Ch 54 Client w/ breast disorder

After a breast biopsy, a client is diagnosed with lobular carcinoma in situ. Which information about treatment will the nurse prepare for this client? Select all that apply.

Frequency of mammograms Chemoprevention strategies

A client has been diagnosed with breast cancer and is awaiting cytology results of a biopsy. During client education, the nurse discusses the possible types of breast malignancies. Which is the most common type?

ductal

At which age should a healthy client begin annual mammograms?

45 years old

A client that is Assigned Female at Birth (AFAB) is diagnosed with stage II breast cancer and informed breast conservation surgery followed by radiation is the best option. The client asks why a modified radical mastectomy wouldn't be done. Which is the nurse's best response?

"According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy."

A client is to undergo an ultrasound-guided core biopsy. The client tells the nurse that a friend of theirs had a stereotactic core biopsy. The client wants to understand the differences between the two procedures. What would be the nurse's best response?

"An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation."

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?

"I need to use an electric shaver when shaving my right armpit."

A client has just been diagnosed with breast cancer and the nurse is performing a client interview. In assessing this client's ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask?

"Is there someone you trust to help you make treatment choices?"

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the group to raise their arms and inspect their breasts in a mirror. A member of the group asks the nurse why raising the arms is necessary. What is the nurse's best response?

"It will help to observe for dimpling more closely."

A client with a 3-cm breast tumor is scheduled for a lumpectomy followed by 5 to 7 weeks of radiation therapy. The patient asks the nurse if this procedure will cure them. What is the nurse's best response?

"Lumpectomy, followed by radiation, has the same predicted long-term survival rates as a mastectomy."

A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when they can take a shower. What should the nurse respond?

"Not until the drain is removed"

A client with stage II breast cancer has received her treatment plan that includes radiation therapy. The nurse knows that the client understands radiation treatment when she makes which statement?

"Radiation therapy will reduce the chance of breast cancer recurrence."

The nurse is caring for an assigned female at birth (AFAB) client whose aunt and mother died of breast cancer. The client states, "My primary care provider and I talked about tamoxifen to help prevent breast cancer. Do you think it will work?" Which would be the nurse's best response? Select all that apply.

"Tamoxifen is known to be a highly effective protective measure." "Tamoxifen is recommended for treatment of estrogen-based breast tumors."

A client is prescribed antibiotic therapy to treat mastitis. For how long will the nurse advise the client that she will be taking the antibiotics? Fill in the blank with a number.

10 days

A client has fibrocystic breast disease. Assuming that there are no sudden or unusual changes, the nurse would suggest that the client have follow-up appointments with her physician every ____ months. Record your answer with a whole number.

6

A client at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the client asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response?

A client at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the client asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response?

A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous?

A nonmobile mass with irregular edges

A nurse is reviewing a client's history, which includes the following information:

Age at first pregnancy

An older client underwent a lumpectomy for a breast lesion that was determined to be malignant. Which factors in the client's history may have increased the risk of breast cancer?

All options are correct. Being female, being older than 50 years of age, and having a family history of breast cancer are the most common risk factors. Additional factors include obesity, and having no children or having children after 30 years of age.

A client recovering from a breast abscess has decided to stop breast-feeding. Which of the following measures would the nurse employ to assist the client?

Apply a tight-fitting brassiere.

A breastfeeding client is reporting pain in the left breast and describes the breast as feeling "doughy." The client is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend?

Apply cold compresses as prescribed.

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?

Assessing the vital signs and oxygen saturation levels.

Based on her knowledge of the most common site of metastatic spread for breast cancer, the nurse would recommend periodic assessments of the:

Bone In metastatic disease, the bone, usually the hips, spine, ribs, or pelvis, is the most common site of spread. Other sites of metastasis include the lungs, liver, pleura, and brain.

The nurse is educating a group at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than breast self examination (BSE)?

Breast self-awareness

Which primary prevention modality aims to prevent the disease before it starts?

Chemoprevention

A 33-year-old client with three children has had a follow-up mammogram after an abnormal BSE. Mammogram findings reveal incidental microscopic abnormal tissue growth in the left breast lobules. The physician orders tamoxifen for the client. The nurse understands that the physician is implementing which primary prevention modality to treat this client?

Chemoprevention Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts.

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?

Concerns regarding the cancer and how the surgery will affect her.

The nurse working on a cancer treatment floor assesses her assigned clients. It is most important for the nurse to report which assessment finding?

Coolness and mottling of a newly constructed breast site

A client is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the client is aware of what potential consequence?

Decreased nipple sensation

Which type of biopsy would the nurse tell the client is a usual procedure for any palpable breast mass found on mammography?

Excisional

A patient is having a biopsy that will remove the entire mass, plus a margin of surrounding tissue. What type of biopsy will be documented on the operative permit?

Excisional biopsy

Which is a characteristic of a breast cancer mass?

Firm, hard, embedded in surrounding tissue

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?

First full-term pregnancy at age 34 years Risk factors associated with breast cancer include menarche before age 12 years, menopause after age 55 years, nulliparity, and late age at first full-term pregnancy.

A patient is told that she has a common form of breast cancer where the tumor arises from the duct system and invades the surrounding tissues, often forming a solid irregular mass. What type of cancer does the nurse prepare to discuss with the patient? You Selected:

Infiltrating ductal carcinoma

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor?

Medication adverse effects

A female patient comes to the clinic with the complaint that she is having a greenish-colored discharge from the nipple and the breast feels warm to touch. What does the nurse suspect these symptoms may indicate?

Infection

Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do?

Inform the physician immediately.

The nurse is assessing an older adult who has not seen their physician in 2 years. The nurse is assisting the patient into a gown and notices that the patient has edema and pitting of the skin on the right breast. What does the nurse understand is the significance of this finding?

It may result from a neoplasm blocking lymphatic drainage, indicating advanced breast cancer.

A nurse is educating a group of Assigned Female at Birth (AFAB) clients about the potential benefits of breast self-examination (BSE). The nurse will educate them that effective BSE is dependent on which factor?

Knowledge of how their breasts normally look and feel

A client with fibrocystic breast disease has been receiving treatment with danazol (Danocrine) therapy for the past 6 months. In anticipation of the drug being discontinued, the nurse instructs the client to inform the healthcare provider about which of the following?

Lack of return of regular menses within 90 days after discontinuing the drug

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements?

Lobules and ducts

Which term is used to describe removal of breast tissue and axillary lymph node dissection leaving muscular structure intact as surgical treatment of breast cancer?

Modified radical mastectomy

The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer?

Mother affected by cancer before 60 years of age Risk for breast cancer increases twofold if first-degree female relatives (sister, mother, or daughter) have had breast cancer. Increased risk is associated with early menarche (i.e. menses beginning before 12 years of age). Nulliparity and later maternal age at first birth are associated with increased risk for breast cancer. Alcohol use remains controversial; however, a slightly increased risk is found in women who consume even one drink daily and doubles among women drinking three drinks daily.

Which is inconsistent as a risk factor for breast cancer?

Multiparity

A patient has undergone surgery for breast cancer and the findings of the surgery are as follows: Invasive undifferentiated tumor Size 2.2 cm Axillary lymph nodes negative High ERBB2 expression Which of these findings would suggest a favorable prognosis?

Negative lymph nodes

The nurse is providing care to a client with a suspected malignant breast tumor. The nurse knows that the mass likely had which characteristic upon palpation?

Non-tender on palpation

A 49-year-old client reports their last known menstrual cycle occurred over 1 year ago. Her records indicate gravida 0, para 0. Upon further review of the chart, the nurse notes that the client has a positive maternal history of hypertension. Moreover, the client has a positive paternal history of diabetes. With no additional significant history noted, which of the nurse's findings is consistent as a risk factor for breast cancer for this client?

Nulliparity

The nurse is caring for a client diagnosed with fibrocystic disease and prescribed danazol (Danocrine). Which is essential before drug therapy is initiated?

Pregnancy test

A nurse has assessed that a client is not yet willing to view their mastectomy site. How will the nurse best assist the client in developing a positive body image? Select all that apply.

Provide the client with encouragement in an empathic and thoughtful manner. Assess readiness to address observing the sit

A 52-year-old client has just been told they have breast cancer and are scheduled for a modified mastectomy the following week. The nurse caring for this client knows that they are anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this client's fears?

Provide the client with relevant information about expected recovery.

A nurse is caring for a group of breast cancer survivors after mastectomy. Which teaching point should the nurse reinforce about activities 6 weeks after surgery?

Resume light household work.

A nurse is assisting with obtaining a specimen of breast milk from a mother with suspected mastitis. What organism would the nurse most expect to be found in the milk that would be consistent with a diagnosis of mastitis?

Staphylococcus aureus

A client scheduled for a simple mastectomy in 1 week is having preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period?

Stop taking aspirin.

A client who is Assigned Male at Birth (AMAB) has come to the clinic for an annual physical. The nurse notes in the client's history that their father was treated for breast cancer. Which action will the nurse perform before the client leaves the clinic? Select all that apply.

Stress importance of discussing risk with their health care provider Discuss benefit of regular clinical breast examinations

A client newly diagnosed with breast cancer states that the health care provider suspects regional lymph node involvement and told the client that there are signs of metastatic disease. The nurse learns that the client has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis?

The client has a 15% chance of 5-year survival.

A nurse is examining a client who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this client's diagnosis?

The client might be referred for a biopsy. Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis.

A patient had a sentinel node biopsy and informs the nurse that something is very wrong with her. The patient explains that she had a bowel movement and urinated and both are a blue color. What should the nurse inform the patient?

The dye that was used during the biopsy is safe and being excreted.

A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred?

The mass may be cystic and was ruptured when the needle was inserted.

A patient has had a total mastectomy 12 hours ago and the nurse is assessing the surgical wound. The nurse observes ecchymosis, swelling, and tightness around the wound, and the patient states that it is painful. What does the nurse suspect has occurred?

The patient has developed a hematoma. Hematoma formation (collection of blood inside a cavity) may occur after either mastectomy or breast conservation and usually develops within the first 12 hours after surgery.

The nurse is providing preoperative instruction for a patient who will be having an excisional breast biopsy. The patient asks the nurse what type of bra should be used after the procedure. What should the nurse inform the patient?

The patient should wear a supportive bra after the procedure. The use of a supportive bra following surgery is encouraged to limit movement of the breast and reduce discomfort.

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?

Upper outer

A health care provider recommends that a patient with breast cancer undergo a modified radical mastectomy. The nurse explains that this procedure involves removal of the entire breast:

and the nipple-areola complex along with the axillary node dissection.

Most women diagnosed with breast cancer exhibit which risk factor?

being older than 50 years old

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE:

between days 5 and 7 after menses.

A client presented to the ED with purulent drainage from the left nipple, and was admitted to the hospital with a diagnosis of breast abscess. The client was started on intravenous antibiotic therapy, and placed on which precautions?

contact

A client is concerned about the lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What could be causing this condition?

cyclical hormonal changes

A school nurse at a middle school finds that students are typically surprised to hear the role of women's breasts. What is their primary function?

lactation

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid?

lymphedema

At a public health fair, the nurse teaches a group about breast cancer awareness. What possible signs of breast cancer would the nurse include in this teaching?

nipple retraction Nipple discharge, breast nodules, nipple retraction, and lymphadenopathy may be signs of breast cancer and should be reported.

What is the likelihood of a woman developing breast cancer?

one in eight

A client is very concerned about possibly having breast cancer, especially after caring for a close family member who recently died from the disease. The nurse informs the client that the primary and most common sign of breast cancer is a:

painless mass in the breast, most often in the upper outer quadrant.

For a cancerous tumor, a client must undergo modified radical mastectomy, which includes axillary node removal and immediate reconstruction. The nurse explains to the client that the axillary nodes will be removed to:

provide prognostic information. Lymph node dissection provides prognostic information by helping to determine if chemotherapy is indicated. Although removal of lymph nodes may assist in prevention of metastasis, lymph node dissection isn't a guarantee that metastasis won't occur

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:

should continue to perform breast self-examination on her right breast.