7.6 Ch. 51 Breast Disorders
2. The client is diagnosed with breast cancer and is considering whether to have a lumpectomy or a more invasive procedure, a modified radical mastectomy. Which information should the nurse discuss with the client? 1. Ask if the client is afraid of having general anesthesia. 2. Determine how the client feels about radiation and chemotherapy. 3. Tell the client she will need reconstruction with either procedure. 4. Find out if the client has any history of breast cancer in her family.
2. The client should understand the treatment regimen for follow-up care. A lumpectomy requires follow-up with radiation therapy to the breast and then systemic chemotherapy. If the cancer is in its early stages, this regimen has results equal to those with a modified radical mastectomy.
6. The nurse is teaching a class on breast health to a group of ladies at a senior citizen's center. Which risk factor is the most important to emphasize to this group? 1. The clients should find out about their family history of breast cancer. 2. Men at this age can get breast cancer also and should be screened. 3. Monthly breast self-examination is the key to early detection. 4. The older a woman gets, the greater the chance of developing breast cancer.
4. The greatest risk factor for developing breast cancer is being female. The second greatest risk factor is being elderly. By age 80, one (1) in every eight (8) women develops breast cancer.
7. One risk factor that increases a woman's chances of getting breast cancer include: (a) family history. (b) young age at first birth. (c) multiple births. (d) underwire bras.
a
16. What describes the use of high-dose brachytherapy radiation (select all that apply)? a. May be completed in 5 days b. Follows local excision of tumor c. Alternative to traditional radiation therapy for early-stage breast cancer d. Used to treat possible local residual cancer cells following a mastectomy e. Used to reduce tumor size and stabilize metastatic lesions for pain relief
a, c. High-dose brachytherapy may be completed in 5 days and is an alternative to traditional radiation for early-stage breast cancer. Primary radiation follows local excision of a tumor. Radiation as an adjuvant to surgery is used to treat possible residual cancer cells postmastectomy. Palliative radiation is used to reduce tumor size and relieve pain.
12. The best prognosis is indicated in the patient with breast cancer when diagnostic studies reveal a. negative axillary lymph nodes. b. aneuploid DNA tumor content. c. cells with high S-phase fractions. d. an estrogen receptor- and progesterone receptor-negative tumor.
a. Axillary lymph node status is one of the most important prognostic factors in primary breast cancer; the more nodes involved, the higher the risk for relapse or metastasis. Aneuploid DNA tumor content indicates that cells have abnormally high or low DNA content compared with normal cells and is associated with tumor aggressiveness. Cells in S-phase have a higher risk for recurrence and can produce earlier cancer death. Hormone receptor-negative tumors are usually poorly differentiated histologically, frequently recur, and are usually unresponsive to hormonal therapy.
9. Which benign breast disorder occurs most often during lactation and is commonly caused by Staphylococcus aureus? a. Mastitis b. Ductal ectasia c. Fibroadenoma d. Senescent gynecomastia
a. Mastitis occurs during lactation and is caused by Staphylococcus aureus. Ductal ectasia involves subareolar area ducts and has multicolored sticky nipple discharge and inflammatory signs. It is not associated with malignancy. Fibroadenoma occurs in 10% of women ages 15 to 40 and has well-delineated, very mobile tumors. A biopsy must be done to exclude malignancy. Senescent gynecomastia occurs in older men, probably from increased conversion of androgens to estrogens in peripheral circulation. It generally regresses in 6 to 12 months.
3. When teaching a 24-year-old woman who desires to learn BSE, the nurse knows that it is important to do what? a. Provide time for a return demonstration. b. Emphasize the statistics related to breast cancer survival and mortality. c. Have the woman set a consistent monthly date for performing the examination. d. Inform the woman that professional examinations are not necessary unless she finds an abnormality.
a. One of the major reasons why women do not examine their breasts regularly is because of a lack of confidence in BSE skill. A teaching program should include allowing time for women to use models to identify problems and perform a return demonstration of the examination on themselves. Fear and denial often interfere with BSE even when women know that the perceived risk for cancer is high, know the statistics, and know that they should seek medical care if an abnormality is detected. Examinations in premenopausal women should be done right after the menstrual period and specific dates are set for postmenopausal women or those who have had hysterectomies.
18. During the immediate postoperative period following a mastectomy, the nurse initially institutes which exercises for the affected arm? a. Have the patient brush or comb her hair with the affected arm. b. Perform full passive range-of-motion (ROM) exercises to the affected arm. c. Ask the patient to flex and extend the fingers and wrist of the operative side. d. Have the patient crawl her fingers up the wall, raising her arm above her head.
c. As early as in the recovery room following a modified radical mastectomy, the patient should start flexing and extending the fingers and wrist of the affected arm with daily increases in activity. Postoperative mastectomy exercises, such as hair care, wall climbing with the fingers, and shoulder rotation and extension, are instituted gradually to prevent disruption of the wound.
7. A patient has fibrocystic changes in her breast. The nurse explains to the patient that this condition is significant because it a. commonly becomes malignant over time. b. can be controlled with hormone therapy (HT). c. makes it more difficult to examine the breasts. d. will eventually cause atrophy of normal breast tissue.
c. Fibrocystic changes make breasts difficult to examine because of fibrotic changes and multiple lumps. A woman with this condition should be familiar with the characteristic changes in her breasts and monitor them closely for new lumps that do not respond in a cyclic manner over 1 to 2 weeks. Estrogen antagonizes the condition and fibrocystic changes are not precancerous.
15. Lymphatic mapping with sentinel lymph node dissection (SLND) is planned for a patient undergoing a modified radical mastectomy for breast cancer. What does the nurse teach the patient and her family? a. If one sentinel lymph node is positive for malignant cells, all of the sentinel lymph nodes will be removed. b. If malignant cells are found in any sentinel nodes, a complete axillary lymph node dissection will be done. c. Lymphatic mapping indicates which lymph nodes are most likely to have metastasis and all of those nodes are removed. d. Lymphatic mapping with SLND provides metastatic lymph nodes to test for responsiveness to chemotherapy.
c. Lymphatic mapping with SLND identifies one to four lymph nodes that drain first from the tumor site. Those nodes are examined for malignant cells. If any of the nodes have malignant cells, a complete axillary lymph node dissection is done. If the sentinel nodes are negative, no additional lymph nodes are removed.
10. The client is being discharged after a left wedge resection. Which discharge instructions should the nurse include? Select all that apply. 1. Notify the HCP of a temperature of 100˚F. 2. Carry large purses and bundles with the right hand. 3. Do not go to church or anywhere with crowds. 4. Try to keep the arm as still as possible until seen by the HCP. 5. Have a mammogram of the right and left breast yearly.
1, 2, 5 1. It is a common instruction for any client who has had surgery to notify the HCP if a fever develops. This could indicate a postoperative infection. 2. The client who has had a mastectomy is at risk for lymphedema in the affected arm because the lymph nodes are removed during the surgery. The client should protect the arm from injury and carry heavy objects with the opposite arm. 3. The client can attend church services and large gatherings. This client had surgery, not chemotherapy, which would make the client immunosuppressed. 4. The client should be taught arm-climbing exercises before leaving the hospital to facilitate maintaining range of motion. 5. The client has developed a malignancy in one breast and is at a higher risk for developing another tumor in the remaining breast area.
7. The client who is scheduled to have a breast biopsy with sentinel node dissection states, "I don't understand. What does a sentinel node biopsy do?" Which scientific rationale should the nurse use to base the response? 1. A dye is injected into the tumor and traced to determine spread of cells. 2. The surgeon removes the nodes that drain the diseased portion of the breast. 3. The nodes felt manually will be removed and sent to pathology. 4. A visual inspection of the lymph nodes will be made while the client is sleeping.
1. A sentinel node biopsy is a procedure in which a radioactive dye is injected into the tumor and then traced by instrumentation and color to try to identify the exact lymph nodes the tumor could have shed into.
5. The client has a diagnosis of rule-out Paget's disease. Which test provides a definitive diagnosis of the disease? 1. A breast biopsy. 2. A diagnostic mammogram. 3. Ultrasound of the breast. 4. Magnetic resonance imaging.
1. Biopsy of the lesion is the only definitive test for Paget's disease, a form of breast cancer accounting for about 1% of all breast cancers.
3. The client has undergone a wedge resection for cancer of the left breast. Which discharge instruction should the nurse teach? 1. Don't lift more than five (5) pounds with the left hand until released by the HCP. 2. The cancer has been totally removed and no follow-up therapy will be required. 3. The client should empty the Hemovac drain about every 12 hours. 4. The client should arrange an appointment with a plastic surgeon for reconstruction.
1. The client has had surgery on this side of the body. Pressure on the incision should be limited until the client is released by the HCP to perform normal daily activities.
11. The client who has had a mastectomy tells the nurse, "My husband will leave me now since I am not a whole woman anymore." Which response by the nurse is most therapeutic? 1. "You're afraid your husband will not find you sexually appealing?" 2. "Your husband should be grateful you will be able to live and be with him." 3. "Maybe your husband would like to attend a support group for spouses." 4. "You don't know that is true. You need to give him a chance."
1. This is restating the client's feelings and is a therapeutic response.
8. The client who is four (4) months pregnant finds a lump in her breast and the biopsy is positive for Stage II cancer of the breast. Which treatment should the nurse anticipate the HCP recommending to the client? 1. A lumpectomy to be performed after the baby is born. 2. A modified radical mastectomy. 3. Radiation therapy to the chest wall only. 4. Chemotherapy only until the baby is born.
2. A modified radical mastectomy is recommended for this client because the client is not able to begin radiation or chemotherapy, which are part of the regimen for a lumpectomy or wedge resection. Many breast cancers developed during pregnancy are hormone sensitive and have the ideal grounds for growth. The tumor should be removed as soon as possible.
5. The client had a mastectomy for cancer of the breast and asks the nurse about a TRAM flap procedure. Which information should the nurse explain to the client? 1. The surgeon will insert a saline-filled sac under the skin to simulate a breast. 2. The surgeon will pull the client's own tissue under the skin to create a breast. 3. The surgeon will use tissue from inside the mouth to make a nipple. 4. The surgeon can make the breast any size the client wants the breast to be.
2. The TRAM flap procedure is one in which the client's own tissue is used to form the new breast. Abdominal tissue and fat are pulled under the skin with one end left attached to the site of origin to provide circulation until the body builds collateral circulation in the area.
12. The nurse is caring for client A, who is postoperative after a breast biopsy. The pathology report is posted on the chart. Which statement is the interpretation of the DNA ploidy pathology report? A 0.5- × 1.2-cm specimen of tissue from the right breast was evaluated with microscope examination. Margins were not clear. Tissue sample indicates high-grade invasive ductal cell carcinoma. DNA ploidy by flow cytometry reveals aneuploid characteristics. Findings: Invasive ductal cell carcinoma of the right breast with aneuploid findings. 1. This is Stage IV breast cancer with a poor prognosis. 2. The cancer will respond to hormonal therapy. 3. The chromosomes do not resemble normal human DNA. 4. The client should have a mastectomy as soon as possible.
3. Aneuploid means the cells do not have human pairing characteristics. This finding indicates the cells cannot be expected to respond as normal human cells respond and the prognosis is not good for the client.
4. The client is diagnosed with left mastitis. Which assessment findings should the nurse observe? 1. Dimpling of the left breast when the client raises the arm. 2. A round lump in the left breast which is tender during menses. 3. A dull pain in the left breast and tough, doughy-feeling skin. 4. Bloody discharge from the nipple and a hard palpable mass.
3. Mastitis is an infection of the breast occurring most often in women who are lactating. The breast becomes red and warm to touch. The skin becomes doughy and tough in consistency, and the client develops a dull pain in the affected breast.
12. The client has been diagnosed with cancer of the breast. Which referral is most important for the nurse to make? 1. The hospital social worker. 2. CanSurmount. 3. Reach to Recovery. 4. I CanCope.
3. Reach to Recovery is a specific referral program for clients diagnosed with breast cancer.
4. Which recommendation is the American Cancer Society's (ACS) guideline for the early detection of breast cancer? 1. Beginning at age 18, have a biannual clinical breast examination by an HCP. 2. Beginning at age 30, perform monthly breast self-exams. 3. Beginning at age 40, receive a yearly mammogram. 4. Beginning at age 50, have a breast sonogram every five (5) years.
3. The ACS recommends a yearly mammogram for the early detection of breast cancer. A mammogram can detect disease that will not be large enough to feel.
1. The client frequently finds lumps in her breasts, especially around her menstrual period. Which information should the nurse teach the client regarding breast self-care? 1. This is a benign process which does not require follow-up. 2. The client should eliminate chocolate and caffeine from the diet. 3. The client should practice breast self-examination monthly. 4. This is the way breast cancer begins and the client needs surgery.
3. The American Cancer Society no longer recommends breast self-examination (BSE) for all women, but it is advisable for women with known breast conditions to perform BSE monthly to detect potential cancer.
9. The client who had a right modified radical mastectomy four (4) years before is being admitted for a cardiac workup for chest pain. Which intervention is most important for the nurse to implement? 1. Determine when the client had chemotherapy last. 2. Ask the client if she received Adriamycin, an antineoplastic agent. 3. Post a message at the head of the bed to not use the right arm. 4. Examine the chest wall for cancer sites.
3. The nurse should post a message at the head of the client's bed to not use the right arm for blood pressures or laboratory draws. This client is at risk for lymphedema, and this is a lymphedema precaution.
2. The nurse is performing the admission assessment on a 78-year-old female client and observes bilateral pendulous breasts with a stringy appearance. Which intervention should the nurse implement? 1. Request a mammogram. 2. Notify the HCP of the finding. 3. Continue with the examination. 4. Assess for peau d'orange skin.
3. These are normal findings in the postmenopausal breast. Glandular tissue is replaced with fibrous tissue, the breasts become pendulous, and the Cooper's ligaments become prominent.
26. The nurse is teaching a class on Breast Health Awareness. Which are the American Cancer Society's recommended guidelines for the performance of breast self examination (BSE)? List in order of recommended performance. 1. Visualize the breast from the front while standing before a mirror. 2. Gently squeeze the nipple to express any fluid. 3. Turn to each side and view each breast in the mirror. 4. Palpate each breast in a circular motion while lying on the back. 5. Palpate each breast in a circular motion while in the shower.
The order should be: 1, 3, 5, 4, 2. 1. The first step in BSE is to visualize the breasts for symmetry while looking at a frontal view before the mirror. 3. The next step is to turn from side to side, looking for any dimpling, puckering, or asymmetry, in front of a mirror. 5. The client should palpate the breasts in a warm shower with the breasts soaped to allow for the fingers to glide over the breast tissue. 4. After the shower, the client should lie on the bed with a towel rolled up and placed under the shoulder to flatten the breast tissue and palpate the breast. 2. The last step in BSE is to gently squeeze the nipple to determine if there is expressed fluid.
22. A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. What should the nurse teach the patient about tissue expansion? a. Weekly injections of water or saline into the expander will be required. b. The expander cannot be placed until healing from the mastectomy is complete. c. This method of breast reconstruction uses the patient's own tissue to replace breast tissue. d. The nipple from the affected breast will be saved to be grafted onto the reconstructed breast.
a. When an expander is used to stretch the skin and muscle at the mastectomy site, the expander is gradually increased in size by weekly injections of water or saline until the site is large enough to hold an implant. Placement of the expander can be at the time of mastectomy or at a later date. A musculocutaneous flap procedure is a type of reconstruction using the patient's own tissue. The nipple of the affected breast is removed at mastectomy and a new nipple can be reconstructed after breast reconstruction from various normal tissues.
13. The health care provider of a patient with a positive biopsy of a 2-cm breast tumor has recommended a lumpectomy with radiation therapy or a modified radical mastectomy as treatment. The patient says that she does not know how to choose and asks the female nurse what she would do if she had to make the choice. What is the best response by the nurse to this patient? a. "It doesn't matter what I would do. It is a decision you have to make for yourself." b. "There are advantages and disadvantages of both procedures. What do you know about these procedures?" c. "I would choose the modified radical mastectomy because it would ensure that the entire tumor was removed." d. "The lumpectomy maintains a nearly normal breast but the survival rate is not as good as it is with a mastectomy."
b. Either treatment choice is indicated for women with early-stage breast cancer because the 10-year survival rate with lumpectomy with radiation is about the same as that with modified radical mastectomy. Each procedure has advantages and disadvantages that the patient must consider in making an informed choice and the nurse should make that information available to the patient to assist in decision making.
21. A 56-year-old patient is undergoing a mammoplasty for breast reconstruction following a mastectomy 1 year ago. During the preoperative preparation of the patient, what is important for the nurse to do? a. Determine why the patient is choosing reconstruction surgery rather than the use of an external prosthesis. b. Ensure that the patient has realistic expectations about the outcome and possible complications of the surgery. c. Inform the patient that implants used for breast reconstruction have been shown to cause immune-related diseases. d. Let the patient know that although the shape will be different from the other breast, the nipple can be reconstructed from other erectile tissue.
b. It is most important for the patient planning a mammoplasty that she have a realistic idea about what the surgery can accomplish and about possible complications. Currently surgery cannot restore nipple sensation or erectility and the breast will not fully resemble its premastectomy appearance but the outcome is usually more acceptable than the mastectomy scar. The woman's motives for breast reconstruction should not be questioned. There have been allegations of immune-related diseases associated with the use of silicone gel implants but after further evaluation the Food and Drug Administration (FDA) has approved these implants for use.
11. The nurse would be most concerned when the patient's breast examination reveals which finding? a. A large, tender, moveable mass in the upper inner quadrant b. An immobile, hard, nontender lesion in the upper outer quadrant c. A 2- to 3-cm, firm, defined, mobile mass in the lower outer quadrant d. A painful, immobile mass with reddened skin in the upper outer quadrant
b. On palpation, malignant lesions are characteristically hard, irregularly shaped, poorly delineated, nontender, and nonmobile and the most common site is the upper outer quadrant of the breast. A fibroadenoma is firm, defined, and mobile. Fibrocystic lesions are usually large, tender, moveable masses found throughout the breast tissue. A painful, immobile mass under a reddened area of skin is most typical of a local abscess.
19. Following a modified radical mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do? a. Avoid skin-softening agents on the arm. b. Protect the arm from any type of trauma. c. Abduct and adduct the arm at the shoulder hourly. d. Keep the arm positioned so that it is in straight and dependent alignment.
b. Removal of the axillary lymph nodes impairs lymph drainage from the affected arm and predisposes the patient to infection of the arm. The arm must be protected from even minor trauma and blood pressure, venipunctures, and injections should not be done on the arm. The arm should never be dependent, even during sleep, and should be elevated to promote lymph drainage.
1. A woman at the health clinic tells the nurse that she does not do breast self-examination (BSE) because it just seems too much of a bother. What is the best response by the nurse about BSE? a. It reduces mortality from breast cancer in women under the age of 50. b. It is useful to help women learn how their breasts normally look and feel. c. BSE has little value in detection of cancer and is not recommended anymore. d. BSE is the most common way that malignant tumors of the breast are discovered.
b. The value of breast self-examination (BSE) in reducing mortality rates from breast cancer in women is currently controversial and under review. However, it is still a useful tool in helping women to become self-aware of how their breasts normally look and feel. None of the other options has been validated at this time.
23. The patient's breast cancer has metastasized. Which medication for metastasis is better tolerated and has fewer and milder side effects than other chemotherapy medications? a. Capecitabine (Xeloda) b. Vinorelbine (Navelbine) c. Doxorubicin (Adriamycin) d. Eribulin mesylate (Halaven)
b. Vinorelbine (Navelbine) is used to treat metastatic breast cancer and is better tolerated with fewer and milder side effects than other chemotherapy medications. Capecitabine (Xeloda) is used in women whose metastatic breast cancer has not responded to started chemotherapy. Doxorubicin (Adriamycin) is a first-line chemotherapy medication and has severe side effects, especially cardiotoxicity. Eribulin mesylate (Halaven) is used in metastatic breast cancer patients who have received at least two prior chemotherapy regimens.
17. A patient with a positive breast biopsy tells the nurse that she read about tamoxifen (Nolvadex) on the Internet and asks about its use. The best response by the nurse includes which information? a. Tamoxifen is the primary treatment for breast cancer if axillary lymph nodes are positive for cancer. b. Tamoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer. c. Tamoxifen is the treatment of choice after surgery if the tumor has receptors for estrogen and progesterone on its cells. d. Because tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment has not been successful.
c. Tamoxifen is an antiestrogen agent that blocks the estrogen-receptor sites of malignant cells and is the usual first choice of treatment in postmenopausal women with hormone receptor-positive tumors, with or without nodal involvement. Tamoxifen reduces the risk for recurrent breast cancer and also that for new primary tumors. The side effects of the drug are minimal and are those commonly associated with decreased estrogen.
20. A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absence of the breast. What is an appropriate nursing intervention for this patient? a. Provide the patient with information about surgical breast reconstruction. b. Restrict visitors and phone calls until the patient feels better about herself. c. Arrange for a Reach to Recovery visitor or similar resource available in the community. d. Encourage the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.
c. The Reach to Recovery program consists of volunteers, all women, who have had breast cancer and can answer questions about what to expect at home, how to tell people about the surgery, and what prosthetic devices are available. It is a valuable resource for patients who have breast cancer and should be used if available in the community. If a volunteer is not available, the nurse is responsible for assisting the patient in the same manner. Although the nurse should stress the importance of wearing a prosthesis, a permanent prosthesis cannot be used until healing is complete and inflammation is resolved.
8. Which characteristics describe an intraductal papilloma (select all that apply)? a. Associated with breast trauma b. Occurs in 10% of women ages 15 to 40 c. Has multicolored, sticky nipple discharge d. Is associated with an increased cancer risk e. Is more common in women ages 40 to 60 f. Has wartlike growth in mammary ducts near nipple
d, e, f. Intraductal papilloma is associated with increased cancer risk, is more common in women 40 to 60 years old, and is a wart-like growth in mammary ducts beneath the areola. Fat necrosis is associated with breast trauma. Fibroadenoma occurs in 10% of young women. Multicolored, sticky nipple discharge is seen in ductal ectasia.
4. Which diagnostic test is most accurate and advantageous in terms of time and expense in diagnosing malignant breast disorders? a. Surgical biopsy b. Mammography c. Fine-needle aspiration d. Core (core needle) biopsy
d. A definitive diagnosis of breast cancer can be made only by a histologic examination of biopsied tissue. A core (core needle) biopsy is as reliable as a surgical biopsy and has the advantages of decreased length of time for the procedure and recovery and reduced cost. A limitation of fine-needle aspiration is that if negative results are found, more definitive biopsy procedures are required.
10. Which patient probably has the highest risk of breast cancer? a. 60-year-old obese man b. 58-year-old woman with sedentary lifestyle c. 55-year-old woman with fibrocystic breast changes d. 65-year-old woman with a sister diagnosed with breast cancer
d. After the age of 60, the incidence of breast cancer increases dramatically and advanced age is the highest risk factor for females. Ninety-nine percent of breast cancer cases occur in women. A first-degree relative with breast cancer is a contributing factor for breast cancer. Obesity and lack of physical activity are other contributing factors. Genetic mutations in BRCA1, BRCA2, p53, ATM, and CHEK2 genes may increase the risk of breast cancer. Fibrocystic breast changes are neither a precursor of breast cancer nor a known risk factor for cancer.
5. A 24-year-old female patient has breast cancer with estrogen receptor-negative cells. Which genomic assay test can be used to provide information about the likely recurrence and need for chemotherapy? a. CA 27-29 b. TNM system c. Oncotype DX d. MammaPrint
d. MammaPrint is used in early-stage breast cancer with estrogen receptor-positive or estrogen receptor-negative breast cancer without nodal involvement to assess risk of recurrence within 10 years without additional treatment and the likely benefit of chemotherapy. CA 27-29 is a cancer marker produced by the MUC1 gene. TNM is not a genomic assay but rather a system for staging cancer using tumor size, nodal involvement, and the presence of metastasis. Oncotype DX genomic assay is used in newly diagnosed early-stage estrogen receptor-positive breast cancer treated with hormonal therapy to assess risk of occurrence and the need for treatment with chemotherapy to prevent recurrence.
6. While examining a patient's breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate question by the nurse? a. "Do you have a high caffeine intake?" b. "When did you last have a mammogram?" c. "Is there a history of breast cancer in your mother or sisters?" d. "Do the size and tenderness of the lumps change with your menstrual cycle?"
d. Most breast lesions are benign and many mobile cystic lesions change in response to the menstrual cycle, whereas most malignant tumors do not. Caffeine has been associated with fibrocystic changes in some women but research has not established caffeine as a cause of breast pain or cysts. Questions regarding a patient's last mammogram or family history are not closely related to the nurse's findings.
14. A patient undergoing either a mastectomy or a lumpectomy for treatment of breast cancer can also usually expect to undergo what other treatment? a. Chemotherapy b. Radiation therapy c. Hormonal therapy d. Sentinel lymph node dissection
d. Sentinel lymph node dissection (SLND) has become the standard of care, with axillary lymph node dissection reserved for patients with clinical indications of disease in the axilla. SLND provides prognostic information and helps to determine further treatment. A lumpectomy, or breast conservation surgery, is followed by radiation therapy to the entire breast and the use of chemotherapy or hormone therapy depends on the characteristics of the tumor and evidence of metastases.
