Chapter 52: Breast Cancer

The nurse is reviewing the physician's notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic? A) Nontenderness B) A size of £ 5 mm C) Softness and a regular shape D) Mobility

A) Nontenderness (Feedback: Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.)

A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond? A) Not until the drain is removed B) On the second postoperative day C) Now, if you wash gently with soap and water D) Seven days after your surgery

A) Not until the drain is removed (Feedback: If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.)

What treatment procedures involve this process? -Excise tumor in breast completely and obtain clear margins while achieving an acceptable cosmetic result

-Lumpectomy, wide excision, partial/segmental mastectomy, quadrantectomy

A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurse's admission assessment, the nurse observes that the patient is distracted and tense. What is it important for the nurse to do? A) Acknowledge the fear the patient is likely experiencing. B) Describe the support groups that exist in the community. C) Assess the patient's stress management skills. D) Document a nursing diagnosis of ineffective coping.

A) Acknowledge the fear the patient is likely experiencing. (Feedback: In the breast cancer diagnostic phase it is appropriate to acknowledge the patient's feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills made be necessary, but the nurse should begin by acknowledging the patient's feelings. Fear is not necessarily indicative of ineffective coping.)

A patient has just returned to the postsurgical unit from post-anesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this patient's immediate plan of care? A) Acute pain related to tissue manipulation and incision B) Ineffective coping related to surgery C) Risk for trauma related to post-surgical injury D) Chronic sorrow related to change in body image

A) Acute pain related to tissue manipulation and incision (Feedback: Although many patients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.)

A patient has been discharged home after a total mastectomy without reconstruction. The patient lives alone and has a home health referral. When the home care nurse performs the first scheduled visit this patient, what should the nurse assess? Select all that apply. A) Adherence to the exercise plan B) Overall psychological functioning C) Integrity of surgical drains D) Understanding of cancer E) Use of the breast prosthesis

A) Adherence to the exercise plan B) Overall psychological functioning C) Integrity of surgical drains (Feedback: Patients who have difficulty managing their postoperative care at home may benefit from a home health care referral. The home care nurse assesses the patient's incision and surgical drain(s), adequacy of pain management, adherence to the exercise plan, and overall physical and psychological functioning. It is unnecessary to assess the patient's understanding of cancer at this stage of recovery. Prostheses may be considered later in the recovery process.)

A patient is to undergo an ultrasound-guided core biopsy. The patient tells the nurse that a friend of hers had a stereotactic core biopsy. She wants to understand the differences between the two procedures. What would be the nurse's best response? A) An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation. B) An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster. C) An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster. D) An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive.

A) An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation. (Feedback: Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.)

A patient has just been told she needs to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this patient for specific educational, physical, or psychosocial needs she might have? A) By encouraging her to verbalize her questions and concerns B) By discussing the possible findings of the biopsy C) By discussing possible treatment options if the diagnosis is cancer D) By reviewing her medical history

A) By encouraging her to verbalize her questions and concerns (Feedback: During the preoperative visit, the nurse assesses the patient for any specific educational, physical, or psychosocial needs that she may have. This can be accomplished by encouraging her to verbalize her fears, concerns, and questions. Reviewing her medical history may be beneficial, but it is not the best way to ascertain her needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating physician.)

A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A) Lumpectomy and radiation B) Partial mastectomy and radiation C) Partial mastectomy and chemotherapy D) Total mastectomy and chemotherapy

A) Lumpectomy and radiation (Feedback: Treatment for breast cancer depends on the disease stage and type, the patient's age and menopausal status, and the disfiguring effects of the surgery. For this patient, lumpectomy is the most likely option because the nodule is well-defined. The patient usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice.)

A patient who has had a lumpectomy calls the clinic to talk to the nurse. The patient tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone drew a line with a red marker. What would the nurse suspect is the woman's problem? A) Mondor disease B) Deep vein thrombosis (DVT) of the breast C) Recurrent malignancy D) An area of fat necrosis

A) Mondor disease (Feedback: Superficial thrombophlebitis of the breast (Mondor disease) is an uncommon condition that is usually associated with pregnancy, trauma, or breast surgery. Pain and redness occur as a result of a superficial thrombophlebitis in the vein that drains the outer part of the breast. The mass is usually linear, tender, and erythematous. Fat necrosis is a condition of the breast that is often associated with a history of trauma. The scenario described does not indicate a recurrent malignancy. DVTs of the breast do not occur.)

A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor? A) Women's knowledge of how their breasts normally look and feel B) The rapport that exists between the woman and her primary care provider C) Synchronizing women's routines around BSE with the performance of mammograms D) Women's knowledge of the pathophysiology of breast cancer

A) Women's knowledge of how their breasts normally look and feel (Feedback: Current practice emphasizes the importance of breast self-awareness, which is a woman's attentiveness to the normal appearance and feel of her breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the patient and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The woman does not need to understand the pathophysiology of breast cancer to perform BSE effectively.)

Risk Factors for breast cancer include: SATA A) Female gender B) Increasing age C) History of STIs D) Personal history of breast cancer E) Family history of breast cancer (HIGH GENETIC RISK) F) Genetic mutation G) Dense breast tissue H) Use of oral contraceptives I) Hormonal Factors: J) Early menarche - before 12 yrs K) Late menopause - after 55 yrs L) Nulliparity - No full-term pregnancies M) Late age at first full-term pregnancy - after 30 years of age N) Hormone replacement therapy (estrogen/progesterone) O) Exposure to ionizing radiation during adolescence/early adulthood P) Obesity Q) High-fat diet R) Alcohol intake (beer, wine, or liquor)- 2-5 drinks daily increases risk by 1.5x S) Smoking

ALL BUT C!! A) Female gender B) Increasing age D) Personal history of breast cancer E) Family history of breast cancer (HIGH GENETIC RISK) F) Genetic mutation G) Dense breast tissue H) Use of oral contraceptives I) Hormonal Factors: J) Early menarche - before 12 yrs K) Late menopause - after 55 yrs L) Nulliparity - No full-term pregnancies M) Late age at first full-term pregnancy - after 30 years of age N) Hormone replacement therapy (estrogen/progesterone) O) Exposure to ionizing radiation during adolescence/early adulthood P) Obesity Q) High-fat diet R) Alcohol intake (beer, wine, or liquor)- 2-5 drinks daily increases risk by 1.5x S) Smoking

Treatments for breast cancer include: SATA A) Surgical management- mastectomies, lumpectomies, sentinel lymph node removal B) Radiation therapy C) Chemotherapy D) Hormonal therapy E) Ovarian ablation F) SERMS

ALL OF THE ABOVE! A) Surgical management- mastectomies, lumpectomies, sentinel lymph node removal B) Radiation therapy C) Chemotherapy D) Hormonal therapy E) Ovarian ablation F) SERMS

A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make? A) Evaluate the patient's milk production. B) Palpate the area for a breast mass. C) Assess the patient's knowledge of breast cancer. D) Assure the patient that this likely an age-related change.

B (Feedback: It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The patient's knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related change.)

A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patient's lump is cancerous? A) Eversion of the right nipple and mobile mass B) A nonmobile mass with irregular edges C) A mobile mass that is soft and easily delineated D) Nonpalpable right axillary lymph nodes

B) A non-mobile mass with irregular edges (Feedback: Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.)

A patient at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response? A) An incisional biopsy is performed because it's known to be less painful and more accurate than other forms of testing. B) An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment. C) An incisional biopsy is performed to assess the potential for recovery from a mastectomy. D) An incisional biopsy is performed on patients who are younger than the age of 40 and who are otherwise healthy.

B) An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment. (Feedback: Incisional biopsy surgically removes a portion of a mass. This is performed to confirm a diagnosis and to conduct special studies that will aid in determining treatment. Incisional biopsies cannot always remove the whole mass, nor is it always beneficial to the patient to do so. The procedure is not chosen because of the potential for pain, the possibility of recovery from mastectomy, or the patient's age.)

A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the patient's history that his father was treated for breast cancer. What should the nurse provide to the patient before he leaves the clinic? A) A referral for a mammogram B) Instructions about breast self-examination (BSE) C) A referral to a surgeon D) A referral to a support group

B) Instructions about breast self-examination (BSE) (Feedback: Instructions about BSE should be provided to men if they have a family history of breast cancer, because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a patient for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary.)

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor? A) Age-related physiologic changes B) Medication adverse effects C) Poor nutrition D) Fluid overload

B) Medication adverse effects (Feedback: Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.)

A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply. A) Patient must understand when she can begin ambulating B) Patient must have someone to accompany her home C) Patient must understand activity restrictions D) Patient must understand care of the biopsy site E) Patient must understand when she can safely remove her urinary catheter

B) Patient must have someone to accompany her home C) Patient must understand activity restrictions D) Patient must understand care of the biopsy site (Feedback: Prior to discharge from the ambulatory surgical center or the office, the patient must be able to tolerate fluids, ambulate, and void. The patient must have somebody to accompany her home and would not be discharged with urinary catheter in place.)

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this patient knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this patient's fears? A) Provide written material on the procedure that has been scheduled for the patient. B) Provide the patient with relevant information about expected recovery. C) Give the patient current information on breast cancer survival rates. D) Offer the patient alternative treatment options.

B) Provide the patient with relevant information about expected recovery. (Feedback: Providing the patient with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the patient alternative treatment options is not within the nurse's normal scope of practice. Addressing survival rates may or may not be beneficial for the patient. Written material is rarely sufficient to meet patients' needs.)

The nurse is performing a comprehensive health history of a patient who is in her 50s. The nurse should identify what risk factor that may increase this patient's risk for breast cancer? A) The patient breastfed each of her children.term-15 B) The patient gave birth to her first child at age 38. C) The patient experienced perimenopausal symptoms starting at age 46. D) The patient experienced menarche at age 13.

B) The patient gave birth to her first child at age 38. (Feedback: Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the patient's health history is considered to be a risk factor for breast cancer.)

A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patient's diagnosis? A) The patient will be scheduled for radiation therapy. B) The patient might be referred for a biopsy. C) The patient's breast mass is considered an age-related change. D) The patient's diagnosis is likely related to her use of oral contraceptives.

B) The patient might be referred for a biopsy. (Feedback: Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.)

A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The woman asks the nurse when her teenage daughters should begin mammography. What is the nurse's best advice? A) Age 28 B) Age 35 C) Age 38 D) Age 48

C) Age 38 (Feedback: A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the daughters should begin mammography at age 38 to 43 years.)

The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend? A) Avoid exercise of the arm for next 2 months. B) Keep cuticles clipped neatly. C) Avoid lifting objects heavier than 10 pounds. D) Use a sling until healing is complete.

C) Avoid lifting objects heavier than 10 pounds. (Feedback: Following an axillary dissection, the patient should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary.)

A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what? A) Supervised breast self-examination B) Mammography C) Fine-needle aspiration D) Chest x-ray

C) Fine-needle aspiration (Feedback: Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although falsenegative and falsepositive findings are possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays can be used to pinpoint rib metastasis. Neither test is considered diagnostic of breast cancer, however.)

A nurse is teaching a client about screening prevention for cancer. Which of the following statements by the client indicates an understanding of the teaching? A) I will need to have a mammogram every 2 years beginning at age 45 B) I should have a colonoscopy every 15 years at age 60 C) I will need to have an annual breast exam every year after 40 D) I should have a fecal occult test done every 3 years

C) I will need to have an annual breast exam every year after 40 Annual mammograms begin at age 40

A patient has just been diagnosed with breast cancer and the nurse is performing a patient interview. In assessing this patient's ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask this patient? A) What is your level of education? B) Are you feeling alright these days? C) Is there someone you trust to help you make treatment choices? D) Are you concerned about receiving this diagnosis?

C) Is there someone you trust to help you make treatment choices? (Feedback: A trusted ally to assist in making treatment choices is beneficial to the patient's coping ability. It is condescending and inappropriate to ask if the patient is feeling alright these days or is concerned about the diagnosis. The patient's education level is irrelevant.)

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising her arms is necessary. What is the nurse's best response? A) It helps to spread out the fat that makes up your breast. B) It allows you to simultaneously assess for pain. C) It will help to observe for dimpling more closely. D) This is what the American Cancer Society recommends.

C) It will help to observe for dimpling more closely. (Feedback: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. Citing American Cancer Society recommendations does not address the woman's question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.(

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements? A) Modified tendons and ligaments B) Connective tissue and smooth muscle C) Lobules and ducts D) Endocrine glands and sebaceous glands

C) Lobules and ducts (Feedback: Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle.)

A woman scheduled for a simple mastectomy in one week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? A) Limit her intake of green leafy vegetables. B) Increase her water intake to 8 glasses per day. C) Stop taking aspirin. D) Have nothing by mouth for 6 hours before surgery.

C) Stop taking aspirin. (Feedback: The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.)

When planning discharge teaching with a patient who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the patient that she should report what sign or symptom to the physician immediately? A) Fatigue B) Temperature greater than 98.5ºF C) Sudden cessation of output from the drainage device D) Gradual decline in output from the drain

C) Sudden cessation of output from the drainage device (Feedback: The patient should report sudden cessation of output from the drainage device, which could indicate an occlusion. Gradual decline in output is expected. A temperature of 100.4°F or greater should also be reported to rule out postoperative infection, but a temperature of 98.5°F is not problematic. Fatigue is expected during the recovery period.)

For which of the following population groups would an annual clinical breast examination be recommended? A) Women over age 21 B) Women over age 25 C) Women over age 40 D) All post-pubescent females with a family history of breast cancer

C) Women over age 40 (Feedback: Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently.)

A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patient's husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurse's best response? A) Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really aren't necessary anymore. B) According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial. C) Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence. D) According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.

D) According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy. (Feedback: Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with particular risk of recurrence.)

A patient in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The patient shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well to her diagnosis and surgery. What nursing intervention is most appropriate to support this patient's coping? A) Encourage the patient's spouse or partner to be supportive while she recovers. B) Encourage the patient to proceed with the next phase of treatment. C) Recommend that the patient remain optimistic for the sake of her children. D) Arrange a referral to a community-based support program.

D) Arrange a referral to a community-based support program. (Feedback: The patient is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences. The nurse may educate the patient's spouse or partner to listen for concerns, but the nurse should not tell the patient's spouse what to do. The patient must consult with her physician and make her own decisions about further treatment. The patient needs to express her sadness, frustration, and fear. She cannot be expected to be optimistic at all times.)

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time? A) At the time of menses B) At any convenient time, regardless of cycles C) Weekly D) Between days 5 and 7 after menses

D) Between days 5 and 7 after menses (Feedback: BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended.)

A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A) More aggressive chemotherapy B) Left mastectomy C) Radiation therapy D) Bilateral mastectomy

D) Bilateral mastectomy (Feedback: Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the patient's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.)

A woman is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the patient is aware of what potential consequence? A) Chronic breast pain B) Unclear mammography results C) Increased risk of breast cancer D) Decreased nipple sensation

D) Decreased nipple sensation (Feedback: During the preoperative consultation, the patient should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication.)

A nurse has assessed that a patient is not yet willing to view her mastectomy site. How should the nurse best assist the patient is developing a positive body image? A) Ask the woman to describe the current appearance of her breast. B) Help the patient to understand that many women have gone through the same unpleasant experience. C) Explain to the patient that her body image does not have to depend on her physical appearance. D) Provide the patient with encouragement in an empathic and thoughtful manner.

D) Provide the patient with encouragement in an empathic and thoughtful manner. (Feedback: Gentle encouragement can help the patient progress toward accepting the change in her appearance. The nurse should not downplay the significance of physical appearance. Explaining that others have had similar experiences may or may not benefit the patient. Asking the patient to describe the appearance of her breast is likely to exacerbate the woman's reluctance to do so.)

A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram? A) It does not use radiation. B) Radiation levels are safe as long as mammograms are performed only once per year. C) The negative effects of radiation do not accumulate until late in life. D) Radiation from a mammogram is equivalent to an hour of sunlight.

D) Radiation from a mammogram is equivalent to an hour of sunlight. (Feedback: The radiation exposure of mammogram is equivalent to about 1 hour of exposure to sunlight. Consequently, the benefits of mammography far outweigh any risks associated with the procedure. Negative consequences are insignificant, and do not accumulate later in life.)

The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurse's best response? A) Yes, it's known to have a slight protective effect. B) Yes, but studies also show an increased risk of osteoporosis. C) You won't need to worry about getting cancer as long as you take Tamoxifen. D) Tamoxifen is known to be a highly effective protective measure.

D) Tamoxifen is known to be a highly effective protective measure. (Feedback: Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.)

A patient newly diagnosed with breast cancer states that her physician suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the patient has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis? A) The patient is not a surgical candidate. B) The patient's breast cancer is considered highly treatable. C) There is a 10% chance that the patient's cancer will self-resolve. D) The patient has a 15% chance of 5-year survival

D) The patient has a 15% chance of 5-year survival (Feedback: The 5-year survival rate is approximately 15% for stage IV breast cancer. Surgery is still a likely treatment, but the disease would not be considered to be highly treatable. Self-resolution of the disease is not a possibility.)

Prognosis of breast cancer depends on what?

Depends on the tumor size and whether tumor has spread to the axillary (underarm) lymph nodes. o Smaller tumor appears = better the prognosis o Also depends on the extent of the spread of breast cancer o 5 year survival rate is 88% for Stage 1 and 15% for Stage 4

In neutropenic patients, monitor them for: ●Immediately notify the practitioner of fever greater than 101° F or a sustained temperature of 100.4° over 1 hour. ●Monitor _________rate, _________ pressure, and ___________saturation via pulse oximetry. ●Administer oxygen, as ordered. ●Monitor the patient for what 4 things? ●Monitor and assess the patient's skin. ●Obtain laboratory specimens for testing. ●Initiate and maintain IV access.

Heart, blood, oxygen 1) Sweating 2) Chills 3) Diarrhea 4) New complaints of abdominal pain

Most effective in cancer cells with estrogen or progesterone receptors (this type of cancer has a better prognosis)

Hormonal therapy

Mastectomies can lead to ______________- a complication characterized by chronic swelling of an extremity due to interrupted lymphatic circulation.

Lymphedema

What condition are these describing? Can be caused by mastectomies: ● Swelling is due to the accumulation of protein-rich fluid in the interstitial space and is somewhat common postoperative complication after ANLD ○ S/S: painful swelling of the arm, weakness, shoulder pain, tingling sensations in the arm/shoulder ● Once lymphedema develops it tends to be chronic - so preventative strategies are vital ● Teach patient hand/arm care to prevent injury/trauma to affected extremity (decreases the likelihood of developing lymphedema) ● Instructed to follow the guidelines for the rest of her life ● Instructed to contact provider immediately if she suspects she has lymphedema

Lymphedema

AVOID ADMINISTERING INJECTIONS, TAKING BP, OR OBTAINING BLOOD FROM CLIENT'S AFFECTED ARM AFTER WHAT PROCEDURE?? PLACE A SIGN ABOVE CLIENT'S BED REGARDING THESE PRECAUTIONS! (If double mastectomy use legs)

Mastectomy

Used to treat invasive breast cancer. § Removal of breast tissue, including nipple-areola complex

Modified Radical Mastectomy

#1 nursing goal in regards to neutropenia is what?

Preventing and managing patient complications- infections

Less invasive alternative to ALND and is considered a standard of care for treatment of early-stage breast cancer

Sentinel Lymph Node Biopsy

This medication has estrogen-blocking effect on certain cells. Its antagonistic effects in the breast prevent estrogen from binding to the receptor sites, thus preventing tumor growth. What is it? Must notify/educate patient on menopausal-like side effects: o Hot flashes o Vaginal dryness/discharge/bleeding o Irregular menses o Nausea/vomiting o Mood disturbances o Rashes o Increased risk for endometrial cancer o Increased risk for DVT o Increased risk for pulmonary embolism

Tamoxifen

This drug has been found to increase the risk of endometrial cancer, deep-vein thrombosis (DVT), and pulmonary embolism.

Tamoxifen Raloxifene doesn't have these side-effects

Selective estrogen receptor modulators (SERMs) include what two medications?

Toremifene (Tamoxifen and raloxifene)

Used in females who are at high risk for breast cancer or who have advanced breast cancer -Suppressed the growth of remaining cancer cells postmastectomy or lumpectomy

Toremifene (Tamoxifen and raloxifene)

Involves removal of breast and nipple-areola complex but NOT ALND

Total Mastectomy