Breast Cancer and Disorders Canvas Quiz

When using the accompanying illustration to teach a patient about breast self-examination, the nurse will include the information that most breast cancers are located in which part of the breast? A. Upper Outer Quadrant B. Upper Inner Quadrant C. Nipple D. Lower Outer Quadrant E. Lower Inner Quadrant

A. The upper outer quadrant is the location of most of the glandular tissue of the breast.

The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? A. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue B. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching C. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene D. A 40-yr-old patient who still has left side chest and arm pain 2 months after a left modified radical mastectomy

A. Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-yr-old patient, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

Which action will the nurse include in the plan of care for a patient with right arm lymphedema? A. Assist with application of a compression sleeve. B. Keep the right arm at or below the level of the heart. C. Check blood pressure (BP) on both right and left arms. D. Avoid isometric exercise on the right arm.

A. Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's left arm. The arm should not be placed in a dependent position.

A 35-year-old woman is diagnosed with stage III breast cancer. She seems to be extremely anxious. What action by the nurse is best? A. Explore the idea of a referral to a breast cancer support group. B. Assess whether there has been any mental illness in her past. C. Encourage the patient to search the Internet for information tonight. D. Ask the patient if sexuality has been a problem with her partner.

A. Support for the diagnosis would be best with a referral to a breast cancer support group. The Internet may be a good source of information, but the day of diagnosis would be too soon. The nurse could assess the frequency and satisfaction of sexual relations but would not assume that there is a problem in that area. Assessment of mental illness is not an appropriate action.

The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that A. the patient should call if she notices ankle swelling. B. the patient will need frequent eye examinations. C. hot flashes may occur with the medication. D. serum electrolyte levels will be drawn monthly.

A. Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.

Which finding in a female patient by the nurse would receive the highest priority of further diagnostics? A. Nontender immobile mass in the upper outer quadrant of the breast B. A 3-cm firm, defined mobile mass in the lower quadrant of the breast C. Small, painful mass under warm reddened skin D. Tender moveable masses throughout the breast tissue

A. Malignant lesions are hard, nontender, and usually located in the upper outer quadrant of the breast and would be the priority for further diagnostic study. The other lesions are benign breast disorders. The tender moveable masses throughout the breast tissue could be a fibrocystic breast condition. A firm, defined mobile mass in the lower quadrant of the breast is a fibroadenoma, and a painful mass under warm reddened skin could be a local abscess or ductal ectasia.

During a well-woman physical examination, a 43-yr-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? A. "Do you currently smoke tobacco?" B. "At what age did you start having menstrual periods?" C. "Have you ever had a breast injury?" D. "Is there a family history of fibrocystic breast changes?"

B. Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? A. The patient's white blood cell (WBC) count is 5000/μL. B. The patient's apical pulse is irregular. C. The patient eats only 25% of meals. D. The patient complains of fatigue.

B. Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the patient indicates a lack of understanding? A. "One cup of coffee in the morning should be enough for me." B. "This condition will become malignant over time." C. "I should refrain from using hormone replacement therapy." D. "This condition makes it more difficult to examine my breasts."

B. Fibrocystic breast condition does not increase a woman's chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.

A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? A. "I will probably need radiation to the breast after having the surgery." B. "Mastectomy is the best choice to decrease the chance of cancer recurrence." C. "I can probably have reconstructive surgery at the same time as a mastectomy." D. "There are several options that I can consider for treating the cancer."

B. The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

When the nurse is working in the women's health care clinic, which action is appropriate to take? A. Discuss scheduling an annual clinical breast examination with a 22-year-old patient. B. Teach a 28-yr-old patient with a BRCA-1 mutation about magnetic resonance imaging (MRI). C. Explain to a 60-yr-old patient that mammography frequency can be reduced to every 3 years. D. Teach a healthy 30-yr-old patient about the need for an annual mammogram.

B. MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A woman should have a clinical breast examination about every 3 years for women in their 20s and 30s and every year for women age 40 years and older. Annual mammograms are recommended for women older than 40 years of age.

The nurse will anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS) about A. lymphatic mapping. B. tamoxifen C. MammaPrint testing. D. lumpectomy.

B. Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about A. raloxifene (Evista). B. tamoxifen C. estradiol (Estrace). D. trastuzumab (Herceptin).

B. Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

The nurse provides discharge teaching for a 61-yr-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? A. "I will keep my left arm in a sling until the incision is healed." B. "I will avoid reaching over the stove with my left hand." C. "I will stop the left arm exercises if moving the arm is painful." D. "I will need to use my right arm and to rest the left one."

B. The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.

A 33-yr-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? A. Take aspirin every 4 hours to reduce inflammation. B. Check wound drains for excessive blood or a foul odor. C. Wear a loose-fitting bra to decrease irritation of the sutures. D. Resume normal activities 2 to 3 days after the mammoplasty.

B. The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? A. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. B. HT does not appear to increase the risk for breast cancer unless there are other risk factors. C. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. D. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

C. Because HT has been linked to increased risk for breast cancer, the patient and health care provider must determine whether or not to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

A patient is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and fluorouracil (5-FU) for breast cancer. Which side effect seen in the patient would the nurse report to the provider immediately? A. Mucositis B. Nausea and vomiting C. Shortness of breath D. Hair loss

C. Doxorubicin (Adriamycin) can cause cardiac problems with symptoms of extreme fatigue, shortness of breath, chronic cough, and edema. These need to be reported as soon as possible to the provider. Nausea, vomiting, hair loss, and mucositis are common problems associated with chemotherapy regimens.

A 68-year-old male patient is embarrassed about having bilateral breast enlargement. Which statement by the nurse is the most appropriate? A. "Gynecomastia usually comes from overeating." B. "Breast cancer in men is quite rare." C. "It is good that you came to be carefully evaluated." D. "When you get older, the male breast always enlarges."

C. The most appropriate statement is the one that is supportive of the patient. A breast mass should be carefully evaluated for breast cancer, even if it is not common. Gynecomastia as a symptom can be related to antiandrogen agents, aging, obesity, estrogen excess, or lack of androgens.

A patient is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best? A. "Numbness, tingling, and swelling are common sensations after a mastectomy." B. "The risk for lymphedema is a real threat and can be very self-limiting." C. "A risk factor for lymphedema is infection, so wear gloves when gardening outside." D. "You do not need to worry about lymphedema since you did not have radiation therapy."

C. Infection can create lymphedema; therefore, the patient needs to be cautious with activities using the affected arm, such as gardening. Radiation therapy is just one of the factors that could cause lymphedema. Other risk factors include obesity and presence of axillary disease. The symptoms of lymphedema are heaviness, aching, fatigue, numbness, tingling, and swelling, and are not common after the surgery. Women with lymphedema live fulfilling lives.

A 58-yr-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? A. "It would not be appropriate for me to make a decision about your health." B. "I would have a lumpectomy, but you need to decide what is best for you." C. "Tell me what you understand about the surgical options that are available." D. "There is no need to make a decision rapidly; you have time to think about this."

C. Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication.

Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? A. A breast lump that increases in size before the menstrual period B. A breast lump that is small, mobile, with a rubbery consistency C. A breast nodule that is 1 cm in size, nontender, and fixed D. Bilateral breast nodules that are tender with palpation

C. Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.

A patient is diagnosed with a fibrocystic breast condition while in the hospital and is experiencing breast discomfort. What comfort measure would the nurse delegate to the unlicensed assistive personnel (UAP)? A. Administer diuretics to decrease breast swelling. B. Teach the patient to wear a supportive bra to bed. C. Aid in the draining of the cysts by needle aspiration. D. Obtain a cold pack to temporarily relieve the pain.

D. All of the options would be comfort measures for a patient with a fibrocystic breast condition. The UAP can obtain the cold or heat therapy. Only the nurse would aid the healthcare provider with a needle aspiration, teach, and administer medications.

The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? A. Ask the patient to describe what she knows about the surgery. B. Discuss options for postoperative pain management. C. Explain the postdischarge care of the axillary drains. D. Teach the patient how to deep breathe and cough.

A. Before teaching, the nurse should assess the patient's current knowledge level. The other teaching also may be appropriate, depending on the assessment findings.

The nurse is examining a woman's breast and notes multiple small mobile lumps. Which question would be the most appropriate for the nurse to ask? A. "Do the small lumps seem to change with your menstrual period?" B. "How many cans of caffeinated soda do you drink in a day?" C. "When was your last mammogram at the clinic?" D. "Do you have a first-degree relative who has breast cancer?"

A. The most appropriate question would be one that relates to benign lesions that usually change in response to hormonal changes within a menstrual cycle. Reduction of caffeine in the diet has been shown to give relief in fibrocystic breast conditions, but research has not found that it has a significant impact. Questions related to the patient's last mammogram or breast cancer history are not related to the nurse's assessment.

Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes? A. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. B. Insist that the patient examine the surgical incision when the initial dressings are removed. C. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. D. Obtain a permanent breast prosthesis before the patient is discharged from the hospital.

A. The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that A. the tumor is not likely to be responsive to hormone therapy. B. HER-2 receptor testing was repeated for a total of three samples. C. estrogen receptor testing identified the three hormones causing the cancer. D. treatment with chemotherapy is not likely to be recommended.

A. A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.

A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? A. Administering an analgesic 30 minutes before scheduled arm exercises B. Evaluating the patient's understanding of instructions about drain care C. Assessing the patient's range of motion for the left arm D. Teaching the patient how to avoid injury to the left arm

A. LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice.

What comfort measure can only be performed by a nurse, as opposed to an unlicensed assistive personnel (UAP), for a patient who returned from a left modified radical mastectomy 4 hours ago? A. Administering morphine for pain at a "4" on a 0-to-10 scale B. Supporting the left arm while initially ambulating the patient C. Elevating the left arm on a pillow D. Placing the head of bed at 30 degrees

A. Only the nurse is authorized to administer medications, but the UAP could inform the nurse about the rating of pain by the patient. The UAP could position the bed to 30 degrees and elevate the patient's arm on a pillow to facilitate lymphatic fluid drainage return. The patient's arm should be supported while walking at first but then allowed to hang straight by the side. The UAP could support the arm while walking the patient.

Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? A. Careful skin care in the radiated area will be necessary. B. Visitors are restricted until the radiation therapy is completed. C. The radiation therapy will take a week to complete. D. Wigs may be used until the hair regrows after radiation therapy.

A. Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Scalp hair loss does not occur with breast radiation therapy. Because the patient does not have radioactive implants, no visitor restrictions are necessary.

A patient is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug? A. It selectively blocks estrogen in the breast. B. It interferes with cancer cell division. C. It blocks the release of luteinizing hormone. D. It inhibits DNA synthesis in rapidly dividing cells.

A. Tamoxifen (Nolvadex) reduces the estrogen available to breast tumors to stop or prevent growth. This drug does not block the release of luteinizing hormone to prevent the ovaries from producing estrogen; leuprolide (Lupron) does this. Chemotherapy agents such as ixabepilone (Ixempra) interfere with cancer cell division, and doxorubicin (Adriamycin) inhibits DNA synthesis in susceptible cells.

A patient is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the patient would indicate that further teaching is needed? A. "I am glad that these tubes will fall out at home when I finally shower." B. "I should be careful how I lie in bed so that I will not kink the tubing." C. "I should measure the drainage each day to make sure it is less than an ounce (30 mL)." D. "If there is a foul odor from the drainage, I should contact my doctor."

A. The drainage tubes (such as a Jackson-Pratt drain) lie just under the skin but need to be removed by the healthcare professional in about 1 to 3 weeks at an office visit. Drainage should be less than 25 mL in a day's time. The patient should be aware of her positioning to prevent kinking of the tubing. A foul odor from the drainage may indicate an infection; the provider would be contacted immediately.

The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? A. Question the patient about current medications. B. Refer the patient for mammography. C. Teach the patient how to palpate the breast tissue for lumps. D. Explain that this is temporary due to hormonal changes.

A. The first action should be further assessment. Because gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.

The nurse is taking the history of a patient who is scheduled for breast augmentation surgery. The patient reveals that she took two aspirin this morning for a headache. Which action by nurse is best? A. Take the patient's vital signs and record them in the chart. B. Notify the surgeon about the aspirin ingestion by the patient. C. Warn the patient that health insurance may not pay for the procedure. D. Teach the patient about avoiding twisting above the waist after the operation.

B. The surgeon must be notified immediately since the aspirin could cause increased bleeding during the procedure. Vital signs would be recorded and postoperative teaching would be completed in the preoperative time frame, but these are not the priority since the procedure may be rescheduled. The warning about the patient's health insurance is not appropriate at this time.

During dressing changes, the nurse assesses a patient who has had breast reconstruction. Which finding would cause the nurse to take immediate action? A. Temperature of 99° F (37.2° C) B. Dusky color of the flap C. Blood pressure of 128/75 mm Hg D. Slightly reddened incisional area

B. A dusky color of the breast flap could indicate poor tissue perfusion and a decreased capillary refill. The nurse would notify the surgeon to preserve the tissue. It is normal to have a slightly reddened incision as the skin heals. The blood pressure is within normal limits and the temperature is slightly elevated but would be monitored.

Which information will the nurse include in patient teaching for a 36-yr-old patient who is scheduled for stereotactic core biopsy of the breast? A. A thin needle will be inserted into the lump and aspirated to remove tissue. B. A local anesthetic will be given before the biopsy specimen is obtained. C. You will need to lie flat on your back and lie very still during the biopsy. D. You should not have anything to eat or drink for 6 hours before the procedure.

B. A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to obtain the specimens.

A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? A. The lumps get more painful before the patient's menstrual period. B. An area on the breast is hot, pink, and tender to the touch. C. Firm, moveable lumps are in the upper outer breast quadrants. D. There is yellow discharge from the patient's right nipple.

B. An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. Manifestations of fibrocystic breast changes include one or more palpable lumps that are often round, well delineated, and freely movable within the breast. Discomfort ranging from tenderness to pain may also occur. The lump is usually observed to increase in size and perhaps in tenderness before menstruation. Nipple discharge associated with fibrocystic breasts is often milky, watery-milky, yellow, or green.

A 51-yr-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that A. if the biopsy results are negative, no further diagnostic testing will be needed. B. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. C. FNA is guided by a mammogram, ensuring that cells are taken from the lesion. D. only a small incision is needed, resulting in minimal breast pain and scarring.

B. FNA is done in outpatient settings, and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound but not by mammogram. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA results are negative.

A patient has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe? A. Elevating the right arm on a pillow B. Checking the amount of urine in the urine catheter collection bag C. Taking the blood pressure on the right arm D. Encouraging the patient to squeeze a rolled washcloth

C. Healthcare professionals need to avoid the arm on the side of the surgery for blood pressure measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage would be compromised. The pressure from the blood pressure cuff could promote swelling. Infection could occur with injections and blood draws. Checking urine output, elevation of the affected arm on a pillow, and encouraging beginning exercises are all safe postoperative interventions.

Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? A. "I will be taking the medication for 6 to 12 months." B. "I should contact you if I have hot flashes." C. "I will call if I have any eye problems." D. "I can expect to have leg cramps."

C. Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? A. Saline-filled implants are placed under the pectoral muscles. B. Muscle tissue removed from the back is used to form a breast C. Recovery from the TRAM surgery takes at least 6 to 8 weeks. D. TRAM flap procedures may be done in outpatient surgery centers.

C. Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.

A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? A. "Many patients do better after surgery if they have more information." B. "It is essential that you know enough to provide informed consent." C. "Tell me what you think is important to know about the surgery." D. "You can wait until after surgery for teaching about pain management."

C. This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

With a history of breast cancer in the family, a 48-year-old female patient is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the patient indicates that more teaching is needed? A. "I am fortunate that I breast-fed each of my three children for 12 months." B. "It looks as though I need to start working out at the gym more often." C. "When I have menopausal symptoms, I must avoid hormone replacement therapy." D. "I am glad that we can still have wine with every evening meal."

D. Modifiable risk factors can help prevent breast cancer. The patient should lessen alcohol intake and not have wine 7 days a week. Breast-feeding, regular exercise, and avoiding hormone replacement are also strategies for breast cancer prevention.

The nurse teaching a young women's community service group about breast self-examination (BSE) will include that A. annual mammograms should be scheduled in addition to BSE. B. BSE will reduce the risk of dying from breast cancer. C. BSE should be done daily while taking a bath or shower. D. performing BSE after the menstrual period is more comfortable.

D. Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.

A woman diagnosed with breast cancer had these laboratory tests performed at an office visit: Alkaline phosphatase125 U/L (2.2 mckat/L)Total calcium12 mg/dL (3 mmol/L)Hematocrit39% (0.39)Hemoglobin14 g/dL (140 mmol/L) Which test results indicate to the nurse that some further diagnostics are needed? A. The elevated hematocrit and hemoglobin indicate dehydration. B. Only alkaline phosphatase is decreased, suggesting liver metastasis. C. Hematocrit and hemoglobin are decreased, indicating anemia. D. Elevated alkaline phosphatase and calcium suggests bone involvement.

D. The alkaline phosphatase (normal value 30 to 120 U/L [0.5 to 2.0 mckat/L)) and total calcium (normal value 9 to 10.5 mg/dL [2.25 to 2.63 mmol/L) levels are both elevated, suggesting bone metastasis. Both the hematocrit and hemoglobin are within normal limits for females.

A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate? A. Inform the patient that this surgery removes all mammary tissue and cancer risk. B. Discourage this surgery since the woman is still of childbearing age. C. Reassure the patient that reconstructive surgery is as easy as breast augmentation. D. Include support people, such as the male partner, in the decision making.

D. The cultural aspects of decision making need to be considered. In the Nigerian culture, the man often makes the decisions for care of the female. Women with a high risk for breast cancer can consider prophylactic surgery. If reconstructive surgery is considered, the procedure is more complex and will have more complications compared to a breast augmentation. There is a small risk that breast cancer can still develop in the remaining mammary tissue.