are both elevated, suggesting bone metastasis. Both the hematocrit and hemoglobin are within normal limits for females.

The nurse is educating a patient about the risks of breast cancer. Which information will the nurse include in this teaching? A. Breast self-exams should be done monthly. B. Breast cancer is rare in men and is not of any concern to them. C. Breast cancer is the leading cause of cancer deaths in women. D. Hyperplasia increases the cancer risk and leads to breast cancer.

D. Hyperplasia increases the cancer risk and leads to breast cancer.

A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate? A. Inform the patient that this surgery removes all mammary tissue and cancer risk. B. Discourage this surgery since the woman is still of childbearing age. C. Reassure the patient that reconstructive surgery is as easy as breast augmentation. D. Include support people, such as the male partner, in the decision making.

D. Include support people, such as the male partner, in the decision making. Rationale: The cultural aspects of decision making need to be considered. In the Nigerian culture, the man often makes the decisions for care of the female. Women with a high risk for breast cancer can consider prophylactic surgery. If reconstructive surgery is considered, the procedure is more complex and will have more complications compared to a breast augmentation. There is a small risk that breast cancer can still develop in the remaining mammary tissue.

Which intervention would the nurse include in the care plan for a patient who is on doxorubicin and cyclophosphamide therapy? A. Monitor for signs of stroke. B. Monitor for vaginal bleeding. C. Monitor for signs of pulmonary embolism. D. Monitor for electrocardiogram (ECG) changes.

D. Monitor for electrocardiogram (ECG) changes.

A patient is diagnosed with a fibrocystic breast condition while in the hospital and is experiencing breast discomfort. What comfort measure would the nurse delegate to the unlicensed assistive personnel (UAP)? A. Administer diuretics to decrease breast swelling. B. Teach the patient to wear a supportive bra to bed. C. Aid in the draining of the cysts by needle aspiration. D. Obtain a cold pack to temporarily relieve the pain.

D. Obtain a cold pack to temporarily relieve the pain. Rationale: All of the options would be comfort measures for a patient with a fibrocystic breast condition. The UAP can obtain the cold or heat therapy. Only the nurse would aid the healthcare provider with a needle aspiration, teach, and administer medications.

A nurse is reviewing medication orders for several patients. Which prescription should the nurse question? A. Patient with mastalgia and prescribed Danazol B. Patient with tuberculosis and prescribed Isoniazid C. Patient with hyperacidity and prescribed Ranitidine D. Patient with breast cancer and prescribed Spironolactone

D. Patient with breast cancer and prescribed Spironolactone

Which condition does the nurse suspect in a patient who underwent the surgical removal of one breast six months ago and reports a tingling sensation, numbness in the arm, and unmanageable itching? A. Ductal ectasia B. Paget's disease C. Lactational mastitis D. Post-breast therapy pain syndrome (PBTPS)

D. Post-breast therapy pain syndrome (PBTPS)

A patient recently has had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? A. Immobilize the patient's right arm until postoperative day three. B. Maintain the patient's right arm in a dependent position when at rest. C. Administer diuretics prophylactically for the prevention of lymphedema. D. Promote gradually increasing mobility as soon as possible following surgery.

D. Promote gradually increasing mobility as soon as possible following surgery.

The nurse teaching a young women's community service group about breast self-examination (BSE) will include that: A. annual mammograms should be scheduled in addition to BSE. B. BSE will reduce the risk of dying from breast cancer. C. BSE should be done daily while taking a bath or shower. D. performing BSE after the menstrual period is more comfortable.

D. performing BSE after the menstrual period is more comfortable. Rationale: Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.