LWW - Ch. 58: Assessment & Management of Pt.'s with Breast Disorders

b

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? a) Mammogram b) Genetic counseling c) Pap testing d) Contacting the American Cancer Society

a

A 32-year-old client is concerned with the lumps that have developed in her breasts and is fearful of cancer. She reports variability in the size of the lumps. What could be causing her condition? a) Cyclical hormonal changes b) Progesterone c) Caffeine d) Nicotine

c

A 33-year-old female patient with three children has had a follow-up mammogram following an abnormal BSE. Mammogram findings reveal an incidental microscopic abnormal tissue growth in the left breast lobules. The physician orders tamoxifen (Soltamox) for the patient. The nurse understands that the physician is implementing which of the following primary prevention modalities to treat this patient? a) Prophylactic mastectomy b) Radiation therapy c) Chemoprevention d) Long-term surveillance

d

A 37-year-old client has been diagnosed with breast cancer and is awaiting the cytology results of her biopsy. During your client education session, you discuss the possible types of breast malignancies. Which is the most common type? a) Medullary b) Infiltrating lobular c) Inflammatory d) Ductal

d

A 43-year-old client is a single parent and has been admitted for a left mastectomy after confirmation of cancer from a node biopsy. She has a daughter who is 12 years old. What are primary issues for the nurse to discuss with this client? a) Effect of surgery on the family's coping abilities. b) History of breast cancer in the family. c) How body image changes will affect her sexual relationships. d) Concerns regarding the cancer and how the surgery will affect her.

a

A 54-year-old woman presents to her healthcare provider's office where you practice nursing. She is very concerned that she might have breast cancer, especially after caring for her sister that recently died from the disease. Included in your discussion is the primary and most common sign of breast cancer. Which of the following would meet this criterion? a) A painless mass in the breast, most often in the upper outer quadrant b) A painful mass in the breast, most often in the lower quadrant near the nipple c) A painless mass in the breast, most often in the lower quadrant near the nipple d) A painful mass in the breast, most often in the upper outer quadrant

e

A 67-year-old client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which of the following are factors in the client's history that may have increased her risk of breast cancer? a) Not giving birth; Giving birth after age 30 y/o. b) Obesity. c) Increased age (>50 y/o). d) Having a family history of breast cancer. e) All options are correct.

c

A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer? a) The lump is soft. b) The client reports tenderness during the palpation. c) The lump is irregularly shaped. d) The lump is mobile.

d

A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following? a) Bathing frequency and living surroundings b) Client's workplace in relation to the surroundings c) Alcohol and caffeine consumption d) Timing of symptoms in relation to the menstrual cycle

b

A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following? a) Client's workplace in relation to the surroundings b) Timing of symptoms in relation to the menstrual cycle c) Bathing frequency and living surroundings d) Alcohol and caffeine consumption

a

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? a) "I need to use an electric shaver when shaving my right armpit." b) "I can lift with my right arm objects that weigh as much as 15 pounds." c) "I should tell my manucurist that it is okay to trim the cuticles on my right hand." d) "Anytime I need blood drawn, they should get the sample from my right arm."

d

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? a) Inspecting the breast site for expected mottling b) Maintaining the client in the supine position c) Monitoring the single incisional site at the breast d) Encouraging coughing and deep breathing exercises

a, c

A client is being discharged to home following a modified radical mastectomy. The nurse is providing discharge instructions and making arrangements for home care. Which of the following interventions will be included in her instructions? Select all that apply. *Separate letter answers with comma(s). a) Advise the client that blood pressure measurements, injections, blood donations, and IV infusions are lifelong restrictions on the side of the mastectomy. b) Encourage the client to wear restrictive clothing on the affected side. c) Recommend wearing gloves while doing yard or housework. d) Advise the client to use a disposable razor for shaving axillary hair.

b

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

b

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? a) Checking level of pain first upon the clients return from the operating room. b) Assessing the vital signs and oxygen saturation levels. c) Checking for urinary retention and the need to void. d) Checking the dressing, drain, and amount of drainage.

a

A client with a fibroadenoma is being scheduled for diagnostic testing. Which of the following would the nurse expect as most likely? a) Ultrasound b) Culture of discharge c) Excisional biopsy d) Mammogram

a

A client with breast cancer is receiving chemotherapy as part of the treatment plan. The client develops neutropenia and is scheduled to receive pegfilgrastim (Neulasta). The nurse would expect this drug to be given at which time? a) Once, approximately 24 hours after chemotherapy b) Weekly during chemotherapy administration c) Every 2 to 3 weeks after chemotherapy is given d) 7 to 10 days after chemotherapy administration

a

A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which of the following best reflects the rationale for using this group of drugs? a) They lower the level of estrogen in the body blocking the tumor's ability to use it. b) They stimulate the immune system to attack a protein common in many tumors. c) They block progesterone-dependent tumors from growing. d) They attach to endogenous protein receptors to slow the growth of cancerous cells.

b

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? a) Reduce the frequency of removing and reapplying the dressings. b) Assist the client to pump the breasts to remove breast milk. c) Instruct the client to wear a tight-fitting bra. d) Encourage the client to include protein content in the diet.

d

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? a) Lower inner b) Upper inner c) Lower outer d) Upper outer

a

A group of students is reviewing information about breast cancer and metastasis in preparation for an examination. The students demonstrate the need for additional study when they identify which of the following as a common site for metastasis? a) colon b) liver c) lungs d) pancreas

d

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? a) Encourage the client to proceed with the next phase of treatment. b) Tell the client's spouse or partner to be supportive while she recovers. c) Recommend that the client remain cheerful for the sake of her children. d) Refer the client to the American Cancer Society's Reach for Recovery program or another support program.

b

A nurse is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: a) on the same day each month. b) immediately after her menses. c) on the first day of the menstrual cycle. d) at the end of her menstrual cycle.

d

A nurse is meeting with a woman scheduled to have a modified radical mastectomy to remove an aggressive breast tumor. The woman tells the nurse that she agreed to have the surgery before considering alternative options. Which of the following statements is the nurse's best response? a) "If I were you, I would consider a second opinion." b) "You might want to consider a less invasive surgical procedure." c) "You have a very competent surgeon and you should move forward as planned." d) "Tell me more about your fears and concerns."

c

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? a) Menopause after age 50. b) Menarche at age 14. c) First full-term pregnancy at age 34. d) None of the above.

c

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: a) mammography. b) breast self-examination. c) fine needle aspiration. d) chest X-ray.

d

A patient has been newly diagnosed with breast cancer. During her preoperative instructions the physician indicated that removal of the breast tissue and axillary lymph node dissection leaving the muscular structure intact was indicated as surgical treatment for her breast cancer. To which of the following procedures is the physician asking the patient to consent? a) Total mastectomy b) Radical mastectomy c) Segmental mastectomy d) Modified radical mastectomy

d

A patient with recurrent, local breast cancer learns that it has within 2 years of initial diagnosis, which places the patient at risk for developing bone metastases. Which of the following statements is INCORRECT? a) 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. b) Overall prognosis and optimal treatment are determined by a variety of factors such as the time to recurrence from the original diagnosis and history of prior treatments. c) Local recurrence in the absence of systemic disease is treated aggressively with surgery, radiation, and hormonal therapy. d) Local recurrence is always initially treated close monitoring for 18 to 24 months.

a

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? a) Breast symmetry b) Peau d'orange skin c) Painless mass d) Nipple retraction

d

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? a) Painless mass b) Peau d'orange skin c) Nipple retraction d) Breast symmetry

d

An early sign of Paget's disease includes which of the following? a) Increased pulse b) Thickening of areola c) Fever d) Nipple erythema

a

Atypical hyperplasia increases a women's risk for breast cancer about how many times compared with that of the general population? a) 4 b) 6 c) 8 d) 2

b

During a breast examination, which finding most strongly suggests that a client has breast cancer? a) Slight asymmetry of the breasts b) A fixed nodular mass with dimpling of the overlying skin c) Multiple firm, round, freely movable masses that change with the menstrual cycle d) Bloody discharge from the nipple

b

In which stage of breast development does breast budding occur? a) 3 b) 2 c) 1 d) 4

t

Is the following statement true or false (t/f)? Alopecia is a common side effect from the use of doxorubicin (Adriamycin); it is best for a patient to be proactive in planning for hair loss so that the client has a suitable plan.

t

Is the following statement true or false (t/f)? Due to recent antiemetic medications, nausea is less common not as prolonged in cancer patient's, and therefore they rarely require a high-calorie diet (however, nutrition emphasis is placed and education on being nutrient-dense, not calorie-dense).

t

Is the following statement true or false (t/f)? The American Cancer Society in some areas offers financial support and guidance in obtaining a wig or head covering for hair loss.

d

Kara Carpenter is a 54-year-old woman who just had a left radical mastectomy. The nurse caring for her is providing information on complications that may arise due to removing the axillary lymph nodes. Which of the following would not be included? a) Reduced range of motion b) Infection c) Tissue necrosis d) All would be included in the discussion.

a

Nursing 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), which acts by competing for estrogen-receptor binding sites. ? a) Tamoxifen b) Exemestane c) Letrozole d) Anastrozole

a

Nursing students are reviewing information about the use of the medications: Exemestane, Letrozole, and Anastrozole. They demonstrate understanding that these three medications are all examples of a(n): a) Aromatase (estrogen synthase) inhibitor. b) Prothrombinase inhibitor. c) Selective estrogen receptor modulator (SERM). d) None of the above.

a

On a follow-up visit, the patient is informed that her breast cancer has recurred. The nurse knows which of the following situations places the patient at risk for developing bone metastases? a) Recurrence within 2 years of the original diagnosis b) No maternal family history of breast cancer c) Aggressive treatment, including surgery, radiation, and hormonal therapy d) Previous therapeutic response to chemotherapy

c

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: a) should schedule a follow-up appointment in 6 months. b) is lucky that the cancer was caught in time. c) should continue to perform breast self-examination on her right breast. d) will have irregular menses.

a

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which of the following complications does this technique help avoid? a) Lymphedema b) Fibroadenoma c) Breast cancer d) Mastalgia

c

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? a) One breast is larger than the other. b) Nipple retractions are noted. c) The lump is round and movable. d) The lump is firm and nonmovable.

d

The nurse has identified the following nursing diagnosis on the plan of care for a client who has undergone breast cancer surgery: Disturbed sensory perception related to nerve irritation in the affected breast area. Which of the following indicates that the outcome has been achieved? a) Client identifies appropriate measures to reduce the risk of lymphedema. b) Client demonstrates appropriate use of prescribed analgesic. c) Client reports a sensation of pulling in the breast area. d) Client states that feeling in her breast area will gradually subside with time.

a

The nurse is caring for a client who is beginning doxorubicin (Adriamycin) therapy for breast cancer. When preparing the client for probable side effects, which would the nurse include? a) Information regarding wigs from the American Cancer Society b) Information regarding depression from a mental health association c) Information regarding high caloric meals from a dietician d) Information about blood donation from the American Red Cross

c

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? a) The procedure allows for conservation of breast tissue. b) The procedure allows for an understanding of the spread of cancer cells. c) The procedure removes all cancer from the body. d) The procedure includes minimal surrounding tissue damage.

d

The nurse is caring for a group of breast cancer survivors post mastectomy. When developing a list of instructions of points to avoid, which point is highlighted? a) Applying cream to breast b) Arm exercises on affected side c) Wearing loose fitting shirts d) No lifting greater than 15 lb

d

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? a) Back pain b) Skin irritation c) Low self-esteem d) Others disapprove

c

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? a) Breast abscess b) Fibroadenoma c) Lymphedema d) Fibrocystic breast disease

a

The nurse is providing shift report related to a client newly received back to the unit from the post anesthesia care unit (PACU). The nurse is stating that the client had breast tissue removed with 7 of 14 lymph nodes, the lining of the chest muscles and pectoralis minor muscle removed. The oncoming nurse documents which procedure completed? a) A modified radical mastectomy b) A radical mastectomy c) A total mastectomy d) A segmental mastectomy

c

The nurse recognizes which of the following statements as accurately reflecting a risk factor for breast cancer? a) Onset of menses before 14 years of age b) Multiparity c) Mother affected by cancer before 60 years of age d) No alcohol consumption

b

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

b

The nurse working on a woman's cancer treatment floor performs nursing assessments on her assigned patients. It is most important for the nurse to report which of the following assessment findings? a) Immediate postoperative reports of throat tenderness b) Coolness and mottling of a newly constructed breast site c) Temperature of 99.2°F, pulse 72, respirations 18, blood pressure 130/80 d) Small amount of bloody drainage on surgical dressing 12 hours postoperatively

b

The nursing 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 completed before the surgery can be done? a) Incisional alignment b) Tissue expansion c) Fluid drainage d) Pain control

a

When the female patient demonstrates a wartlike growth near the nipple, causing bloody nipple discharge, the patient is exhibiting signs of which disease process? a) Intraductal papilloma b) Fibroadenoma c) Paget's disease d) Acute mastitis

a

Which of the following is a characteristic of a breast cancer mass? a) Firm, hard, embedded in surrounding tissue b) Occurs as disseminated masses c) Symmetrical mass d) Tender upon palpation

b

Which of the following is a primary prevention modality that aims at preventing the disease before it starts? a) Prophylactic mastectomy b) Chemoprevention

d

Which of the following is considered a diagnostic tool for breast cancer? a) Clinical breast exam b) Ultrasonography c) Mammography d) Breast biopsy

d

Which of the following is one of the most important prognostic factor in breast cancer? a) Age of patient b) Obesity c) Family history d) Status of lymph nodes

d

Which of the following terms is used to describe removal of the breast tissue and an axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer? a) Radical mastectomy b) Total mastectomy c) Segmental mastectomy d) Modified radical mastectomy

a

Which of the following terms refers to breast pain? a) Mastalgia b) Mammoplasty c) Mastitis d) Gynecomastia

d

Which of the following would be inconsistent as a risk factor for breast cancer? a) Family history of breast cancer b) Increased age c) Late menopause d) Multiparity

c

Which type of biopsy is used for nonpalpable lesions found on mammography? a) Tru-Cut core b) Incisional c) Stereotactic d) Excisional

b

Your patient is receiving adjuvant chemotherapy for breast cancer. Which of the following is most likely her node status and tumor size? a) node negative, tumor size 0.3 cm b) node negative, tumor size 1.2 cm c) node negative, tumor size 0.2 cm d) node negative, tumor size 0.5 cm