Breast Cancer quiz

It is time for the client's vancomycin. The vancomycin IV 1 g is in a 250 mL bag of 0.9% sodium chloride 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.)

250 x 15/60 minutes = 62.5 rounded to 63 drops/minute.

After receiving vancomycin for 7 days, the client complains that her mouth is painful when she swallows. When assessing her mouth, the nurse visualizes white, patchy lesions. Which nursing intervention best promotes effective communication?

A Candida superinfection is common side effect of antibiotic therapy. A superinfection is a secondary infection that occurs during antibiotic therapy when normal microbial flora are disrupted. Fungal infections, such as Candida, are commonly occurring superinfections. White, patchy lesions are typical of Candida and are treated with nystatin.

The client goes on to say that she can control this with exercising and a change in her eating habits. Which nursing intervention best promotes effective communication in reply to the client's solution?

Confirm with the client her hesitation to discuss the need for surgery. This will help the client clarify her thinking and verbalize her feelings.

Clinical Manifestations The nurse reviews signs and symptoms of recurring breast cancer, including nipple discharge and retraction. The client becomes anxious and begins crying. What action is most important for the nurse to take?

Continue to review the signs and symptoms of breast cancer recurrence. The nurse can give the client a few minutes to get her thoughts and emotions settled but the information needs to be given to the client prior to discharge.

Which ethical principle has the greatest weight in the nurse's decision to inform the client's surgeon about the snack?

Nonmaleficence. This ethical principle has the greatest weight in this situation, because the wrong decision by the nurse could cause harm to the client.

Another client 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 BRCA1 mutation identifies an increased risk for breast cancer. A positive BRCA1 gene mutation test indicates an increased risk for breast cancer. Screening procedures should be emphasized.

Management Issues The nurse enters the client's room and observes that a graduate nurse is assessing the dressing while the unlicensed assistive personnel (UAP) takes postoperative vital signs. The UAP is preparing to take the client'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. The priority is to ensure that postoperative vital signs are monitored correctly and in a timely manner that is not harmful to the client. The BP should not be taken in the operative arm, so the UAP should first be instructed to stop and the BP should be taken in the nonoperative arm. The nurse or UAP should also place a sign over the bed to prevent BPs and venipunctures from being obtained on the operative side. Once safe care is ensured, the nurse can discuss the situation with the graduate nurse and UAP privately.

Which nursing care measures will be most beneficial in the management of the client's lymphedema? (Select all that apply.)

Apply a sequential compression device. Lymphedema is managed with arm elevation and the use of an arm, sleeve, or sequential compression device to promote fluid return. Elevate the affected arm. Lymphedema is managed with arm elevation and the use of an arm, sleeve, or sequential compression device to promote fluid return.

Hormonal Therapy The client seems happy and she tells the nurse that she received some good news. She states that her tumor was negative for estrogen receptor sites and it is less likely of a recurrence or spread of the cancer. What action should the nurse take first?

Ask the client to clarify how she learned this information. Since the client's understanding is incorrect, the nurse should first determine how the client learned the information so that a plan for further teaching can be developed.

Follow-Up The client's resulting cellulitis from her injury and the complication of lymphedema are resolved and the nurse is preparing her for discharge. The nurse continues to reinforce the HCP's instructions regarding activity limitations and exercises. Which intervention should the nurse include in the client's discharge instructions?

Avoid lifting anything over 10 pounds for at least 4 weeks. Avoid lifting heavy objects (over 5-10 pounds) until wound has healed (usually about 4-6 weeks). This will prevent injury and develops muscle strength slowly. *Unless there are complications, driving can usually be resumed after the first 2 week post-operative follow-up appointment. *Exercises such as squeezing a ball, bending and flexing wrist and elbow, hand wall climbing, pulley exercises, rope turning, arm swings, elbow pull-in, or scissors should begin once discharged. It is good to report progress, however not required. *Hand may be used over head in one of the post-operative exercises such as hand wall climbing. Submit

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 responsible for the incorrect action of the UAP. The UAP is responsible for safely and correctly performing the skills for which the UAP is certified. The graduate nurse is responsible for supervising the UAP's actions and providing accurate direction.

Since the client's tumor is estrogen-receptor negative, she is not a candidate for hormonal therapy. Tamoxifen is an antiestrogen drug that is often used to prevent or treat recurrent breast cancer. The client states that a friend of hers took this drug and has had no recurrence of her breast cancer. The nurse asks the client if her friend experienced any problems when taking tamoxifen. Which side effect of tamoxifen should the nurse instruct the client to report immediately?

Decrease in visual acuity. Decreased visual acuity can occur in women receiving high doses of tamoxifen and can be irreversible. The client should immediately report decreased visual acuity.

The client 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?

Demonstrate how arm should be positioned behind or over the head. Placing the arm over the head when lying down helps spread the breast tissue over the chest wall, making palpation more effective. The client did correctly use her fingerpads, which are more sensitive than the fingertips.

After the client is awake and stable, she is moved from the PACU to the medical-surgical unit. The nurse observes the client performing wrist flexion and extension exercises 4 hours after surgery. What action should the nurse take?

Encourage the client to continue performing these exercises. This is an appropriate exercise following surgery. The client can begin finger and wrist flexion and extension immediately after surgery and progress to flexion of the elbow. Arm range of motion exercises are typically started after the drain is removed or about 1 week after surgery. It is also important that the client's arm be elevated on a pillow following surgery to promote fluid return and prevent lymphedema.

Chemotherapy The client elects to take chemotherapy to reduce her risk for recurrence. The nurse prepares the client for common adverse effects that she may experience. Which interventions should the nurse include in the client's plan of care related to the antineoplastic chemotherapy she has decided to do? (Select all that apply.)

Explain how alopecia occurs with antineoplastic chemotherapy. Alopecia, or hair loss, is a common side effect of antineoplastic agents. Provide management options for bouts of diarrhea. GI side effects are common with the use of antineoplastic agents. *Vision, hearing, and seizure are uncommon side-effects. DON'T LIST THEM

The nurse reviews signs and symptoms with the client that would require her to contact her HCP. Which signs or symptoms should the client be instructed by the nurse to immediately report?

Increased swelling around incisions. This is likely a sign of infection and should be reported immediately. *Signs of depression are often related to this type of body-alterning surgery. A good social support network is important. However, unless having harmful thoughts, these feeling may not require immediate attention by the HCP. *Full range of motion should be regained within 3-6 months and is not an urgent issue. *Transient edema may occur as she increases use of the affected arm and this should subside as collateral lymphatic circulation develops.

The client is disappointed to learn that she will not benefit from hormonal therapy. The client's friend informed her that tamoxifen was like experiencing menopause. Which nursing intervention best promotes effective communication?

Inform the client that tamoxifen is an antiestrogen agent and can cause symptoms that resemble menopause. Tamoxifen is an antiestrogen agent and may cause the same symptoms of decreased estrogen that occur during menopause, such as hot flashes, dry skin, nausea, and menstrual irregularities. *Estrogen levels are not enhanced with the use of tamoxifen or during menopause. *Menopausal-like symptoms are common side effects of tamoxifen, but they are not expected side effects of breast cancer. *Menopausal-like symptoms are common adverse effects of tamoxifen, but they are not expected adverse effects after a mastectomy.

The nurse can complete the client's discharge teaching. The client reflects and reminds the nurse that the only symptom she had was a lump she felt during a breast self-exam. The client wants to teach other women the importance of breast self-exams. Which nursing intervention best promotes effective communication?

Instruct the client to continue breast self-exams for the nonoperative breast. The characteristic description of a cancerous breast mass that is palpable includes hard, irregular shape, poorly delineated, nontender, and nonmobile. Most palpable masses occur in the upper outer quadrant of the breast. It is extemely important for the client to continue breast self-exams. Removal of one breast does not automatically protect the other breast from cancer.

A multi-lumen central venous catheter has been inserted, and the nurse is preparing to administer a dose of chemotherapy through the central line by first flushing the lumens. The nurse notes that two of the four lumens do not flush easily. Which intervention should the nurse implement?

Notify the HCP that the central line is may no longer be functional. For central venous catheters, notify the HCP and obtain requests for a diagnostic study or low-dose thrombolytic agents to lyse the clot. *It is true that multi-lumen catheters are designed so that each lumen can be used as a separate IV line. However, for central venous catheters, notify the HCP and obtain requests for a diagnostic study or low-dose thrombolytic agents to lyse the clot. A nurse should not leave a client with the potential for emboli.

The nurse confirms that the client has signed the informed consent for surgery but learns that the client 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. The surgeon has the responsibility to inform the client adequately about the procedure and should provide any further explanation, even if consent has already been obtained.

Post-Mastectomy Nursing Management After surgery, the client is admitted to the Post Anesthesia Care Unit (PACU) for immediate postoperative management. Which nursing actions have the highest priority in the initial postoperative period? (Select all that apply.)

Observe the wound drainage system. Keeping the system patent and monitoring for excessive bleeding will help prevent fluid accumulation in the operative site, thereby reducing pain. Place head of the bed up at least 30 degrees with affected arm elevated on a pillow. Positioning the client with head of bed at least 30 degrees (semi-Fowler's) position and elevating the affected arm promotes lymphatic fluid return. Place sign at head of bed alerting staff to avoid taking blood pressure in arm of operative side. After mastectomy, no blood pressure, IV catheters, or IV sticks should be performed. Avoiding these will decrease risk of infection, trauma, and subsequent lymphedema.

The client's prescriptions include vancomycin IV 1 g every 12 hours; obtain peak and trough levels; acetaminophen 500 mg PO for fever greater than 100° F (37.7o C). What action should the nurse implement?

Schedule to draw the vancomycin trough fifteen minutes prior to administration of the next dose of the drug. The trough level should reflect the lowest amount of the drug circulating in the client's system. This provides useful information about the dosage of the medication to reduce the risk for drug toxicity.

At the community education program, the client learns that breast self-exam (BSE) is best performed 2-3 days after the start of the menstrual flow when the breasts are least engorged and tender. Since the client had a hysterectomy 5 years ago, she does not have periods. She asks the nurse if she still needs to perform BSE, and if so, when. Which nursing explanation best promotes effective communication?

Select a day that is easy to remember to perform BSE consistently every month. Whatever day is best for the client will improve compliance and be easiest for her to remember. Suggesting the first day of the month is one easy approach.

The client's family member states that she will schedule a mammogram and she asks the nurse if it will be painful. How should the nurse respond?

Show the client's family what most women say causes the discomfort during a mammogram. The positioning of the breast may be painful or uncomfortable during the procedure.

A Complication Occurs: Cellulitis and Lymphedema The client 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. The client is admitted to the hospital with a medical diagnosis of lymphedema and possible cellulitis. Which assessment finding warrants immediate intervention by the nurse related to the complication of lymphedema?

Swelling and numbness in the affected arm. Swelling, numbness, tingling, heaviness, and aching are symptoms of lymphedema. Circulation needs to be assessed to evaluate urgency of intervention. *stinky drainage = infection *LYMPHedema = thickening not thinning of skin *Low calcium levels can cause thin and brittle fingernails. not relevant?

Diagnostic Testing While performing a BSE, the client discovers a lump.After seeing her healthcare provider (HCP), the client is scheduled for a mammogram. She brings a family member with her to the Women's Health Center to learn about mammograms. The client's family member tells the nurse that she does not need a mammogram annually because she has no risk factors for breast cancer, except that her father's sister had breast cancer. Which nursing intervention best promotes effective communication?

Teach the client's family that even women with no identified risk factors are at risk. The single most important risk factor for breast cancer is being an older female. Teaching the client's family about the need for routine BSE and mammograms is the nurse's highest priority, so the client will be able to make an informed decision about screening.

Therapeutic Communication A mass is seen on the client's mammogram, and a follow-up stereotactic core needle biopsy is performed. The tumor specimen is found to be cancerous. The client learns that she has a cancerous tumor requiring surgery. She tells the nurse that this is a mistake. She is insistent her specimen was mixed up with someone else's. Which nursing intervention best promotes effective communication?

Tell the client feelings of disbelief are understandable. This response acknowledges the overwhelming situation the client is facing yet does not encourage her denial. It is open-ended, leaving the client the opportunity to share her feelings further

Ethical-Legal Issues in Preoperative Care The client 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. The client arrives at the surgery center 2 hours before her scheduled surgery. The nurse confirms the client's NPO status. The client states she had a cracker this morning just before coming to the surgery center. She informs the nurse that she is so nervous about the surgery and may back out if she is unable to have it today. The client asks the nurse not to tell anyone about the cracker. What action is most important for the nurse to take?

Tell the client that to ensure her safety, the surgeon will need to be notified about the cracker. The surgeon and/or anesthesia personnel need this information to determine the safest schedule for the surgery.

The nurse is aware that treatment with antineoplastic chemotherapeutic agents can cause immunosuppression, which predisposes the client to infection. Which assessment finding warrants intervention by the nurse?

Temperature of 99.5° F (37.5oC). An immunosuppressed individual may only develop a low-grade fever in response to infection. The immunosuppressed client should report a low-grade fever, a persistent cough, any unusual drainage, or any other symptoms of infection to the HCP immediately. *Epistaxis, or nosebleed, may occur as the result of chemotherapy-induced thrombocytopenia, but it is not an indication of infection. *Tingling in fingers is an adverse effect of some chemotherapy medications, but it is not an indication of infection. *Nausea is an adverse effect of some chemotherapy medications, but it is not generally an indication of infection.