Breast Cancer PrepU

The nurse is reviewing the history and physical exam of a woman who has come to the clinic for a routine physical. Which factor would the nurse identify as increasing the client's risk for breast cancer? 39 years of age Asian race menarche at age 14 history of ovarian cancer

A personal history of ovarian cancer is considered a risk factor for breast cancer. Typically, breast cancer is associated with aging (women over 50 years of age). Breast cancer is more common in Whtie women, but Black women are more likely to die of it. Early menarche (before 12 years of age) or late onset of menopause (after age 55 years) is associated with an increased risk for breast cancer.

A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to: drink a lot of water. limit fluid intake. take the medication at bedtime. increase the protein in her diet.

An adverse effect of this drug is the incidence of hemorrhagic cystitis. The nurse should encourage the patient to drink at least 2 liters of fluid a day and, in high-dose therapy, administer the uroprotectant agent mesna. Therapy should include prehydrating the patient orally and intravenously with at least 2 liters of normal saline solution. Potassium and magnesium additives may be indicated. The nurse will monitor urine output vigilantly to ensure an output of at least half of the intake. Taking the medication at bedtime and increasing protein in her diet are not associated with limiting the possible adverse effects of the drug.

A nurse is preparing for a presentation about breast cancer to a local women's group. Which type of breast cancer would the nurse describe as being the most common type? invasive ductal carcinoma invasive lobular carcinoma tubular carcinoma colloid carcinoma

By far the most common breast cancer is invasive ductal carcinoma, accounting for 85% of all cases. Invasive lobular carcinoma accounts for 10% of all cases of breast cancer. Other invasive less common types are tubular carcinoma and colloid carcinoma.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Urine output of 400 ml in 8 hours Serum potassium level of 2.6 mEq/L Blood pressure of 120/64 to 130/72 mm Hg Sodium level of 142 mEq/L

Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

A 38-year-old woman with proliferative breast changes of papilloma asks the nurse about her risk for breast cancer. Which statement of risk is correct? Low unless other relatives have cancer Higher because of your papilloma High due to your increasing age Lower as a result of your exercising

Clients with proliferative lesions such as calcifications, hyperplasia, sclerosing adenosis, and intraductal papillomas should be evaluated regularly because if these lesions develop atypical cells, they are more likely to develop into cancerous growths. Cancer risk increases when a woman has several first-degree relatives with breast cancer, is obese, is older, has a history of benign breast disease, is childless or did not breast-feed, consumes more than one alcoholic beverage per day, and had early onset of menstruation or late menopause.

A client with metastatic breast cancer is undergoing chemotherapy. What adverse effects should the nurse identify as resulting from the drugs' lack of complete selective toxicity? (Select all that apply.) The client has mouth pain resulting from stomatitis. The client has alopecia. The client reports intense fatigue and malaise. The client reports a complete loss of appetite. The client reports nausea and has vomited twice in 24 hours.

Correct response: The client has mouth pain resulting from stomatitis. The client has alopecia. Explanation: The lack of complete selective toxicity in chemotherapeutics means that they affect non-cancerous cells, especially the rapidly dividing cells of the GI tract and in hair follicles. The other listed effects are common during chemotherapy but are not directly attributable to the lack of complete selective toxicity.

A ductal carcinoma in situ (DCIS) is considered to be which stage of breast cancer? 0 1 2 3

DCIS is frequently manifested on a mammogram with the appearance of calcifications, and it is considered breast cancer stage 0.

A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis? Anastrozole Exemestane Letrozole Tamoxifen

Deep vein thrombosis, pulmonary embolism, and superficial phlebitis are all thromboembolic events that are adverse reactions to tamoxifen. Refer to Table 33-2 in the text.

The nurse is reviewing the history of an older adult female client who was recently diagnosed with coronary heart disease. What factors are known to contribute to this condition? Select all that apply. Used hormone therapy for 5 years No use of alcoholic beverages Smoked 1 pack/day for 20 years Has hypertension for 15 years Has two grown children

Hormone therapy (HT) has been implicated in coronary heart disease, venous thromboembolism, breast cancer, and cerebral vascular accident (CVA). Hypertension and smoking are also common factors that contribute to coronary heart disease.

TNM system

In the TNM system, T1, T2, T3, and T4 describe tumor size, N0, N1, N2, and N3, lymph node involvement; and M0 or M1, the absence or presence of metastasis. In the AJC system, cancers are divided into stages 0 to IV incorporating the size of the primary lesions and the presence of nodal spread and distant metastasis.

At a follow-up visit, the client is informed that her breast cancer has recurred. The nurse knows that which situation places the client at risk for developing bone metastases? Aggressive treatment, including surgery, radiation, and hormonal therapy Recurrence within 2 years of the original diagnosis No maternal family history of breast cancer Previous therapeutic response to chemotherapy

Local recurrence may be an indicator that systemic disease will develop in the future, particularly if it occurs within 2 years of the original diagnosis. Local recurrence in the absence of systemic disease is treated aggressively with surgery, radiation, and hormonal therapy. Overall prognosis and optimal treatment are determined by a variety of factors such as the time to recurrence from the original diagnosis and treatment history.

In some cancers, the presenting factor is an effusion, or fluid, in the pleural, pericardial, or peritoneal spaces. Research has found that almost 50% of undiagnosed effusions in people not known to have cancer turn out to be malignant. Which cancers are often found because of effusions? Colon and rectal cancers Lung and ovarian cancers Breast and colon cancers Ovarian and rectal cancers

Lung cancers, breast cancers, and lymphomas account for about 75% of malignant pleural effusions. Reports of abdominal discomfort, swelling, and a feeling of heaviness and an increase in abdominal girth, which reflect the presence of peritoneal effusions or ascites, are the most common presenting symptoms in ovarian cancer, occurring in up to 65% of women with the disease.

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

Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing. Fibrocystic breast disease and fibroadenoma are two benign breast conditions that occur usually in premenopausal woman. Breast abscess is the infectious and inflammatory breast condition that is common among breast-feeding mothers.

What will the nurse assess in a client diagnosed with Paget disease as a cause of breast cancer? A lesion of the nipple on the affected breast Increased menstruation Vaginal discharge Enlargement of all lymph nodes in the axilla

Paget disease accounts for 1% of all breast cancer and presents as an eczematous lesion of the nipple and areola. When the lesion is limited to the nipple only, the rate of axillary metastasis is approximately 5%. The other findings are not typical of Paget disease.

A client is to receive brachytherapy as part of her treatment plan for breast cancer. After teaching the client about this therapy, the nurse determines that additional teaching is needed when the client identifies which condition as a possible side effect? inflammation redness around the catheter fever infection

Side effects of brachytherapy include redness or discharge around the catheters, fever, and infection. Inflammation is not a side effect.

The nurse is caring for a 52-year-old woman whose sisters and mother died of breast cancer. The client states, "My doctor wants me to take tamoxifen to help prevent breast cancer. What do you think?" What would be the nurse's best response? "We call this drug a chemotherapy agent." "Tamoxifen prevents osteoporosis." "I would recommend raloxifene." "Tamoxifen reduces the incidence."

Tamoxifen is referred to as a chemopreventive agent, not a chemotherapeutic agent. It does prevent osteoporosis, but this response does not address breast cancer prevention. Raloxifene is another drug that shows promise as a chemopreventive agent. Tamoxifen reduces breast cancer incidence by 49%.

A client who is diagnosed with breast cancer asks the nurse if cancer cells ever die. Which statement is the nurse's best response? "It really does not matter as it is more important to work on killing them." "Cancer cells differ from normal cells by being immortal and have an unlimited life span." "You need to ask your doctor about this." "Knowing this is not that important and you should not worry about that."

The best response for the nurse to make is to tell the client the truth: that cancer cells are immortal and can divide an infinite number of times, hence achieving immorality. The other responses are not therapeutic.

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer? Serial bone marrow biopsies Biopsy of the axillary lymph nodes Careful grading of the tumor cells Gauging her response to radiation therapy

The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.

A 43-year-old client is a single parent and has been admitted for a left mastectomy after confirmation of cancer from a node biopsy. She has a daughter who is 12 years old. What are primary issues for the nurse to discuss with this client? How body image changes will affect her sexual relationships. Concerns regarding the cancer and how the surgery will affect her. Effect of surgery on the family's coping abilities. History of breast cancer in the family.

The two primary concerns are the confirmation of cancer and the impending mastectomy. The other issues are important, but not as high a priority at this time.

A client has undergone extensive diagnostic testing and has been diagnosed with breast cancer staged as T3, N0, M0. What conclusion can the nurse draw from the staging of the client's breast cancer? The client has a tumor that is estimated to be 3 mm in diameter. The client has a tumor that does not have the potential for metastasis. The client has a sizable tumor but there is no lymphatic involvement. The client's tumor is not considered to be neoplastic and it has not metastasized.

This client's staging indicates a tumour of significant size but no evidence of lymph node involvement or metastasis. The "3" in "T3" does not denote a specific size of 3 mm, however. Metastasis is not currently present, but this does not mean that it is not a future possibility if left untreated.

While performing a clinical breast examination, the nurse notes a firm and rubbery nodule that is well circumscribed and moves freely. How should the nurse counsel the client? "You may have breast cancer." "It's most likely a fibroadenoma, but we may need to do a biopsy." "This is a normal breast finding, and you don't have to worry about it." "This could be a fibrocystic breast change, but we may need to do a biopsy."

This description most closely matches a fibroadenoma, but diagnostic imaging and even biopsy are warranted to confirm and rule out a cancerous tumor. The nurse should never tell the client that she may have cancer because this will only cause anxiety.

A client diagnosed with breast cancer is receiving chemotherapy. The nurse assesses the client for possible side effects of this therapy. Which side effect would the nurse report immediately to the health care provider? diarrhea nausea stomatitis bone marrow suppression

Typical side effects include nausea and vomiting, diarrhea or constipation, hair loss, weight loss, stomatitis, fatigue, and immunosuppression. The most serious is bone marrow suppression (myelosuppression). This causes an increased risk of infection, bleeding, and a reduced red blood cell count, which can lead to anemia.

A woman is crying because she just recently received the results of her biopsies, and they confirm that she has invasive breast cancer. Which response by the nurse is the most appropriate? "I'm sure you are going to be fine. You are in great hands." Listen to the woman talk, and remain silent for a while "You'll beat this thing, I know it. You are very strong." "I know a great support group you can join."

When a woman first receives the devastating news of the diagnosis of cancer, most often the best response is to allow the woman to express her feelings and concerns before speaking. Giving her false reassurances is not therapeutic and can break reliability and trust in a provider/patient relationship. Attempting to give her information about groups or next steps before she is in a state to take it in is also nontherapeutic.

The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease? One breast is larger than the other. The lump is firm and nonmovable. The lump is round and movable. Nipple retractions are noted.

When assessing a breast with fibrocystic disease, the lumps typically are different from cancerous lumps. The characteristic breast mass of fibrocystic disease is soft to firm, circular, movable, and unlikely to cause nipple retraction. A cancerous mass is typically irregular in shape, firm, and nonmovable. Lumps typically do not make one breast larger than the other. Nipple retractions are suggestive of cancerous masses.

A woman diagnosed with breast cancer is to undergo a lumpectomy followed by radiation therapy. When reviewing the treatment plan with the client, the nurse determines that the woman has understood the information based on which client statement? "I'll have a portion of my breast removed, and then they'll do high-dose radiation in the operating room." "After they remove the tumor and some of the normal tissue, I'll start radiation in about 2 to 4 weeks." "The radiation will be targeted to the area near my underarm to get at the lymph nodes." "After the lumpectomy, I'll have to wait about 6 months before I can begin to receive the radiation."

Women undergoing breast-conserving therapy receive radiation after lumpectomy with the goal of eradicating residual microscopic cancer cells to limit locoregional recurrence. In women who do not require adjuvant chemotherapy, radiation therapy typically begins 2 to 4 weeks after surgery to allow healing of the lumpectomy incision site. Radiation is administered to the entire breast at daily doses over a period of several weeks. Breast-conserving surgery, the least invasive procedure, is the wide local excision (or lumpectomy) of the tumor along with a 1-cm margin of normal tissue.