Chapter 51: Breast Disorders

28. 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.1 b.2 c.3 d.4 e.5

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

15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing? a.CA 15-3 level testing b.HER-2 receptor testing c.Estrogen receptor testing d.Oncotype DX assay testing

ANS: A Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer, not to detect or diagnose breast cancer. The other tests are likely to be used for additional diagnostic testing in a patient with breast cancer

3. A 51-year-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.FNA is done in the outpatient clinic and results are available in 1 to 2 days. b.only a small incision is needed, resulting in minimal breast pain and scarring. c.if the biopsy results are negative, no further diagnostic testing will be needed. d.FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

ANS: A 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 is negative

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

ANS: B 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

6. A 58-year-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.I would have a lumpectomy, but you need to decide what is best for you. b.Tell me what you understand about the surgical options that are available. c.It would not be appropriate for me to make a decision about your health. d.There is no need to make a decision rapidly; you have time to think about this.

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

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

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

5. A 53-year-old woman at 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.

ANS: C Because HT has been linked to increased risk for breast cancer, the patient and 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 nonBRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms

2. During a well woman physical exam, a 43-year-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.Have you ever had a breast injury? c.At what age did you start having menstrual periods? d.Is there a family history of fibrocystic breast changes?

ANS: C 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.

8. After a 48-year-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.estradiol (Estrace). b.raloxifene (Evista). c.tamoxifen (Nolvadex). d.trastuzumab (Herceptin).

ANS: C 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.

13. 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.There are several options that I can consider for treating the cancer. b.I will probably need radiation to the breast after having the surgery. c.Mastectomy is the best choice to decrease the chance of cancer recurrence. d.I can probably have reconstructive surgery at the same time as a mastectomy.

ANS: C 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

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

ANS: D 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.

25. The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a.The patient complains of fatigue. b.The patient eats only 25% of meals. c.The patients apical pulse is irregular. d.The patients white blood cell (WBC) count is 5000/L.

YEARS: C 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.

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

YEARS: D 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-year-old, 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

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

YEARS: D Before teaching, the nurse should assess the patients current knowledge level. The other teaching also may be appropriate, depending on the assessment findings.

24. 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.Teaching the patient how to avoid injury to the left arm b.Assessing the patients range of motion for the left arm c.Evaluating the patients understanding of instructions about drain care d.Administering an analgesic 30 minutes before scheduled arm exercises

YEARS: D LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patients understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice

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

YEARS: D MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A young woman should have a clinical breast exam every 3 years. Annual mammograms are recommended for women over 50

16. The nurse will anticipate teaching a 56-year-old patient who is diagnosed with lobular carcinoma in situ (LCIS) about a.lumpectomy. b.lymphatic mapping. c.MammaPrint testing. d.tamoxifen (Nolvadex)

YEARS: D 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.

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

YEARS: 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 under age 40, and newer guidelines suggest delaying them until age 50.