Chapter 62: Breast Disorders

14. A client has chosen to undergo a simple mastectomy for stage I breast cancer. Which response below best describes this surgical procedure? a. removal of the tumor mass and a small portion of adjacent tissue b. removal of only the cancerous mass c. removal of the entire breast, lymph nodes, and underlying muscle d. removal of the entire breast and lymph nodes

ANS: A A simple mastectomy removes the tumor mass and only a small portion of the adjacent tissue. A lumpectomy is surgical removal of the cancerous mass. In the modified mastectomy, the entire breast tissue and nearby lymph nodes are removed; the muscles of the chest wall are left relatively intact. With the radical mastectomy, the entire breast, lymph nodes, and underlying pectoralis muscle are removed.

7. An important area to include in a breast self exam in addition to the nipple, areola, and upper and outer quadrants of the breast is the : a. axillary region b. area near the clavicle c. ribcage area underneath the breast d. area over sternum between breasts

ANS: A Breast cancers often occur in the upper, outer quadrant of the breast and may extend into the tail of the breast and spread upward into the axilla. It is important to teach clients to examine the axillary region as well as the breast during BSE.

4. Client teaching for a client who has fibrocystic breast disease should emphasize: a. avoiding foods high in saturated fat b. performing a self-breast-examination monthly c. having mammograms every 6 months d. having the health care provider examine breasts monthly

ANS: B Medical-surgical management includes administering vitamin E and eliminating caffeinated beverages from the client's diet; the cystic tissue may also be aspirated or excised for diagnostic or therapeutic reasons. Nursing care includes instructing the client about the condition, reducing her anxiety about the diagnosis, and emphasizing the importance of performing a self-breast-examination monthly.

9. What is the MOST common presenting symptom with breast cancer? a. extremely painful mass or lump b. painless mass or lump c. swelling of part of a breast d. low grade fever with malaise

ANS: B A new painless mass or lump is the most common presenting symptom. Other signs and symptoms of breast cancer include lumps, thickening, and generalized swelling of part of a breast; skin dimpling, redness, scaliness, and irritation; nipple pain, retraction or discharge other than breast milk.

11. A client has a breast tumor 3 centimeters in diameter, with no lymph nodes involved or metastases evident. The client's cancer would be considered to be in which stage? a. I b. II c. III d. IV

ANS: B In stage I, the tumor is <2 cm, no lymph nodes are involved, and no metastases are evident. In stage II, the tumor is 2-5 cm, no lymph nodes are involved, and no metastases are evident. In stage III, the tumor is >5 cm, no lymph nodes are involved and no metastases are evident or tumor is between 0 and 5 cm and the lymph node is involved with no metastases evident. In stage IV, the tumor is of any size, the lymph node may or may not be involved, and metastases are evident.

17. Letrozole and anastrozole are aromatase inhibitors. The mechanism of action of these drugs is to: a. increase testosterone production in females b. stop estrogen production in women c. interfere with DNA replication d. inhibit cellular growth

ANS: B Letrozole (Femara), exemestane (Aromasin), and anastrozole (Arimidex) are aromatase inhibitors that stop estrogen production in post-menopausal women and have been approved to treat both early and advanced breast cancer.

20. The nurse is reviewing a client's chemotherapy plan and notices that the client has been ordered to receive paclitaxel (Taxol). The nurse knows one of the Taxol's benefits is that: a. it is a once-a-month injection b. it causes less nausea than many other chemotherapeutic agents c. it is an oral medication d. it can be administered at home

ANS: B Paclitaxel (Taxol) has demonstrated positive results in clinical trials with breast cancer therapies. It acts by prohibiting cell replication. One of the benefits of this agent is that it causes milder nausea than many of the other chemotherapy agents that are used.

18. Breast reconstruction after mastectomy can be determined by which of the following? a. size of breast prior to mastectomy b. amount of breast tissue and muscle remaining after initial procedure c. client's age d. client's sexuality

ANS: B Reconstructive surgery after a mastectomy may be determined by the amount of breast tissue and muscle remaining after the initial procedure, the position of the mastectomy scar, and the probability of recurrent breast cancer. Breast reconstruction can help the client deal with the disfigurement that results from the mastectomy.

12. A client diagnosed with breast cancer elects to have a procedure in which the breast tissue and nearby lymph nodes are removed, but the muscles of the chest wall are left relatively intact. What is the name of this procedure? a. lumpectomy b. modified mastectomy c. partial mastectomy d. radical mastectomy

ANS: B The primary treatment modality is surgical removal of the affected portion of breast (lumpectomy) or simple, modified mastectomy (breast tissue, nearby lymph nodes are removed, but the muscles of the chest wall are intact), or radical mastectomy (total removal). Depending on the amount of breast tissue removed, reconstructive breast surgery can be performed at a later time.

13. Breast cancer spreads throughout the body by: a. blood vessels b. the lymphatic system c. bony ingrowth d. the abdominal plexus

ANS: B There is an abundance of lymphatic vessels proximal to the breast. Malignant cells can thus escape into the general lymphatic system and be spread throughout the body.

19. A client is reporting an increase in swelling in the left arm post mastectomy. Which of these interventions is most appropriate? a. allowing the arm to hang at the client's side b. wearing a blouse with an elastic band just above the elbow c. wearing an elastic sleeve for compression on the affected arm d. very minimal range-of-motion exercises with affected arm

ANS: C The more lymph nodes that are removed, the greater the chance the client will have lymphedema, an accumulation of lymph in soft tissue. An elastic sleeve may be worn for compression, and range-of-motion (ROM) exercises may reduce edema. A sodium-restricted diet may be ordered.

2. Women who are at greatest risk for breast cancer are those who: (Select all that apply.) a. have breast fed b. have a history of fibrocystic breasts c. had first child over the age of 30 d. started menstruation at age 13 e. experienced a late menopause f. are physically active g. consume a low fat diet full of fruits and vegetables h. smoke

ANS: B, C, E, H Women at greatest risk for developing breast cancer are those who had a mother or sibling with breast cancer, never had children or had their first child after the age of 30, never breast-fed, have a history of fibrocystic breast changes, started menstruating before age 10, are obese, consume a high-fat diet and a moderate amount of alcohol, smoke, and experienced a late menopause.

1. The nurse is caring for a client with a possible diagnosis of fibrocystic breast disease. The client asks, "What symptoms should I watch for?" The BEST response by the nurse would include which of the following? (Select all that apply.) a. cysts that are painless with palpation b. green, sticky nipple discharge c. decreased estrogen levels d. white, sticky nipple discharge e. cysts that are more tender as the menstrual period approaches

ANS: B, E Fibrocystic breast disease (FBD), the most common breast lesion in women, usually occurs between the ages of 35 and 50 and increases the potential for developing breast cancer. The primary manifestation of FBD is single or multiple cysts that are more tender as the menstrual period approaches; the cysts are often filled with fluid. A green, sticky nipple discharge may also appear from one or both breasts.

5. The main focus of treatment for fibrocystic breasts is: a. bilateral mastectomy b. repeated lumpectomy c. hormonal drug therapy (oral contraceptives) d. dietary supplementation

ANS: C Hormonal drug therapy (oral contraceptives) is the main focus of treatment. Vitamins B, C, and E may also be prescribed.

16. A client is hospitalized for chemotherapy following a mastectomy for stage IV breast cancer. What should the nurse recognize about the client's cancer? a. It involved the proximal lymph nodes. b. It involved the distal lymph nodes. c. It had metastasized prior to surgery. d. It was larger than 5 centimeters in diameter.

ANS: C In stage I, the tumor is < 2 cm, no lymph nodes are involved, and no metastases are evident. In stage II, the tumor is 2 cm to 5 cm, no lymph nodes are involved, and no metastases are evident. In stage III, the tumor is > 5 cm, no lymph node are involved, and no metastases are evident, or the tumor is between 0 cm and 5 cm and the lymph node is involved with no metastases evident. In stage IV, the tumor is of any size, the lymph node may or may not be involved, and metastases are evident.

1. At a community health fair, the nurse is answering questions at a booth about breast health. The nurse is educating women on the changes they should look for that would require referral to a physician. These include a discharge from the breast, dimpling of the skin, unilateral change in breast size, an "orange-peel" appearance, as well as which of the following? a. sagging breasts b. old freckles on the breast c. retraction of the nipple d. hair on the areola

ANS: C Signs and symptoms of breast cancer include breast masses, lumps, thickening, and generalized swelling of part of a breast; skin dimpling, redness, scaliness, and irritation; nipple pain, retraction (an inward pulling of the nipple) or discharge other than breast milk.

10. The primary treatment for breast cancer is: a. immunotherapy b. gene therapy c. surgery d. radiation

ANS: C Surgery is the primary treatment for breast cancer. Radiation and chemotherapy are used as adjuvant therapy. Other types of treatment for breast cancer include targeted therapy, immunotherapy, photodynamic therapy, gene therapy, hyperthermia, and antiangiogenesis therapy.

3. The pathophysiology of a fibrocystic breast is: a. fluid filled sacs originating from the dermis and epidermis b. fibrous tissue from glands c. fibrous tissue caused by hyperplasia of epithelial cells in breast lobules or ducts d. cysts extending from areola

ANS: C The pathophysiology of a fibrocystic breast is the formation of fibrous tissue caused by hyperplasia of the epithelial cells in the breast lobules and ducts. The proliferation of the fibrous tissue deviates from the expected normal cyclic response to female hormone shifts during the menstrual cycle.

8. The presence of tiny, palpable clusters of calcium may be indicative of a(n): a. excessive intake of calcium supplements b. breast tissue post mammogram c. early sign of breast cancer d. localized breast inflammatory process

ANS: C The presence of tiny, palpable clusters of calcium, or "microclusters," may be an early sign of breast cancer.

6. A client with a history of fibrocystic breasts calls into the office very fearful of developing breast cancer. The next step the nurse takes is to: a. schedule the client a bilateral mammogram b. allow the client to come into the office for a breast exam c. telling the client there is nothing to worry about d. listen to the client and explain the differences between fibrocystic breasts and breast neoplasms

ANS: D A key role of the nurse is to explain the differences between malignant breast lesions and fibrocystic breast changes to help alleviate the client's anxiety.

15. Postsurgical teaching for a client who has just undergone a modified mastectomy would include which of the following? a. Wear purse straps over the affected arm. b. Minor injuries on the affected side are to be expected. c. Slight swelling or bruising of the affected limb is normal in the first month. d. Vaccinations and blood draws should be done on the unaffected side only.

ANS: D After a mastectomy, the client teaching should include the following: avoid carrying items in affected arm or wearing purse straps over affected shoulder, have vaccinations and blood draws done on the unaffected side only, and obtain immediate medical attention for all injuries and infections of the affected side to prevent complications.

2. Fibrocystic breasts are most commonly found in which age group? a. teenage females b. postmenopausal women c. women between 20 and 30 years of age d. women between 30 and 50 years of age

ANS: D Fibrocystic breast changes are common between 30 and 50 years of age and occur in more than half of women at some point in their lifetime. Many cases will subside after menopause.