Med Surg II - Chapter 70 - Care of Patients with Breast Disorders
The nurse is instructing a patient with breast cancer who will be undergoing chemotherapy about the side effects of doxorubicin. Which side effect does the nurse instruct the patient to report to the health care provider? 1 Edema 2 Dysphagia 3 Diaphoresis 4 Hearing loss
1 Edema Doxorubicin is an anthracycline, and patients must be instructed to be aware of and to report cardiotoxic effects, including edema, shortness of breath, chronic cough, and excessive fatigue. Diaphoresis (profuse sweating), dysphagia (difficulty swallowing), and hearing loss are not associated side effects of doxorubicin.
A premenopausal patient diagnosed with breast cancer will be receiving hormonal therapy. The nurse anticipates that the health care provider will prescribe which medication for this patient? 1 Leuprolide 2 Fulvestrant 3 Anastrazole 4 Trastuzumab
1 Leuprolide Leuprolide is used in premenopausal women whose main estrogen source is the ovaries and who may benefit from luteinizing hormone-releasing hormone (LH-RH) agonists that inhibit estrogen synthesis. Anastrazole is an aromatase inhibitor that is used in postmenopausal women whose main source of estrogen is not the ovaries, but rather body fat. Fulvestrant is a second-line hormonal therapy for postmenopausal women with advanced breast cancer. Trastuzumab is not a hormone and is used for targeted therapy for breast cancer.
A patient who had a modified radical mastectomy for cancer 8 hours ago has a Jackson-Pratt drainage tube in place. What is the priority for care of the patient at this time? 1 Monitor the amount and color of drainage 2 Teach the patient postmastectomy exercises 3 Position the patient supine with the affected arm at her side 4 Teach the patient how to use patient-controlled analgesia (PCA)
1 Monitor the amount and color of drainage Monitoring the amount and color of drainage ensures that the drainage system is functioning and any early signs of obstruction or hemorrhage can be identified. The patient should have the head of the bed placed at a 30-degree angle with the arm elevated on a pillow rather than lying supine with the arm at her side. Teaching the patient how to use PCA and about postmastectomy exercises is important in the immediate postoperative period, but is not the priority.
Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a patient who is having a breast biopsy? 1 Monitor vital signs after surgery 2 Assess anxiety level about the surgery 3 Teach about postoperative routine care 4 Obtain data about breast cancer risk factors
1 Monitor vital signs after surgery Vital sign assessment is included in UAP education and usually is part of the job description for UAPs working in a hospital setting. Nursing assessment, obtaining data, and patient teaching are not within the scope of practice for the UAP and should be done by the licensed nursing staff.
The nurse is teaching a patient how to correctly perform a breast self-examination (BSE). Which information should the nurse include in the teaching? 1 Perform palpation when lying down 2 Use fingertips when palpating the breast tissue 3 Do not apply pressure when palpating the breast tissue 4 Inspect the breasts in front of the mirror with arms straight up
1 Perform palpation when lying down Breasts should be palpated when lying down with arms over the head because this spreads the tissue over the chest wall for effective palpation. Finger pads are more sensitive than the fingertips, so the finger pads should be used to palpate the breasts. Pressure must be applied during palpation to detect the underlying tissues. The patient should inspect the breasts in front of a mirror with her hands pressed firmly on her hips; this contracts the muscles in the chest making any changes in breast tissue more prominent.
The nurse is caring for a patient after breast reconstruction surgery. Which nursing intervention is appropriate for this patient? 1 Position the patient on the nonoperative side 2 Tell the patient to resume contact sports in 3 weeks 3 Instruct the patient to resume driving within a week 4 Reassure the patient that optimal appearance will occur in 1 month
1 Position the patient on the nonoperative side The patient who has undergone breast reconstruction surgery should be positioned on the nonoperative side post-surgery to avoid pressure on the flap and suture lines. The patient can return to her usual activity level gradually, but contact sports must be avoided because they can cause trauma to the chest. The patient must refrain from driving until advised by the health care provider. Optimal appearance will not occur until 3 to 6 months postoperatively.
The nurse is providing discharge education to a patient who has undergone breast reconstruction surgery. The nurse instructs the patient to avoid which sleeping position in the postoperative period? 1 Prone 2 Supine 3 Side-lying 4 Semi-Fowler's
1 Prone Patients who have undergone breast reconstruction should avoid sleeping prone to prevent complications. Supine, side-lying, and semi-Fowler's positions are recommended instead.
A patient who recently had a mastectomy requests a volunteer to visit her home to discuss what to do next. Which community resource does the nurse recommend? 1 Reach to Recovery 2 Young Survival Coalition 3 Susan Komen for the Cure 4 National Breast Cancer Coalition
1 Reach to Recovery The American Cancer Society's program Reach to Recovery provides volunteers who visit patients in the hospital or at home. They bring personal messages of hope; informational materials on breast cancer recovery; and a soft, temporary breast form. The National Breast Cancer Coalition is an organization dedicated to ending breast cancer through action and advocacy. Susan G. Komen for the Cure is an organization that supports breast cancer research. The Young Survival Coalition is an organization dedicated to educating the medical, research, breast cancer, and legislative communities about breast cancer, as well as serving as a point of contact for young women living with breast cancer. None of these other community resources provide volunteers to visit the home.
A 32-year-old female patient tells a nurse that she thinks that she has a small lump in her left breast, and although her mother had breast cancer, she hesitates to seek medical care because she is probably too young to have breast cancer. What does the nurse tell the patient is true about breast cancer in younger women? Select all that apply. 1 "Breast cancer is the leading cause of cancer death in women." 2 "Younger women often present with more aggressive forms of the disease." 3 "Genetic predisposition to breast cancer is a strong risk factor for younger women." 4 "The number of cases of advanced breast cancer in younger women is increasing." 5 "Screening tools are more effective in younger women because of dense breast tissue."
2 "Younger women often present with more aggressive forms of the disease." 3 "Genetic predisposition to breast cancer is a strong risk factor for younger women." 4 "The number of cases of advanced breast cancer in younger women is increasing." The nurse can tell the patient that younger women often present with more aggressive forms of the disease, the number of cases of advanced breast cancer in younger women is increasing, and genetic predisposition is a strong risk factor for younger women. In addition, breast cancer is the second-leading cause of cancer deaths in women; lung cancer is the leading cause. Screening tools are less effective, not more effective, in younger women because the breast tissue is denser and mammographic recognition of breast cancer may be impaired in areas of dense tissue.
The nurse is caring for a patient to be discharged the same day after a modified radical mastectomy. What does the nurse teach the patient? 1 Lie flat in the supine position. 2 Elevate the affected arm on a pillow. 3 Keep the affected arm flexed while walking. 4 Start ambulating and exercising the same day.
2 Elevate the affected arm on a pillow. The patient should elevate the arm on a pillow to promote lymphatic fluid return after the removal of lymph nodes and channels. The head of the patient's bed must be elevated at an angle of at least 30 degrees to prevent edema. The patient must start ambulating and resume a regular diet the day after the procedure. The patient must avoid the hunched-back position with the arm flexed because of the risk for elbow contracture.
Which complementary and alternative medicines may be effective for treating hot flashes in the patient undergoing radiation therapy for breast cancer? Select all that apply. 1 Ginger 2 Flax seed 3 Acupuncture 4 Black cohosh 5 Aromatherapy
2 Flax seed 3 Acupuncture 4 Black cohosh Acupuncture, flax seed, and black cohosh are often used to treat the hot flashes that result from radiation therapy. However, if the patient underwent a modified radical mastectomy, needles should not be inserted into the affected arm. Aromatherapy is used to treat nausea or vomiting, muscle tension, anxiety, stress, fear, and depression. Ginger is used to treat nausea or vomiting.
Which statement about the early detection of breast masses is correct? 1 The goal of screening for breast cancer is early detection 2 Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age 3 Clinical breast examinations should be done yearly, starting at age 20 4 Detection of breast cancer before or after axillary node invasion yields the same survival rate
2 Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age The purpose of screening is for the early detection of cancer before it spreads. It is recommended that the clinical breast exam be part of a periodic health assessment at least every 3 years for women in their 20s and 30s, and every year for asymptomatic women who are at least 40 years of age. Detection of breast cancer before axillary node invasion increases the chance of survival. The American Cancer Society recommends screening with mammography annually beginning at age 40.
While caring for a patient who is recovering from breast cancer surgery, the nurse observes the patient's reaction to the surgical incision for assessment of what purpose? 1 The status of the incision 2 The patient's coping skills 3 The patient's functional ability 4 The patient's knowledge about the illness
2 The patient's coping skills Observing the patient's reaction to the incision site helps the nurse assess the patient's coping skills. Observing the patient's daily activities is a way to assess the patient's functional ability. The patient's knowledge about the illness can be assessed by discussing the illness with the patient. The nurse will assess the status of the incision by visually and objectively observing it, not by assessing the patient's reaction to it.
The nurse is reviewing a patient chart. Which of the patient's characteristics does the nurse identify as carrying the highest risk for the development of breast cancer? Select all that apply. 1 BMI 32 2 Nulliparity 3 Female gender 4 53 years of age 5 High postmenopausal bone density 6 Sister and mother both had breast cancer
3 Female gender 4 53 years of age 6 Sister and mother both had breast cancer There is no single known cause for breast cancer. Being a female over the age of 50 years with two or more first-degree relatives (mother, sister, or daughter) with breast cancer are high-risk category identifiers. Having a high postmenopausal bone density is a moderate risk category identifier. Obesity and nulliparity (no pregnancies) are both lower-risk category identifiers.
A patient is scheduled for a breast mammography. What is the purpose of this diagnostic test? 1 It helps rule out metastases 2 It determines the size of the cancer in the breast 3 It reveals masses too small to be palpated by hand 4 It helps differentiate a fluid-filled cyst from a solid mass
3 It reveals masses too small to be palpated by hand Mammography reveals masses too small to be palpated by hand. Ultrasonography helps differentiate fluid-filled cysts from solid masses. Magnetic resonance imaging (MRI) helps determine the size of cancer and looks for other cancers in the breast. X-ray and computed tomography (CT) are used to rule out metastases.
The nurse provides education to a patient with breast cancer about how to prevent side effects associated with tamoxifen. What should the nurse include in the teaching? 1 Increase salt intake 2 Avoid taking aspirin 3 Avoid taking ginseng 4 Eat flaxseeds regularly
4 Eat flaxseeds regularly The patient with breast cancer is prescribed tamoxifen, which has adverse effects that include weight gain and hot flashes. Flaxseeds contain omega 3-fatty acids, which help reduce hot flashes and weight; therefore, the nurse should instruct the patient to eat flaxseeds regularly. Ginseng should be avoided in patients who are scheduled for breast augmentation surgery because these herbs may increase the risk of bleeding; therefore, the nurse would instruct the patient to avoid taking ginseng. Salt increases the risk of edema; therefore, the nurse would instruct the patient to limit the intake of salt or sodium. Aspirin is an analgesic, which helps to reduce pain, but it increases the risk of bleeding in patients who are scheduled for breast augmentation. As a result, the nurse would instruct the patient to avoid taking aspirin.
Which option for prevention and early detection of breast cancer is the option of choice for a patient with a high genetic risk? 1 Prophylactic mastectomy 2 Breast self-examination (BSE) beginning at 20 years of age 3 Hormone replacement therapy (HRT) combining estrogen and progesterone 4 Magnetic resonance imaging (MRI) and mammography every year beginning at age 30
4 Magnetic resonance imaging (MRI) and mammography every year beginning at age 30 The American Cancer Society recommends that high-risk women (greater than 20% lifetime risk) have an MRI and mammogram every year beginning at age 30. BSE is an option for everyone, not just those at high genetic risk for breast cancer. Use of HRT containing both estrogen and progestin increases risk; risk diminishes after 5 years of discontinuation. With a prophylactic mastectomy, there is a small risk that breast cancer will develop in residual breast glandular tissue because no mastectomy reliably removes all mammary tissue.
A postmenopausal patient is undergoing treatment for breast cancer. To decrease the patient's risk of osteoporosis, which drug should the nurse anticipate will be prescribed? 1 Goserelin 2 Leuprolide 3 Fulvestrant 4 Tamoxifen
4 Tamoxifen Tamoxifen is a selective estrogen receptor modulator, which helps treat breast cancer by blocking the action of estrogen in the breast. It does not create a risk of osteoporosis. Goserelin and Leuprolide are provided as a hormonal therapy for the treatment of breast cancer in premenopausal women. They block the release of luteinizing hormone and follicle-stimulating hormone, thereby preventing ovarian production of estrogen. Fulvestrant is an aromatase inhibitor, which helps treat breast cancer in postmenopausal women by reducing estrogen levels; however, fulvestrant causes bone resaborption, which increases the risk of osteoporosis.
A community health nurse is teaching a group of young women about breast self-examination (BSE). Which instruction should be included in the teaching plan? 1 Stand with the right arm behind the head 2 Use different levels of pressure to feel all the breast tissue 3 Use the thumb of the left hand to feel for lumps in the breast 4 Women should conduct a BSE one week after their menstrual period
4 Women should conduct a BSE one week after their menstrual period In premenopausal women, lumps can come and go along with the monthly menstrual cycle. Premenopausal women should be instructed to do BSE one week after their menstruation period.Three different levels of pressure are needed to feel all the breast tissues: light pressure for the tissue closest to the skin, medium pressure to feel a little deeper, and firm pressure for the tissues close to the chest and ribs. The best position for this is lying on the back with one arm behind the head. With one hand above the head, use the finger pads on the middle fingers of the opposite hand to feel for lumps.