Breast Cancer - Module 2C
The nurse evaluates teaching provided to a group of community members on breast cancer awareness. Which statement indictates that teaching on risk factors has been effective? (Select all that apply.) A. "Not breastfeeding increases the risk of breast cancer." B. "Having children after age 30 increases the risk of breast cancer." C. "Having previous irradiation of the chest increases the risk of breast cancer." D. "Experiencing menopause after age 50 increases the risk of breast cancer." E. "Having a first- or second-degree relative with breast cancer increases the risk of breast cancer." F. "Having harmful mutations in BRCA1 or BRCA2 suppression increases the risk of breast cancer."
A. "Not breastfeeding increases the risk of breast cancer." B. "Having children after age 30 increases the risk of breast cancer." C. "Having previous irradiation of the chest increases the risk of breast cancer." F. "Having harmful mutations in BRCA1 or BRCA2 suppression increases the risk of breast cancer." Rationale: Not breastfeeding, having children after age 30, previous irradiation of the chest, and presence of harmful mutations in BRCA1 or BRCA2 suppression all increase the risk for breast cancer. Experiencing menopause after age 55, not 50, increases risk. Having a first-degree relative, but not having a second-degree relative, with breast cancer increases risk.
The nurse is reviewing care instructions for a client who had a radical mastectomy of the right breast. Which instructioni is appropriate for the nurse to include in the teaching session? (Select all that apply.) A. "Sleep with the right arm elevated on a pillow." B. "You will be able to resume playing golf with your friends." C. "You should apply hot compresses to the right arm if it is aching." D. "Do not allow anyone to take your blood pressure in the right arm." E. "It is okay to carry your purse on your right arm as long as it is not heavy."
A. "Sleep with the right arm elevated on a pillow." D. "Do not allow anyone to take your blood pressure in the right arm." Rationale: Elevation of the affected extremity after lymph node removal will allow drainage of fluid, prevent swelling, and promote circulation. Compression of the arm on the surgical side may increase the risk of developing lymphedema. The client should avoid carrying a purse or a briefcase on the affected arm. The client should avoid hot water contact on the affected extremity. Heat promotes vasodilation and fluid accumulation. Sports such as golf should be avoided in a client with a radical mastectomy.
A client has a mass that has been identified by a mammogram. Which test may be ordered to further differentiate the mammogram results? A. Chest x-ray B. Breast biopsy C. PET scan D. HER2/neu testing
B. Breast biopsy Rationale: A breast biopsy may be used to further assess the tumor identified in the mammogram. A PET scan would not be used to further confirm the diagnosis of breast cancer. Rather, this test is used to assess for metastasis. A chest x-ray will not further differentiate mammogram results. HER2/neu testing is used to guide prognosis and treatment.
The nurse is caring for a client who is scheduled for a biopsy of a suspicious mass in the breast. The client is crying and is tachycardic and tachypneic. Based on this assessment data, which problem is a priority? A. Risk for infection B. Impairment of gas exchange C. Body image disturbance D. Anxiety
D. Anxiety Rationale: The client is exhibiting signs and symptoms of anxiety, which is a common nursing problem in clients with a breast disorder. The data provided do not support the nursing problems of risk for infection, body image disturbance, or impaired gas exchange.
The nurse reviews a list of clients scheduled for women's health visits. For which age range should the nurse emphasize the importance of early detection and treatment of breast cancer? A. 75-79 B. 50-54 C. 60-64 D. 45-49
A. 75-79 Rationale: The incidence of breast cancer is highest in women between the ages of 75 and 79 years in the United States. Even so, all women should be counselled on actions for prevention and early detection of breast cancer.
A client with metastatic breast cancer asks where the cancer has spread. Which site should the nurse include in the response? (Select all that apply.) A. Bone B. Liver C. Brain D. Lungs E. Kidney
A. Bone B. Liver C. Brain D. Lungs Rationale: Common sites for metastasis from breast cancer include the brain, liver, bone, and lungs. The kidney is not considered a common site for metastasis from breast cancer.
The nurse is updating the care plan for a client recovering from a mastectomy. Which should the nurse include to prevent infection? (Select all that apply.) A. Change dressings and IV tubing using aseptic technique. B. Encourage range-of-motion exercises in the affected arm each shift. C. Observe incision and IV sites for pain, redness, swelling, and drainage. D. Assess surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. E. Tell the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed.
A. Change dressings and IV tubing using aseptic technique. C. Observe incision and IV sites for pain, redness, swelling, and drainage. D. Assess surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. E. Tell the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed. Rationale: The care plan would include changing dressings and IV tubing using aseptic technique; observing incision and IV sites for pain, redness, swelling, and drainage; and assessing surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. Telling the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed will also help to prevent infection. Encouraging range-of-motion exercises in the affected arm will help to promote optimal circulation.
The nurse prepares to visit the home of a client recovering from a mastectomy for breast cancer. Which should be included in the ongoing care of this client? (Select all that apply.) A. Postmastectomy exercises B. Signs and symptoms of infection C. Importance of adequate rest periods D. Possible participation in a support group E. Keeping the affected limb immobile as much as possible
A. Postmastectomy exercises B. Signs and symptoms of infection C. Importance of adequate rest periods D. Possible participation in a support group Rationale: The ongoing care of the client who has undergone surgical interventions for breast cancer include telling about the importance of adequate rest, talking about signs and symptoms of infection, teaching postmastectomy exercises, and possibly participating in a support group. The client should be encouraged to use the affected limb for daily needs to maintain function and strength; the client should not keep it immobile.
The nurse prepares a teaching poster for placement in a women's health clinic. Which activity should the nurse identify to help prevent breast cancer? (Select all that apply.) A. Refraining from smoking B. Engaging in physical activity C. Completing monthly self-breast exams D. Limiting hormone therapy in duration and dose E. Avoiding exposure to environmental pollution and radiation
A. Refraining from smoking B. Engaging in physical activity D. Limiting hormone therapy in duration and dose E. Avoiding exposure to environmental pollution and radiation Rationale: Refraining from smoking, engaging in physical activity, limiting hormone therapy in duration and dose, and avoiding exposure to environmental pollution and radiation can all help prevent the development of breast cancer. Completing monthly self-breast exams can help detect breast cancer early but does not prevent breast cancer.
A client with breast cancer is scheduled for radiation prior to surgery. Which situation supports the use of radiation prior to surgery? A. The tumor is unusually large. B. The tumor is expressing the HER2/neu receptor. C. Pain from the tumor is severe. D. The cancer has already metastasized.
A. The tumor is unusually large. Rationale: Radiation may be done to shrink an unusually large tumor prior to surgery. Palliative radiation may be used to treat chest wall recurrences and some bone metastases to help control pain and prevent fractures. Radiation is not necessarily indicated if the tumor has already metastasized. Herceptin, not radiation, may be used to stop the growth of tumors that express the HER2/neu receptor.
The nurse assesses a client with dimpling of the skin in the left upper outer quadrant of the right breast and nipple discharge. Which question should the nurse ask to learn if the client is experiencing other clinical manifestations of breast cancer? A. "Have you noticed a rash or skin irritation around the nipple area?" B. "Have you noticed any itching around the nipple or in the area affected by dimpling?" C. "Have you been experiencing any night sweats or low-grade fevers?" D. "Does the skin in the left upper outer quadrant of the right breast feel warm to touch?"
A. "Have you noticed a rash or skin irritation around the nipple area?" Rationale: A persistent rash near the nipple area and skin irritation can both be clinical manifestations of breast cancer. Night sweats, low-grade fevers, itching of the breast and warmth in the affected area are not common manifestations of breast cancer.
The nurse is caring for a client with breast cancer who is having chemotherapy treatments. The client tells the nurse, "I am always tired, cannot concentrate, and am so forgetful." Which statement made by the nurse in response to the client is true? (Select all that apply.) A. "This is also called chemo-brain." B. "This may occur with chemotherapy; however, it is rare." C. "You might want to make notes if needed as a memory aid." D. "This may last up to 2 years after completion of chemotherapy." E. "This is an abnormal side effect of chemotherapy and is very concerning."
A. "This is also called chemo-brain." C. "You might want to make notes if needed as a memory aid." D. "This may last up to 2 years after completion of chemotherapy." Rationale: The client is experiencing a normal side effect of chemotherapy, also called chemo-brain. The nurse should suggest that the client make notes or use other memory aids as needed. These side effects may last up to 2 years after completion of chemotherapy.
The nurse is discussing early detection of breast cancer with a group of teenage women. Which information should the nurse include to decrease the risk for mortality and promote positive client outcomes? A. Encourage genetic testing for BRCA 1 and 2. B. Encourage monthly self-breast exams. C. Encourage annual laboratory tests including red blood cell, white blood cell, and platelets. D. Encourage annual mammograms beginning at age 30.
B. Encourage monthly self-breast exams. Rationale: Early detection does not prevent breast cancer but it can reduce risk for mortality and promote better outcomes. Because of this, clients should be encouraged to do monthly breast self-examinations. Genetic testing, annual mammograms beginning at age 30, and annual laboratory tests would not be recommended to detect early breast cancer.
A client with breast cancer receives diagnostic testing and scan results that indicate a tumor that is 4.2 cm in size with evidence of metastasis to movable ipsilateral axillary nodes only. According to the TNM staging system, how should this client's breast cancer be staged? A. T3 N2 M1 B. T2 N1 M0 C. Tis N1 M0 D. T1 N0 MO
B. T2 N1 M0 Rationale: This client's breast cancer would be staged as T2 N1 M0. T2 indicates a tumor no larger than 5 cm, N1 indicates metastasis to movable ipsilateral axillary nodes, and M0 indicates no distant metastasis. T1 indicates a tumor no larger than 2 cm. This indicates a tumor in situ. T3 indicates a tumor larger than 5 cm. N0 indicates no regional lymph node metastasis. N2 indicates metastasis to ipsilateral fixed axillary nodes. M1 indicates distant metastasis.
A client is diagnosed with adenocarcinoma of the breast. Based upon this diagnosis, where should the nurse expect the source of the cancer to be? A. Mammary layer fatty tissue B. Terminal section of the breast ductal tissue C. Nipple epithelium D. Subcutaneous fat
B. Terminal section of the breast ductal tissue Rationale: Most breast cancers are adenocarcinomas and arise out of the terminal section of the breast ductal tissue.
A college-age client asks the nurse about the relationship between breast cancer and alcohol use. Which response by the nurse provides the most accurate information for this client? A. "The amount of alcohol that increases risk varies from person to person due to differences in metabolism and alcohol tolerance." B. "Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to one drink per day." C. "If you are drinking hard liquor, you should limit it to one per day, but if you are drinking beer or wine, you can have more than one drink per day." D. "They have not established a firm link between alcohol use and breast cancer. Thus I would not be too concerned."
B. "Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to one drink per day." Rationale: Alcohol is a known risk factor for breast cancer. Recommendations include limiting alcohol intake to a maximum of one drink per day. The other statements are not valid.
A client with breast cancer asks which medication will most likely be used for chemotherapy before having surgery. Which medication should the nurse explain as the most common hormone therapy used to treat breast cancer? A. Anastrozole B. Letrozole C. Tamoxifen D. Trastuzumab
C. Tamoxifen Rationale: Tamoxifen is the most common hormone therapy drug used to treat breast cancer. It works by preventing estrogen from attaching to estrogen receptors on the cancer cells, which inhibits tumor growth and ultimately kills tumor cells. Letrozole (an aromatase inhibitor) has Trastuzumab (Herceptin) is used to stop the growth of breast tumors that express the HER2/neu receptor. Anastrozole (Arimidex) is the aromatase inhibitor used as first line treatment in postmenopausal women.
The nurse is providing health counseling to a 32-year-old woman whose mammogram indicates that she has dense breast tissue. Which information should the nurse provide to this client concerning this finding and breast health? A. Dense breast tissue is a protective effect for breast cancer, and rates of breast cancer in women with dense breast tissue are very low. B. Dense breast tissue is very common at this age and does not affect breast health. C. The presence of dense breast tissue increases the risk of breast cancer before the age of 45. D. Precancerous cells are found in dense breast tissue; thus, she should have further screening done for breast cancer.
C. The presence of dense breast tissue increases the risk of breast cancer before the age of 45. Rationale: The presence of dense breast tissue increases the risk of breast cancer before the age of 45. The statement that dense breast tissue is not necessarily common at this age and increases the risk for breast cancer is not valid. Precancerous cells are not necessarily found in dense breast tissue, nor does dense breast tissue provide a protective effect against cancer.
A client with breast cancer asks how a modified radical mastectomy differs from a radical mastectomy. What should the nurse respond to this client? A. "A modified radical mastectomy removes just the tumor and the surrounding margins." B. " A modified radical mastectomy includes removal of the breast followed by immediate breast reconstruction surgery." C. "A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact." D. "A modified radical mastectomy removes the complete breast only."
C. "A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact." Rationale: A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact, whereas a radical mastectomy also removes the chest wall muscles. Removal of only the complete breast is a simple mastectomy. Removal of the tumor and surrounding margins only is a segmental mastectomy. A modified radical mastectomy does not include breast reconstruction.
Which intervention promotes optimal circulation after a surgical intervention for breast cancer? A. Observing the surgical site for redness and swelling B. Assessing for manifestations of lymphedema C. Monitoring surgical drains for amount and color of drainage D. Encouraging range-of-motion exercises in the affected arm
D. Encouraging range-of-motion exercises in the affected arm Rationale: Encouraging range-of-motion exercises in the affected arm will help promote optimal circulation. Assessing for manifestations of lymphedema, observing the surgical site for redness and swelling, and monitoring surgical drains for amount and color of drainage do not help promote optimal circulation.
