Breast Cancer - HESI
After receiving vancomysin (Vancocin) for 7 days, Chandra complains that her mouth is painful when she swallows. When assessing her mouth, the nurse visualizes white, patchy lesions. What is the most probable cause of this finding?
Candida superinfection
The nurse is discussing the situation with the graduate nurse and UAP. What should the nurse emphasize in the discussion?
Both the graduate nurse and the UAP are at fault for the incorrect action of the UAP
Chandra talks about the modifiable risk factors for breast cancer. Which modifiable risk factors should Chandra discuss?
Breastfeed for a year or more
At the community education program, Chandra learns that breast self-exam (BSE) is best performed 7 days after the start of the menstrual flow when the breasts are least engorged and tender. Since Chandra had a hysterectomy 5 years ago, she does not have periods. She asks the nurse if she still needs to perform BSE, and so, when.
Select whatever day you can best remember to perform BSE consistently every month
Since Chandra's tumor is estrogen-receptor negative, she is not a candidate for hormonal therapy. Tamoxifen (Nolvadex) is an antiestrogen drug that is often used to prevent or treat recurrent breast cancer. Chandra states that a friend of hers took this drug and has had no recurrence of her breast cancer. The nurse asks Chandra if her friend experienced any problems when taking Tamoxifen (Nolvadex). Which side effect is most often associated with Tamoxifen?
Hot flashes
Which ethical principle has the greatest weight in the nurse's decision to inform Chandra's surgeon about the snack?
Nonmaleficence
A multi-lumen central line has been inserted and the nurse is preparing to administer a dose of chemotherapy through the central line by first flushing the IV lumens. The nurse notes that two of the four lumens do no flush easily. What intervention is appropriate for the nurse to implement?
Notify the HCP that the central line is no longer functional
The nurse confirms that Chandra has signed the informed consent for surgery, but learns that Chandra does not understand the procedure for breast reconstruction that is to be performed. What action should the nurse implement?
Notify the surgeon that further explanation of the procedure is necessary
After surgery, Chandra is admitted to the PACU for immediate postoperative management. Which nursing actions have the highest priority in the initial postoperative period? (Select all that apply.)
Observe the Jackson-Pratt drainage device Place head of the bed up at least 30 degrees with affected arm elevated on a pillow Monitor vital signs and pulse oximetry
The nurse reviews signs and symptoms of breast cancer, including nipple discharge and retraction. The nurse describes a change called peau d'orange. Which symptom of breast cancer does this describe?
Unusual skin texture
Which nursing care measures will be most beneficial in the management of Chandra's highest priority problem? (Select all that apply._)
Apply a sequential compression device Elevate the affected arm
Chandra seems happy and she tells the nurse that she received some good news. She states that her tumor was negative for estrogen receptor sites. She continues, "That means I have less likelihood of a recurrence or spread of the cancer." What action should the nurse take first?
Ask Chandra to clarify how she learned this information so that a plan for further teaching can be developed.
Chandra goes on to say, "I can control this. I will start exercising and I will change my eating habits That will take care of it." How should the nurse respond?
"It sounds like you do not want to have surgery."
A mass is seen on Chandra's mammogram, and a follow-up stereotactic core needle biopsy is performed. The tumor specimen is found to be cancerous. Chandra learns that she has a cancerous tumor requiring surgery. She tells the nurse, "They make mistakes. I know that happens. My specimen probably got switched with someone else's, right?"
"It's hard to believe that this is happening, isn't it?"
Chandra is disappointed to learn that she will not benefit from hormonal therapy, but she states that her friend indicated that taking the medication was like experience menopause. How should the nurse respond?
"The medication decreases estrogen levels, which is what also causes the symptoms of menopause."
Chandra decides to have surgery and is scheduled for a modified radical mastectomy with immediate abdominal myocutaneous flap reconstruction. A modified radical mastectomy involves removal of breast tissue and lymph nodes, but it conserves the pectoralis major muscle. The reconstruction involves the use of a flap of skin and muscle from the abdomen to create a breast mound. Chandra arrives at the Surgery Center 2 hours before her scheduled surgery. The nurse confirms Chandra's NPO status. Chandra states, "I had a cracker this morning before I came here. I am so nervous. I have to have this surgery today, or I will back out. Please don't tell anyone." What is the best response by the nurse?
"To ensure your safety, I need to notify the surgeon of the crackers you ate."
It is time for Chandra's vancomycin (Vancocin). The vancomycin (Vancocin) IV 1 g is in a 250 mL bag of 0.9% normal saline to be delivered in 1 hour. The IV tubing set is 15 drops/mL. How many drops per minute would the nurse set on the IV pump? (Enter the numerical value only. If rounding is necessary, round to the whole number._)
63 250 x 15/60 minutes = 62.5 rounded to 63 drops/min
Chandra's resulting cellulitis from her injury and the complication of lymphedema are resolved and she is discharged. She will continue with further chemotherapy, and she is aware of the need for regular follow-up to assess for cancer recurrence both locally and distally. Chandra is asked to speak at a women's health symposium to share her experiences with breast cancer. She works with the nurse to develop her presentation. The nurse begins by discussing risk factors for breast cancer. Which client's history indicates the person at highest risk for breast cancer?
A 65 year old woman, who is a retired teacher and who never married or had children
Another woman in the class said she had heard that there is a genetic test that would diagnose breast cancer. What is the best response by the nurse?
A positive test for the BRCA 1 mutation identifies an increased risk for breast cancer, but is not a certainty
The nurse enters Chandra's room and observes that a graduate nurse is assessing Chandra's dressing while the unlicensed assistive personnel (UAP) takes postoperative vital signs. The UAP is preparing to take Chandra's BP on her operative side because there is an IV in the other arm. Which action should the nurse implement first?
Advise the UAP to immediately stop and obtain the blood pressure in the nonoperative arm
Which nursing diagnosis should be reflected in Chandra's plan of care?
Anticipatory grieving
Because of her relatively young age, and the presence of a positive lymph node, Chandra elects to take chemotherapy to reduce her risk of recurrence. The nurse prepares Chandra for common adverse effects that she may experience. Which adverse effects most often associated with antineoplastic chemotherapy used to treat breast neoplasms should be included in this discussion? (Select all that apply.)
Diarrhea Alopecia
After Chandra is awake and stable, she is moved from the PACU to the regular post-op unit. The nurse observes Chandra performing wrist flexion and extension exercises 4 hours after surgery. What action should the nurse take?
Encourage Chandra to continue performing these exercises
Chandra's prescription include vancomycin (vancocin) IV 1 g every 12 hours, obtain peak and trough levels, ad acetaminophen 500 mg PO for fever > 100 F (37.8 C). When is the best time to obtain the vancomycin serum trough level?
Fifteen minutes prior to administration of the next dose of the drug
Chandra shares with the group that a lump she felt during breast self -exam was the only symptom she had. Which description of a breast lump is most typical of breast cancer?
Hard, irregular, and does not move freely
Chandra has completed her first round of chemotherapy. She calls the nurse to report that she cut her arm on the operative side while doing yard work the previous day and now her arm appears very swollen and tender. Chandra is admitted to the hospital with a medical diagnosis of lymphedema and possible cellulitis. Which assessment findings led to the diagnosis of lymphedema?
Swelling and numbness in the affected arm.
While performing a BSE, Chandra discovers a lump. After seeing her healthcare provider (HCP), Chandra is scheduled for a mammogram. Chandra brings her 60 year old sister in law, Francie with her to the Women's Health Center to learn about mammogram annually because she has no risk factors for breast cancer, except that her father's sister had breast cancer when she was 50. What intervention should the nurse implement first?
Teach Francie that even women with no identified risk factors are at risk
Chandra demonstrates BSE technique for the nurse using a practice model. She uses her fingerpads and states that when lying down, her arm should be relaxed at her side. What instructions should the nurse provide?
When you are lying down, your arm should be positioned over your head.
Francie states that she will schedule a mammogram and she asks the nurse if the x-ray is painful. How should the nurse respond?
You may experience some discomfort, but only for a few minutes.
The nurse is aware that treatment with antineoplastic chemotherapeutic agents can cause immunosuppression, which predisposes the client to infection. Which assessment finding would cause the nurse to suspect that an immunosuppressed client has an infection?
oral temperature of 99.5 F.
