Chapter 6: Disorders of the Breasts

After teaching a woman about breast self-examination, the nurse understands that the teaching was successful when the woman makes which statement? A. "I'll do the check about a week after my period." B. "I'll feel my breasts using my thumb and index finger." C. "I don't have to check under my arm if I don't feel any breast lumps." D. "I will check my breasts every other week."

A. "I'll do the check about a week after my period." Explanation: Breast self-examination is best performed a week after menses, when swelling has subsided. Breast self-examination is typically performed every month. Both the breast area and the area between the breast and underarm, including the underarm itself, should be part of breast self-examination. The woman should use the pads of her three middle fingers for palpation. Pg. 187

How should the nurse counsel a postpartum client on how to prevent mastitis? A. "Wash your hands thoroughly, and let your breasts dry after each feeding." B. "Be sure to keep your breasts covered when you are not feeding or pumping." C. "Sterilize your bottles and pump equipment after each use." D. "If you notice that your breast is warm, hard, or red, stop feeding on that side and pump from that breast instead."

A. "Wash your hands thoroughly, and let your breasts dry after each feeding." Explanation: Handwashing is one of the best ways to prevent infection. If the woman feels that her breast is warm, hard, or red, she should increase the amount of breastfeeding from that side. It is not necessary to sterilize bottles and pumping equipment after each use; washing in the dishwasher is sufficient. Keeping the breasts exposed to the air to dry will aid in preventing infection. Pg. 192

A nurse is caring for a female client undergoing radiation therapy after her breast surgery. The client is refusing to eat and states she does not have a desire to eat at this time. Which action should the nurse do first? A. Continue to monitor the client. B. Assess the client's BMI. C. Notify the health care provider. D. Begin parenteral nutrition.

A. Continue to monitor the client. Explanation: A nurse would monitor for signs of anorexia as it is a likely side effect of radiation therapy, along with swelling and heaviness of the breast, local edema, inflammation, and sunburn-like skin changes. The nurse would continue to monitor the client since this is a common, expected side effect of radiation. Pg. 201

A client who is receiving external beam radiation therapy as part of her treatment for breast cancer comes to the clinic for a follow-up visit. The nurse determines that the client is experiencing side effects of the treatment based on which findings? Select all that apply. A. anorexia B. infection C. breast swelling D. fever E. skin pallor at the site

A. anorexia C. breast swelling Explanation: Side effects of traditional radiation therapy include inflammation, local edema, anorexia, swelling, and heaviness in the breast; sunburn-like skin changes in the treated area; and fatigue. Fever and infection are side effects associated with brachytherapy. Pg. 201

When preparing for a class on breast cancer, the nurse should explain which nonmodifiable risk factors? Select all that apply. A. being a 52-year-old female B. high-fat dietary intake C. menarche at age 11 D. BRCA1 gene E. failing to breastfeed infants

A. being a 52-year-old female C. menarche at age 11 D. BRCA1 gene Explanation: Risk factors can be divided into those that cannot be changed (nonmodifiable) and that that can (modifiable). Nonmodifiable risk factors include gender, age (>50 years old), genetic mutations, personal history of ovarian or colon cancer, early menarche (<12 years old) and race (higher in white women) just to name a few. Failing to breastfeed, high fat dietary intake, and lack of exercise are examples of modifiable risk factors. Pg. 194

During a routine assessment, a client reports to the nurse a new lump in her right breast and occasional nipple pain. The client has a family history of breast cancer. The nurse will anticipate preparing the client for which procedure first? A. breast examination B. mammogram C. fine-needle aspiration biopsy D. right breast ultrasound

A. breast examination Explanation: The nurse will first prepare the client for a breast examination to be done by the health care provider to assess the client's reported symptoms. Testing begins with the least invasive and then progresses as needed. First, the client's findings need to be verified and the extent of severity needs to be determined for a decision on additional testing to be made by the health care provider. The client may then be scheduled for a mammogram, biopsy, or ultrasound to screen or diagnose breast cancer. Pg. 195

Which factors contribute to the development of breast cancer? Select all that apply. A. family history B. antibiotic use C. aging D. hormonal factors E. high breast density

A. family history C. aging D. hormonal factors E. high breast density Explanation: The following factors are thought to contribute to the development of breast cancer: aging, hormonal factors, delayed childbearing or not having children, high breast density, a family history of breast or ovarian cancer, and late menopause. Antibiotic use has not been identified as a factor contributing to the development of breast cancer. Pg. 194

When preparing a teaching plan for a woman with mastitis, the nurse would include which instruction? A. Avoid the use of a supportive bra to prevent pressure on the inflamed breast. B. Apply warm compresses to the affected breast. C. Cease breastfeeding to prevent transmission to the infant. D. Limit fluid intake to minimize swelling.

B. Apply warm compresses to the affected breast. Explanation: Warm compresses are soothing and help reduce inflammation. Breastfeeding is encouraged with mastitis to ensure continued emptying of the breast. Fluid intake is encouraged to promote milk production and resolution of infection. Wearing a supportive bra 24 hours a day is necessary to support the breasts. Pg. 187

A 45-year-old female client tells the nurse she has a dimpling of the right breast that has occurred in the past 2 weeks. What action will the nurse take next? A. Determine if the client has a family history of breast cancer. B. Perform an examination of both of the client's breasts. C. Notify the health care provider. D. Prepare the client for a right breast ultrasound.

B. Perform an examination of both of the client's breasts. Explanation: It would be most important for the nurse to palpate the breast to determine the presence of a mass and compare it to the left. 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. Determining if the client has a family history will not change the course of action and is not a priority. Before notifying the health care provider, the nurse will assess the client as the client is stable. The client will be assessed before additional procedures are completed to determine the best procedures, if any, for the client. Pg. 204

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? A. Avoid working in the garden or yard altogether. B. Wear gloves and protective clothing to avoid any injuries. C. Avoid household chores for at least 6 to 9 months. D. Increase the frequency of follow-up visits if she does work.

B. Wear gloves and protective clothing to avoid any injuries. Explanation: 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 be 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. Pg. 200

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

B. bone marrow suppression Explanation: Typical side effects include nausea and vomiting, diarrhea or constipation, hair loss, weight loss, stomatitis, fatigue, and immunosuppression. The most serious is bone marrow suppression (myelosuppression). This causes an increased risk of infection, bleeding, and a reduced red blood cell count, which can lead to anemia. Pg. 201

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 sign? A. painless mass B. breast symmetry C. peau d'orange skin D. nipple retraction

B. breast symmetry Explanation: 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 (asymmetry instead of symmetry). Pg. 206

A nurse is assessing a client who is receiving immunotherapy as part of her treatment plan for breast cancer. The nurse would be alert for which potential side effects? Select all that apply A. bone pain B. cardiac toxicity C. hot flashes D. headache E. vascular thrombosis

B. cardiac toxicity E. vascular thrombosis Explanation: Adverse effects of immunotherapy include cardiac toxicity, vascular thrombosis, hepatic failure, fever, chills, nausea, vomiting, and pain with first infusion. Hot flashes, bone pain, and headache are associated with endocrine therapy agents. Pg. 203

A 41-year-old female client arrives at a health care setting reporting dull nipple pain with a burning sensation, accompanied by pruritus around the nipple. The primary care provider suspects mammary duct ectasia. Which prescription should the nurse question? A. penicillin orally for 10 days B. cool compresses to the affected area C. monitor temperature D. acetaminophen as needed for discomfort

B. cool compresses to the affected area Explanation: The symptom of mammary duct ectasia include the presence of green, brown, straw-colored, reddish, gray, or cream-colored nipple discharge with a consistency of toothpaste. Treatment includes antibiotic therapy with penicillinase-resistant penicillin or cephalosporin, pain medication, and warm compresses to the inflamed area. Pg. 191

A nurse is assigned to educate a group of adolescent women on cancer awareness. Which risk factor(s) for breast cancer is modifiable? Select all that apply. A. previous abnormal breast biopsy B. failing to breastfeed for up to a year after pregnancy C. early menarche or late menopause D. postmenopausal use of estrogen and progestins E. not having children until after age 30

B. failing to breastfeed for up to a year after pregnancy D. postmenopausal use of estrogen and progestins E. not having children until after age 30 Explanation: The modifiable risk factors for breast cancer are postmenopausal use of estrogen and progestins, not having children until after the age of 30, and failing to breastfeed for up to a year after pregnancy. Early menarche or late menopause and previous abnormal breast biopsy are the nonmodifiable risk factors for breast cancer. Pg. 194

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 complication? A. fibroadenoma B. lymphedema C. fibrocystic breast disease D. breast abscess

B. lymphedema Explanation: 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 breastfeeding mothers. Pg. 199

The nurse is preparing a client for breast biopsy of a lump. The nurse explains that a needle with a cutting edge will be inserted into a lump and rotated to remove a core sample. What type of breast biopsy is this client undergoing? A. aspiration B. needle biopsy C. incisional biopsy D. excisional biopsy

B. needle biopsy Explanation: During a needle biopsy, a needle with a cutting edge will be inserted into a lump and rotated to remove a core sample. With aspiration, cells from a lump are drawn into a syringe. In excisional biopsy, an entire lump is removed and analyzed, and in incisional biopsy a part of a lump is removed as a sample. Pg. 197

A breast tumor is most likely found in what part of the breast? A. near the nipple B. the upper outer quadrant C. the upper inner quadrant D. at the areola

B. the upper outer quadrant Explanation: Although they can occur throughout the breast, breast tumors are most frequently located in the upper outer quadrant of the breast. Pg. 193

A nurse is providing care to a client diagnosed with stage II breast cancer. Which finding would the nurse interpret as characteristic of this stage? A. tumor that is about 0.75 inch (1.9 centimeters) in diameter B. tumor that is about 1.5 inches (3.8 centimeters) in diameter with positive lymph nodes C. tumor that has metastasized to other organs D. tumor that is localized in the early stages

B. tumor that is about 1.5 inches (3.8 centimeters) in diameter with positive lymph nodes Explanation: Stage II breast cancer is characterized by a tumor that is 1 to 2 inches (2.5 to 5.1 centimeters) in diameter and spreads to axillary lymph nodes. Stage I breast cancer is characterized by a localized tumor, less than 1 inch (2.5 centimeters) in diameter. Stage IV breast cancer is characterized by a tumor that has metastasized to other body organs. Pg. 193

A client who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. Which response is most appropriate by the nurse while preparing the client for the procedure? A. "Were your mother or grandmother ever diagnosed with breast cancer?" B. "Breast reconstruction is a way for you to maintain your feminine appearance." C. "During this procedure, a small sample of tissue will be removed for testing." D. "If you do in fact have breast cancer, there are lots of treatment options."

C. "During this procedure, a small sample of tissue will be removed for testing." Explanation: At this time, the nurse will discuss the purpose of the procedure and not begin discussing breast cancer treatment or reconstruction. Determining if the client has a family history should have already been completed. If not, it is not appropriate at this time. It will only add to the client's stress and concern. It can be asked at a later time if needed. Discussing treatment and reconstruction can occur after the procedure, if indicated. At this time, the nurse should focus on helping the client stay calm, reducing stress, and making sure the procedure is being completed. Pg. 207

At a class for new mothers, the nurse notes that the participants need more teaching when one of the mothers makes which comment? A. "I can use warm compresses to ease the discomfort." B. "Breastfeeding every four hours appears to help." C. "I have to stop breastfeeding because of mastitis." D. "I have been using a breast pump after feeding my baby."

C. "I have to stop breastfeeding because of mastitis." Explanation: The nurse should teach the women about the etiology of mastitis and encourage breastfeeding, emphasizing that it is safe for infants. Continued emptying of the breast or pumping improves the outcome, decreases the duration of symptoms, and decreases the incidence of breast abscess. Pg. 191

A nurse is teaching a woman who has undergone breast augmentation about developing breast awareness through breast self examination. The nurse determines that the teaching was successful based on which client statement? A. "My implants will feel the same as my normal breasts." B. "I need to check my breast about 2 to 3 times a year." C. "I should do the exam just like I was doing before the implants." D. "I need to press lightly to avoid breaking the implants."

C. "I should do the exam just like I was doing before the implants." Explanation: Breast examination in women with reconstructive surgery is done exactly the same way as for natural breasts. Breasts with implants in place usually feel firmer than normal breast tissue on palpation due to the formation of a fibrotic band or capsule around the implant. If implants are used, the woman will press firmly inward at the edges of the implant to feel the ribs beneath it. Pg. 200

A new mother who is breastfeeding her newborn comes to the clinic reporting sore breasts. Assessment reveals mastitis. Which instruction would the nurse include when teaching the client about this disorder? A. Wear a supportive bra at night when in bed. B. Stop breastfeeding the newborn for the next several days. C. Massage the breasts before and during breastfeeding. D. Limit the amount of fluids ingested for the next week.

C. Massage the breasts before and during breastfeeding. Explanation: The nurse should instruct the new mother to continue breastfeeding as tolerated to keep the milk flowing; massage the breasts before and during breastfeeding to encourage milk extraction; wear a supportive bra 24 hours a day to support the breasts for comfort; and increase her fluid intake to stay hydrated. Pg. 192

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

C. history of ovarian cancer Explanation: A personal history of ovarian cancer is considered a risk factor for breast cancer. Typically, breast cancer is associated with aging (women over 50 years of age). Breast cancer is more common in white women, but black women are more likely to die of it. Early menarche (before 12 years of age) or late onset of menopause (after age 55 years) is associated with an increased risk for breast cancer. Pg. 194-195

A client is considering breast augmentation. What would the nurse recommend to the client to ensure that there are no malignancies? A. mastopexy B. breast biopsy C. mammogram D. ultrasound

C. mammogram Explanation: 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. Pg. 200

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

D. "After they remove the tumor and some of the normal tissue, I'll start radiation in about 2 to 4 weeks." Explanation: Women undergoing breast-conserving therapy receive radiation after lumpectomy with the goal of eradicating residual microscopic cancer cells to limit locoregional recurrence. In women who do not require adjuvant chemotherapy, radiation therapy typically begins 2 to 4 weeks after surgery to allow healing of the lumpectomy incision site. Radiation is administered to the entire breast at daily doses over a period of several weeks. Breast-conserving surgery, the least invasive procedure, is the wide local excision (or lumpectomy) of the tumor along with a 1-cm margin of normal tissue. Pg. 199

A young client desires to know her risk of developing breast carcinoma. She has a positive family history of breast carcinoma. The nurse would suggest that she should undergo which diagnostic test? A. fine-needle biopsy B. DNA ploidy status C. digital mammography D. BRCA-1 genetic marker

D. BRCA-1 genetic marker Explanation: Individuals with BRCA1 and BRCA2 mutations have a 75% lifetime risk of breast cancer and a 30% lifetime risk of ovarian cancer. The genetic influences of BRCA1 and BRCA2 are recognized to be a risk factor for developing breast carcinoma among family members. DNA ploidy status is used to confirm a malignant breast mass. Digital mammography is used to screen for breast masses. A fine-needle biopsy is used to identify if a mass is benign or malignant. Pg. 198

Mammography is recommended for a client diagnosed with intraductal papilloma. Which factor should the nurse ensure when preparing the client for a mammography? A. Client has taken an aspirin before the testing. B. Client is just going to start her menses. C. Client has not consumed fluids 1 hour before testing. D. Client has not applied deodorant on the day of testing.

D. Client has not applied deodorant on the day of testing. Explanation: When preparing a client for mammography, the nurse should ensure the client has not applied deodorant or powder on the day of testing because these products can appear on the X-ray film as calcium spots. It is not necessary for the client to avoid fluid intake 1 hour prior to testing. Mammography has to be scheduled just after the client's menses to reduce chances of breast tenderness, not when the client is going to start her menses. The client can take aspirin or acetaminophen after the completion of the procedure to ease any discomfort, but these medications are not taken before mammography. Pg. 196

In the United States, what type of cancer accounts for one-third of cancer diagnoses and is the most common cancer in women? A. ovarian cancer B. uterine cancer C. lung cancer D. breast cancer

D. breast cancer Explanation: According to the American Cancer Society (ACS), in the United States, breast cancer is the most common cancer in women and accounts for 1 in 3 cancer diagnoses. Pg. 192

The health care provider has just informed the client that her breast biopsy is positive for carcinoma. One of the nurse's first responsibilities is to assist with: A. telling the client her options. B. treatment. C. psychiatric issues. D. education.

D. education. Explanation: The primary care provider will ultimately be responsible for treatment and deciding the client's options. The nurse will assist by helping the woman to prioritize the voluminous amount of information given to her so she can make informed decisions. The nurse should prepare an individual packet of information and review it with the client. Pg. 203

What is the most common breast mass in women? A. intraductal papilloma B. mastitis C. duct ectasia D. fibroadenoma

D. fibroadenoma Explanation: A fibroadenoma is a benign mass in the breast. It is the most common breast mass among women. Pg. 189

What is the most common type of breast cancer, accounting for approximately 85% of cases? A. medullary carcinoma B. tubular carcinoma C. invasive lobular carcinoma D. invasive ductal carcinoma

D. invasive ductal carcinoma Explanation: Invasive ductal carcinoma is the most common type of breast cancer. Invasive lobular carcinoma is the second most common type of breast cancer and accounts for approximately 10% to 15% of all cases. Pg. 193

A woman is scheduled to undergo a modified radical mastectomy. Which information would the nurse include when describing this surgery to the client? A. sparing of the pectoral muscles and axillary lymph nodes B. wide excision of the tumor along with a 1-cm margin of normal tissue C. the resulting concave appearance of the anterior chest D. removal of breast tissue and axillary nodes

D. removal of breast tissue and axillary nodes Explanation: A modified radical mastectomy is a surgical option conducive to breast reconstruction and resulting in greater mobility and less lymphedema. This procedure involves removal of breast tissue, and a few positive axillary nodes. The surgery will not produce a concave anterior chest. With a simple mastectomy, all breast tissue, the nipple, and the areola are removed, but the axillary nodes and pectoral muscles are spared. A lumpectomy, or breast-conserving surgery, involves the wide local excision of the tumor along with a 1-cm margin of normal tissue. Pg. 199

As part of a presentation on breast cancer being given to a local woman's group, the nurse describes the need for early detection through screening. Applying the guidelines from the American Cancer Society, the nurse would emphasize which recommendation? A. clinical breast examinations every 2 years for women over age 30 B. breast self-examination at least yearly for women over age 20 C. mammograms every 3 years for women between the ages of 20 and 39 years D. yearly mammograms for women starting at age 40

D. yearly mammograms for women starting at age 40 Explanation: The American Cancer Society recommends yearly mammograms for women starting at age 40. Clinical breast examinations are recommended every year starting at age 40. According to the American Cancer Society Breast Cancer Screening Guidelines, breast self-examination an is an option for women starting in their 20s. Pg. 195-196