Chapter 58: Assessment and Management of Patients With Breast Disorders

The nurse is educating a patient about the best time to perform breast self-examination (BSE). When does the nurse inform her is the best time after menses to perform BSE? 3 to 4 days 5 to 7 days 8 to 9 days After the 10th day

5 to 7 days Most women notice increased tenderness and lumpiness before their menstrual periods; therefore, BSE is best performed after menses (day 5 to day 7, counting the first day of menses as day 1).

A group of students are reviewing material in preparation for a test on the male and female breasts. The students demonstrate understanding of the material when they identify which of the following? The breasts contain a limited supply of blood vessels. Progesterone is primarily responsible for the growth of breast tissue. A primary function of the female breast is to produce milk. Striated muscle in the nipples contract causing them to become erect.

A primary function of the female breast is to produce milk. A primary function of the female breast is to produce milk, a process called lactation. The breasts contain an abundant supply of blood vessels and lymphatics. Estrogen is the hormone primarily responsible for the growth and development of breast tissue. Smooth muscle in the nipples contracts, causing them to become erect when cold, touched, or sexually stimulated.

The nurse working on a cancer treatment floor assesses her assigned clients. It is most important for the nurse to report which assessment finding? Immediate postoperative report of throat tenderness Small amount of bloody drainage on surgical dressing 12 hours postoperatively Temperature 99.2°F, pulse 72, respirations 18, blood pressure 130/80 Coolness and mottling of a newly constructed breast site

Coolness and mottling of a newly constructed breast site Mottling or an obvious decrease in skin temperature may signify flap loss and needs to be reported to the surgeon immediately. The vital signs presented are within acceptable range for a postoperative client. Throat discomfort immediately following surgery is an expected effect of airway management during surgery. A small amount of bloody drainage is an expected finding 12 hours postoperatively.

A client is diagnosed with a palpable mass in her breast. The nurse would anticipate diagnostic testing using which of the following? Core needle biopsy Ultrasound-guided core biopsy Wire needle localization biopsy MRI-guided core biopsy

Core needle biopsy For a palpable breast mass, a core needle biopsy or fine needle aspiration most likely would be done for tissue analysis. An ultrasound-guided core biopsy, MRI-guided core biopsy, and wire needle localization are used for nonpalpable masses.

How can breast cancer prevention programs best serve at-risk women from lower socioeconomic backgrounds? Increase access to health care. Develop screening and educational programs. Provide access to health insurance. Increase support services.

Develop screening and educational programs. Breast cancer prevention programs can best serve at-risk women from lower socioeconomic backgrounds by developing screening and educational programs tailored to their needs. Without increasing educational awareness and screening, access to insurance, access to health care, and support services don't help these women. According to the National Breast and Cervical Cancer Early Detection Program, research shows that without better screening and education programs, women with low incomes are three to seven times more likely to die from cancer than those with higher incomes.

A nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: mammography. fine needle aspiration. chest X-ray. breast self-examination.

fine needle aspiration. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.

On discharge, a client who underwent left modified radical mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she: should schedule a follow-up appointment in 6 months. should continue to perform breast self-examination on her right breast. will have irregular menses. is lucky that the cancer was caught in time.

should continue to perform breast self-examination on her right breast. Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider. Modified radical mastectomy shouldn't affect the menstrual cycle.

A patient has been taught how to perform breast self-examination. After standing in front of a mirror and checking both breasts for anything unusual, which of the following would the patient do next?

After checking both breasts for anything unusual while looking in the mirror, the patient then clasps her hands behind the head and presses forward, noting any change in the contour of the breasts. Next, the patient would press her hands firmly on her hips and bow slightly toward the mirror, noting any changes. After, the patient would feel the breast firmly with the fingers of the opposite hand. This palpation is repeated with the patient lying down.

A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation? Assist the client to pump the breasts to remove breast milk. Instruct the client to wear a tight-fitting bra. Encourage the client to include protein content in the diet. Reduce the frequency of removing and reapplying the dressings.

Assist the client to pump the breasts to remove breast milk. The nurse should help the client pump the breasts and remove breast milk to prevent engorgement. Because the client has decided to continue breastfeeding, the client should wear a loose-fitting bra. Including protein content in the diet would be unrelated to the client's current situation. Frequency of dressing changes does not play a role in the intervention.

A 30-year-old client whose mother died of breast cancer at age 44, and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic? Contacting the American Cancer Society Genetic counseling Papanicolaou (Pap) testing every 6 months Mammogram

Genetic counseling The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and three-generational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society will provide the client with information about cancer but the organization won't help assess the client's risk for developing cancer.

A patient is told that she has a common form of breast cancer where the tumor arises from the duct system and invades the surrounding tissues, often forming a solid irregular mass. What type of cancer does the nurse prepare to discuss with the patient? Medullary carcinoma Mucinous carcinoma Infiltrating ductal carcinoma Infiltrating lobular carcinoma

Infiltrating ductal carcinoma Infiltrating ductal carcinoma—the most common histologic type of breast cancer accounts for 80% of all cases. The tumors arise from the duct system and invade the surrounding tissues. They often form a solid irregular mass in the breast.

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid? Fibroadenoma Breast cancer Mastalgia Lymphedema

Lymphedema Validating the lack of lymph node metastasis allows the surgeon to preserve more breast and axillary tissue and chest muscle. Leaving more normal lymph nodes intact reduces the potential for complications, such as lymphedema caused by the extensive disruption of lymphatic circulation.

A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include? Delaying childbearing until after age 30 Maintaining an ideal weight Opting for estrogen only replacement therapy during menopause Increasing the intake of caffeinated drinks

Maintaining an ideal weight Maintaining an ideal weight decreases the risk of breast cancer. Having no children or having children after age 30 is associated with an increased risk for breast cancer. Some breast tumors are hormone dependent, such that estrogen (or progesterone) enhances tumor growth. Women are advised to avoid the consumption of alcohol, not caffeine, because alcohol correlates with an increased risk of breast cancer

The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer? Onset of menses before 14 years of age Mother affected by cancer before 60 years of age No alcohol consumption Multiparity

Mother affected by cancer before 60 years of age Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age). Nulliparity and later maternal age at first birth are associated with increased risk for breast cancer. Alcohol use remains controversial; however, a slightly increased risk is found in women who consume even one drink daily and doubles among women drinking three drinks daily.

Which is an early sign of Paget disease? Nipple erythema Fever Increased pulse Thickening of areola

Nipple erythema Early signs of Paget disease include nipple and areola erythema. Late signs include thickening, scaling, and erosion of the nipple and areola.

A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous? Eversion of the right nipple and mobile mass Mobile mass that is soft and easily delineated Nonmobile mass with irregular edges Nonpalpable right axillary lymph nodes

Nonmobile mass with irregular edges Breast cancer tumors are 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.

The nurse is completing the admission history for a client who is admitted for a reduction mammoplasty. Which of the following client statements is uncommon when explaining the rationale for the procedure? Low self-esteem Others disapprove Skin irritation Back pain

Others disapprove The rationale for a reduction mammoplasty most often comes from the client herself as she is experiencing a complication due to the size of the breast. Back pain, low self-esteem and a self-consciousness, and skin irritation are common rationales.

When a female client demonstrates thickening, scaling, and erosion of the nipple and areola, the nurse recognizes that the client is exhibiting signs of which disease process? Peau d'orange (edema) Fibroadenoma Paget disease Acute mastitis

Paget disease Paget disease is a malignancy of mammary ducts with early signs of erythema of nipple and areola. Acute mastitis is demonstrated by nipple cracks or abrasions along with reddened and warm breast skin and tenderness. Fibroadenoma is characterized as the occurrence of a single, nontender mass that is firm, mobile, and not fixed to breast tissue or chest wall. Peau d'orange is associated with the breast and demonstrates an orange peel appearance of breast skin with enlargement of skin pores.

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? Exemestane Letrozole Tamoxifen Anastrozole

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.

Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)? Anastrozole Letrozole Tamoxifen Exemestane

Tamoxifen Tamoxifen is an example of a SERM. It acts by competing for estrogen-receptor binding sites. Anastrozole, letrozole, and exemestane are examples of aromatase inhibitors, drugs that block estrogen production.

A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred? The mass may be cystic and was ruptured when the needle was inserted. The mass is not palpable because it is an inflammatory lesion. The mass has been absorbed into the tissues of the breast. The mass may not have been located correctly.

The mass may be cystic and was ruptured when the needle was inserted. A simple cyst often disappears on aspiration, and the fluid is usually discarded.

Which of the following is accurate regarding breast cysts? They may be exacerbated during menopause. They develop as breast ducts dilate. They occur most commonly in women over 65 years of age. They increase a woman's risk for developing breast cancer.

They develop as breast ducts dilate. Cysts are fluid-filled round or ovoid masses, derived from the terminal duct lobular unit, that develop as breast ducts dilate. They do not increase a woman's risk for developing breast cancer. Cysts occur most commonly in women 30 to 55 years of age and may be exacerbated during perimenopause.

The nurse is caring for a client who will be having artificial implants for breast reconstruction. The client is arriving at the physician's office for which procedure to be completed before the surgery can be done? Pain control Tissue expansion Incisional alignment Fluid drainage

Tissue expansion Before an implant for breast reconstruction can produce an optimum cosmetic appearance, the skin and tissue on the chest wall are expanded to provide a large enough space to fill and approximate the size of the remaining breast. The other options are not correct.

A group of students are reviewing the anatomy and physiology of the breasts. The students demonstrate understanding of breast structure when they identify the tail of Spence as an extension of which quadrant? Lower outer Upper outer Upper inner Lower inner

Upper outer The tail of Spence is an area of breast tissue that extends from the upper outer quadrant of the breast into the axilla. The upper and lower inner quadrants are closer to the midline. The lower outer quadrant is below the upper outer quadrant.

During a teaching demonstration on breast self-examination (BSE), the nurse should always explain that the majority of breast cancers are found in the: Upper, inner quadrant. Lower, inner quadrant. Lower, outer quadrant. Upper, outer quadrant.

Upper, outer quadrant. Breast cancers are usually found in the upper outer quadrant where the majority of breast tissue is located.

A client is concerned about the lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What could be causing this condition? progesterone caffeine nicotine cyclical hormonal changes

cyclical hormonal changes The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.

A nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms: after the first menstrual period and annually thereafter. every 3 years between ages 20 and 44 and annually thereafter. yearly starting at age 45. after the birth of the first child and every 2 years thereafter.

yearly starting at age 45. The American Cancer Society recommends a mammogram yearly for women age 40 and older. It's recommended that women between ages 20 and 44 have a professional breast examination (not a mammogram) every 3 years.

A client who has had a left total mastectomy is about to view her surgical site for the first time. Which of the following would be most appropriate for the nurse to say? "Did you have reconstructive surgery when they removed your breast?" "Don't be afraid. Everybody feels the same way." "Do you feel like you're ready to look at your incision now?" "You need to look at the incision so you can heal emotionally."

"Do you feel like you're ready to look at your incision now?" Looking at the surgical site for the first time is an emotional experience no matter how prepared the client may think she is. Therefore, the nurse needs to determine the client's readiness to view the site and provide gentle encouragement. Although the client needs to look at the surgical site to promote a positive body image and cope with the loss, telling the client that she must do so ignores how the client may be feeling and does not allow the client any choice. Telling the client not to be afraid also ignores how the client may be feeling. Asking about reconstructive surgery does nothing to help the client to prepare for what she might see.

The nurse is obtaining a history from a client who states recurrent breast tenderness. The client inquires if there is something wrong with her breasts. Which question by the nurse is a priority? "Does the tenderness occur around the same time each month?" "Have you pulled a muscle or had any injury to the breast?" "Do you have a history of breast disorders and cancer in the family?" "When did you first recognize the symptoms?"

"Does the tenderness occur around the same time each month?" The breasts are part of the female reproductive system, and they respond to the hormonal cycle associated with ovulation, menstruation, and pregnancy. Because the hormonal cycle is monthly, it is best to ask the client if the tenderness occurs at the same time each month. The other options are also important questions to ask.

A client has had a right modified radical mastectomy and axillary lymph node dissection. The nurse is teaching the client about measures to reduce the risk of complications. The client demonstrates understanding of the instructions when she states which of the following? "I should tell my manicurist that it is okay to trim the cuticles on my right hand." "Anytime I need blood drawn, they should get the sample from my right arm." "I need to use an electric shaver when shaving my right armpit." "I can lift with my right arm objects that weigh as much as 15 pounds."

"I need to use an electric shaver when shaving my right armpit." To prevent complications after a right modified radical mastectomy and axillary lymph node dissection, the client should shave her right axillary area with an electric razor rather than a straight razor to reduce the risk of trauma to or breaks in the skin. Blood sampling should be done with the client's left arm, not the right one. The client should not lift objects more than 5 to 10 pounds with the right arm, and cuticles on the affected hand should be pushed back, not cut.

A nurse is reviewing a female client's history, which includes the following information: Age at menarche: 14 years Cesarean delivery: 2 pregnancies Age at first pregnancy: 35 years Alcohol use: approximately 1 to 2 glasses of wine/month The nurse identifies which as a possible risk factor for the client to develop breast cancer? Age at first pregnancy Alcohol use Age at menarche Cesarean deliveries

Age at first pregnancy Risk factors for breast cancer include an early menarche (before 12 years), nulliparity, late age at first full-term pregnancy, and an alcohol intake of 2 to 5 drinks daily.

A client returns to the recovery room following a mastectomy. An initial postoperative assessment is performed by the nurse. What is the nurse's priority assessment? Checking level of pain first upon the clients return from the operating room. Checking for urinary retention and the need to void. Assessing the vital signs and oxygen saturation levels. Checking the dressing, drain, and amount of drainage.

Assessing the vital signs and oxygen saturation levels. The nurse prioritizes vital signs and breathing based on principles of ABCs.

After teaching a group of students about the signs and symptoms of breast cancer, the instructor determines that additional teaching is needed when the group identifies which of the following? Breast symmetry Painless mass Nipple retraction Peau d'orange skin

Breast symmetry The primary sign of breast cancer is a painless mass in the breast. Other signs of breast cancer include a bloody discharge from the nipple, a dimpling of the skin over the lesion, retraction of the nipple, peau d'orange (orange peel) appearance of the skin, and a difference in size between the breasts.

A client has undergone a transverse rectus abdominis myocutaneous (TRAM) flap procedure for breast reconstruction immediately following a mastectomy. Which of the following would be most appropriate to include in the client's postoperative plan of care? Encouraging coughing and deep breathing exercises Maintaining the client in the supine position Monitoring the single incisional site at the breast Inspecting the breast site for expected mottling

Encouraging coughing and deep breathing exercises A client who has undergone a TRAM flap procedure has incisions at both the mastectomy and abdominal donor sites. In addition, the breathing and leg exercises are essential because the client is more limited in her activity and is at greater risk for respiratory complications and deep vein thrombosis. Mottling at the newly created breast site must be reported to the surgeon immediately. Elevating the head of the bed 45 degrees and flexing the client's knees help to reduce tension on the abdominal incision during the first postoperative week.

The nurse is monitoring a client with metastatic breast cancer who is receiving morphine for pain control. The nurse would be alert for which of the following? Malaise, diarrhea, and stomatitis Excessive sedation, confusion, and weakness Central nervous system (CNS) depression, amenorrhea, and anemia Bone marrow depression, granulocytopenia, and anemia

Excessive sedation, confusion, and weakness Clients taking morphine, an opioid analgesic, should be monitored for adverse reactions that include excessive sedation, confusion, weakness, hypotension, constipation, dry mouth, nausea, vomiting, and anorexia. Although CNS depression may occur, amenorrhea and anemia are not associated with morphine. Malaise, diarrhea, stomatitis, bone marrow depression, granulocytopenia, and anemia are often associated with antineoplastic agents.

A nurse is reviewing a client's history for possible risk factors associated with breast cancer. Which of the following would the nurse identify as increasing the client's risk? Menopause at age 50 years First full-term pregnancy at age 34 years One of three living children born prematurely Menarche at age 14 years

First full-term pregnancy at age 34 years Risk factors associated with breast cancer include menarche before age 12 years, menopause after age 55 years, nulliparity, and late age at first full-term pregnancy.

Hematoma and seroma (build-up of clear bodily fluids in a place on your body where tissue has been removed by surgery) formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon? Gross swelling Bruising of the skin Pain at the site Tightness of the skin

Gross swelling The presence of gross swelling or increased bloody output from the drain are abnormal and should be immediately reported to the surgeon.

A female patient comes to the clinic with the complaint that she is having a greenish-colored discharge from the nipple and the breast feels warm to touch. What does the nurse suspect these symptoms may indicate? Cancer A ruptured cyst Blocked lymph duct Infection

Infection A green discharge could indicate an infection. Any discharge that is spontaneous, persistent, or unilateral is of concern. Although bloody discharge can indicate a malignancy, it is often caused by a benign wart-like growth on the lining of the duct called an intraductal papilloma.

The nurse is assessing an older adult female who has not seen her physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding? It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. It may result from inflammation due to mastitis while the patient is breastfeeding. This finding is not uncommon and is significant only when of recent origin. This finding is most likely related to benign cysts of the breast in the nipple area.

It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. 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.

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? Breast abscess Fibroadenoma Fibrocystic breast disease Lymphedema

Lymphedema 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.

A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies? Ultrasound Mammogram Breast biopsy Mastopexy

Mammogram When caring for a client considering breast augmentation, the nurse should provide her with a general guideline to have a mammogram to verify that there are no malignancies. Mastopexy involves a breast lift for drooping breasts. Ultrasound or breast biopsy would not be necessary unless there was evidence of a problem.

The nurse teaches a premenopausal female client to perform breast self-examination (BSE) at which interval? On day 2 to day 4, counting the first day of menses as day 1 With the onset of menstruation Any time during the month On day 5 to day 7, counting the first day of menses as day 1

On day 5 to day 7, counting the first day of menses as day 1 BSE is best performed after menses, when less fluid is retained. Because most women notice increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is not recommended with the onset of menses. Because these symptoms generally continue through menses, BSE is not recommended during that time. BSE is best performed at a time that takes menses into account.

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? No maternal family history of breast cancer Previous therapeutic response to chemotherapy Aggressive treatment, including surgery, radiation, and hormonal therapy Recurrence within 2 years of the original diagnosis

Recurrence within 2 years of the original diagnosis 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.

A nurse is caring for a group of breast cancer survivors after mastectomy. Which teaching point should the nurse reinforce about activities 6 weeks after surgery? Wear tight-fitting shirts for support. Exercise only the unaffected side until seen by the healthcare provider. Brisk walking and stretching exercises can be introduced. Resume light household work.

Resume light household work. The client is instructed about postoperative activity limitation. In general, heavy lifting (more than 5 to 10 pounds) is avoided for about 4 to 6 weeks, after which light household and work-related activities are promoted to maintain muscle tone. Brisk walking, the use of stationary bikes and stepping machines, and stretching exercises may begin as soon as the client feels comfortable. Once the drain is removed, the client may begin to drive if she has full arm range of motion and is no longer taking opioid analgesic agents. General guidelines for activity focus on the gradual introduction of previous activities (e.g., bowling, weight training) once fully healed.

A health care provider tells a breast cancer client that he is going to prescribe hormone therapy that has been found to significantly reduce mortality. Which drug would most likely be prescribed? Lapatinib Trastuzumab Tamoxifen Bevacizumab

Tamoxifen Women whose breast cancers have positive estrogen receptors may take hormone therapy to block the effects of estrogen on tumor growth. Both premenopausal and postmenopausal women may take tamoxifen if their tumors test positive for hormone receptors. Tamoxifen is recommended for 5 years and has demonstrated significant reduction in the recurrence rate and in mortality.

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. Nipple retractions are noted. The lump is firm and immovable. The lump is round and movable.

The lump is round and movable. 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 immovable. Lumps typically do not make one breast larger than the other. Nipple retractions are suggestive of cancerous masses.

The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction? The procedure removes all cancer from the body. The procedure includes minimal surrounding tissue damage. The procedure allows for an understanding of the spread of cancer cells. The procedure allows for conservation of breast tissue.

The procedure removes all cancer from the body. Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.

During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate? Increase the frequency of follow-up visits if she does works. Avoid household chores for at least 6 to 9 months. Avoid working in the garden or yard altogether. Wear gloves and protective clothing to avoid any injuries.

Wear gloves and protective clothing to avoid any injuries. The nurse should recommend that the client wear gloves when doing backyard work or housework to prevent injuries that may heal slowly or become infected. Working, whether it is in the backyard or doing some household chores, can be helpful in promoting feelings of usefulness, thereby enhancing the client's coping abilities and self-esteem. She could be advised to follow-up more frequently; however, this would not help prevent any untoward injury.

During a follow-up visit, a female client who underwent a mastectomy presents with an infection that requires an antibiotic. She admits she has been doing some gardening. What further instruction and reinforcement of teaching is needed? Avoid household chores for at least 6 to 9 months. Avoid working in the garden or yard altogether. Increase the frequency of follow-up visits if she does works. Wear gloves and protective clothing to avoid any injuries.

Wear gloves and protective clothing to avoid any injuries. The nurse should recommend that the client wear gloves when doing backyard work or housework to prevent injuries that may heal slowly or become infected. Working, whether it is in the backyard or doing some household chores, can be helpful in promoting feelings of usefulness, thereby, enhancing the client's coping abilities and self-esteem. She could be advised to follow up more frequently; however, this would not help prevent any untoward injury.

A client is very concerned about possibly having breast cancer, especially after caring for a close family member who recently died from the disease. The nurse informs the client that the primary and most common sign of breast cancer is a: painful mass in the breast, most often in the lower quadrant near the nipple. painless mass in the breast, most often in the upper outer quadrant. painful mass in the breast, most often in the upper outer quadrant. painless mass in the breast, most often in the lower quadrant near the nipple.

painless mass in the breast, most often in the upper outer quadrant. The primary sign of breast cancer is a painless mass in the breast, most often in the upper outer quadrant.

A patient is having a biopsy that will remove the entire mass, plus a margin of surrounding tissue. What type of biopsy will be documented on the operative permit? Incisional biopsy Core biopsy Excisional biopsy Ultrasound-guided core biopsy

Excisional biopsy Excisional biopsy is the standard procedure for complete pathologic assessment of a palpable breast mass. The entire mass, plus a margin of surrounding tissue, is removed. Incisional biopsy surgically removes a portion of a mass. Core needle biopsy is similar to FNA, except a larger-gauge needle is used (usually 14 gauge). A local anesthetic is applied, and tissue cores are removed via a spring-loaded device. The principles for ultrasound-guided core biopsy are similar to those of stereotactic core biopsy, but by using ultrasound guidance, computer coordination and mammographic compression are not necessary.

A 28-year-old woman is learning about breast self-examination. The nurse teaches the woman that the best time of each month to examine her breasts is during the: Week before menstruation occurs. Week that menstruation occurs. First week after menstruation. Week that ovulation occurs.

First week after menstruation. It is recommended that a woman examine the breasts during the first week after menstruation. During this period, the breasts are least likely to be tender or swollen because the secretion of estrogen, which prepares the uterus for implantation, is at its lowest level.

Which statement demonstrates that a client has understood instructions about breast self-examination? "I need to use the pads of three fingers to apply pressure when checking each breast." "I should move the palm of my hand around the breast in a diagonal fashion." "I don't need to check the nipple area of the breast or under my arm." "I should perform the exam on the first day of my menstrual period."

I need to use the pads of three fingers to apply pressure when checking each breast." When performing breast self-examination, the client should examine the breasts 3 days after the end of her menstrual period, use light medium, and firm pressure applied with the pads of three fingers, move the fingers in circles, spokes of a wheel, or rows, and feel every part of the breast, including the nipple area and the armpit to the collar bone.

A client is demonstrating breast self-examination while the nurse is observing the woman's technique. The nurse stops the client and provides reinstruction when the nurse observes the client palpating in which manner? In a concentric circular pattern beginning at the outer edge and working toward the nipple In a clockwise fashion from the outer edge toward the nipple for each number on the face of a clock In a horizontal pattern across each quadrant of the breast from the inner edge outward In an up-and-down manner using imaginary vertical lines on the breast.

In a horizontal pattern across each quadrant of the breast from the inner edge outward When palpating the breasts, the entire surface of the breast and axillary tail is systematically palpated proceeding in a clockwise direction, following imaginary concentric circles from the outer limits of the breast toward the nipple. Other acceptable methods are to palpate from each number on the face of the clock toward the nipple in a clockwise fashion or along imaginary vertical lines on the breast. A horizontal pattern across each breast quadrant would not be appropriate.

The nurse is assessing the breast of a female patient and observes a prominent venous pattern on the left breast. What does the nurse understand that this can be indicative of? Thrombus formation Infection Ulceration of the nipple Increased blood supply required by a tumor

Increased blood supply required by a tumor A prominent venous pattern can signal increased blood supply required by a tumor.

A client with fibrocystic breast disease has been receiving treatment with danazol (Danocrine) therapy for the past 6 months. In anticipation of the drug being discontinued, the nurse instructs the client to inform the health care provider about which of the following? Inability to sleep after discontinuing the drug. Nausea or vomiting occurring beyond 9 days after discontinuing the drug. Lack of return of regular menses within 90 days after discontinuing the drug. Constipation occurring 90 days after discontinuing the drug.

Lack of return of regular menses within 90 days after discontinuing the drug. The nurse should tell the client to inform the healthcare provider if regular menses do not resume within 90 days after discontinuing the drug. Nausea, constipation, and sleep are not associated with danazol or its discontinuation.

A client is scheduled to undergo a procedure to lift her breasts that have drooped because of significant weight loss. The nurse identifies this procedure as which of the following? Autogenous breast reconstruction Reduction mammoplasty Mastopexy Mastectomy

Mastopexy A mastopexy is a procedure that involves lifting a breast. This procedure is similar to a reduction mammoplasty (removal of glandular breast tissue, fat, and skin bilaterally to decrease the size of large pendulous breasts), although the incision and scar line are smaller and the recovery time is shorter. Autogenous breast reconstruction involves the harvesting of the client's tissue from the rectus abdominis muscle to create a new breast. A mastectomy is a removal of a breast.

A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping? Refer the client to the American Cancer Society's Reach for Recovery program or another support program. Encourage the client to proceed with the next phase of treatment. Recommend that the client remain cheerful for the sake of her children. Tell the client's spouse or partner to be supportive while she recovers.

Refer the client to the American Cancer Society's Reach for Recovery program or another support program. The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, either through Reach for Recovery or another formal support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't tell the client's spouse what to do. The client must consult with her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She can't be expected to be cheerful at all times.

A client who is to have breast conservation surgery is also to undergo a sentinel lymph node biopsy (SLNB). Which of the following would the nurse include in the client's preoperative teaching plan? The client will need less emotional support because the procedure is less invasive. The client will most likely be admitted for an overnight stay. The client has an increased risk for developing lymphedema. The client's urine may have a blue-green discoloration in the first 24 hours.

The client's urine may have a blue-green discoloration in the first 24 hours. The client needs to be informed that her urine or stool may be discolored by the dye used during the SNLB. Typically, when SNLB is performed with breast conservation surgery, the client is discharged the same day. If the SNLB was done with a total mastectomy, then the client would remain in the facility overnight. Although the risk of lymphedema is less, it is still a possibility. Emotional support, regardless of the procedure, is still an important nursing intervention that must not be overlooked.