Chapter 52
The nurse is obtaining a history from a client who states recurrent breast tenderness. The client inquires if there is something wrong with her breasts. Which question by the nurse is a priority? a. "Have you pulled a muscle or had any injury to the breast?" b. "Does the tenderness occur around the same time each month?" c. "When did you first recognize the symptoms?" d. "Do you have a history of breast disorders and cancer in the family?"
"Does the tenderness occur around the same time each month?"
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? a. "I should tell my manicurist that it is okay to trim the cuticles on my right hand." b. "Anytime I need blood drawn, they should get the sample from my right arm." c. "I can lift with my right arm objects that weigh as much a
"I need to use an electric shaver when shaving my right armpit."
The nurse is caring for four clients in an oncology unit. Following report on diagnosis and treatment, which client would the nurse identify as having the most life-threatening diagnosis? a. A client diagnosed with a stage one tumor with no lymph node involvement b. A client with stage IV cancer receiving palliative care c. A client with an estrogen receptor-positive tumor receiving oral chemotherapy d. A client receiving chemotherapy and radiation with a low blood count
A client with stage IV cancer receiving palliative care
A group of students are reviewing material in preparation for a test on breasts. The students demonstrate understanding of the material when they identify which of the following? a. A primary function of the breast is to produce milk. b. Striated muscle in the nipples contract causing them to become erect. c. The breasts contain a limited supply of blood vessels. d. Progesterone is primarily responsible for the growth of breast tissue.
A primary function of the breast is to produce milk.
A 33-year-old client is recovering from a modified radical mastectomy with immediate reconstruction. This is the client's fourth day postoperatively. Vital signs are temperature 99°F, pulse 82, respirations 18, and blood pressure 152/90. She continues to complain of considerable pain, with a pain rating of 9 on a scale of 1 to 10, with 10 being the worst possible pain. The client was discharged home with a prescription for oxycodone and acetaminophen and has been taking the drugs as prescribe
A well-defined oval area near the incision site
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? a. not giving birth b. increased age c. obesity d. All options are correct.
All options are correct.
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? a. Checking for urinary retention and the need to void. b. Checking level of pain first upon the clients return from the operating room. c. Assessing the vital signs and oxygen saturation levels. d. Checking the dressing, drain, and amount of drainage.
Assessing the vital signs and oxygen saturation levels.
A client is diagnosed with a breast abscess. They would like to continue to breastfeed their newborn. Which of the following would be most appropriate in this situation? a. Reduce the frequency of removing and reapplying the dressings. b. Assist the client to pump the breasts to remove breast milk. c. Encourage the client to include protein content in the diet. d. Instruct the client to wear a tight-fitting bra.
Assist the client to pump the breasts to remove breast milk.
Based on her knowledge of the most common site of metastatic spread for breast cancer, the nurse would recommend periodic assessments of the: a. Liver b. Bone c. Brain d. Lungs
Bone
A nurse is describing the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which of the following? a. Cataract formation b. Risk for endometrial cancer c. High density lipoprotein levels d. Bone mineral density
Bone mineral density
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)? a. Breast self-awareness b. Hormone replacement c. Mammography every year d. Ultrasound with mammography
Breast self-awareness
How can breast cancer prevention programs best serve at-risk clients from lower socioeconomic backgrounds? a. Provide access to health insurance. b. Increase support services. c. Increase access to health care. d. Develop tailored screening and educational programs.
Develop tailored screening and educational programs.
A client has undergone a transverse rectus abdominis myocutaneous (TRAM) flap procedure for breast reconstruction immediately following a mastectomy. Which of the following would be most appropriate to include in the client's postoperative plan of care? a. Inspecting the breast site for expected mottling b. Monitoring the single incisional site at the breast c. Encouraging coughing and deep breathing exercises d. Maintaining the client in the supine position
Encouraging coughing and deep breathing exercises
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? a. Excisional biopsy b. Core biopsy c. Incisional biopsy d. Ultrasound-guided core biopsy
Excisional biopsy
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? a. Menopause at age 50 years b. Menarche at age 14 years c. One of three living children born prematurely d. First full-term pregnancy at age 34 years
First full-term pregnancy at age 34 years
A 28-year-old client is learning about breast self-examination. The nurse teaches them the best time of each month to examine their breasts is during the: a. Week before menstruation occurs. b. Week that menstruation occurs. c. Week that ovulation occurs. d. First week after menstruation.
First week after menstruation.
A 30-year-old client whose mother died of breast cancer at age 44, and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic? a. Mammogram b. Genetic counseling c. Contacting the American Cancer Society d. Papanicolaou (Pap) testing every 6 months
Genetic counseling
Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon? a. Gross swelling b. Bruising of the skin c. Pain at the site d. Tightness of the skin
Gross swelling
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? a. Blocked lymph duct b. A ruptured cyst c. Cancer d. Infection
Infection
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? a. Infiltrating lobular carcinoma b. Medullary carcinoma c. Mucinous carcinoma d. Infiltrating ductal carcinoma
Infiltrating ductal carcinoma
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? a. Check the area after the next menses. b. Put a heating pad on the area to reduce inflammation. c. Squeeze the nipple to check for drainage. d. Inform the physician immediately.
Inform the physician immediately.
When a client demonstrates a wart-like growth near the nipple, causing bloody nipple discharge, the client is exhibiting signs of which disease process? a. Fibroadenoma b. Acute mastitis c. Intraductal papilloma d. Paget disease
Intraductal papilloma
A client is receiving adjuvant chemotherapy for breast cancer. Which is most likely her node status and tumor size? a. Node negative, tumor size 0.5 cm b. Node negative, tumor size 0.3 cm c. Node negative, tumor size 1.2 cm d. Node negative, tumor size 0.2 cm
Node negative, tumor size 1.2 cm
Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid? a. Lymphedema b. Fibroadenoma c. Mastalgia d. Breast cancer
Lymphedema
The nurse is providing care to a client who has had surgery as treatment for breast cancer. The nurse would be alert for the development of which of the following? a. Lymphedema b. Fibrocystic breast disease c. Breast abscess d. Fibroadenoma
Lymphedema
A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include? a. Maintaining an ideal weight b. Increasing the intake of caffeinated drinks c. Delaying childbearing until after age 30 d. Opting for estrogen only replacement therapy during menopause
Maintaining an ideal weight
A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies? a. Breast biopsy b. Ultrasound c. Mammogram d. Mastopexy
Mammogram
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? a. Radical mastectomy b. Modified radical mastectomy c. Total mastectomy d. Segmental mastectomy
Modified radical mastectomy
The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer? a. Multiparity b. Onset of menses before 14 years of age c. Mother affected by cancer before 60 years of age d. No alcohol consumption
Mother affected by cancer before 60 years of age
Which is inconsistent as a risk factor for breast cancer? a. Late menopause b. Family history of breast cancer c. Older age d. Multiparity
Multiparity
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? a. Family history of breast cancer b. Family hi
Nulliparity
The nurse teaches a premenopausal client to perform breast self-examination (BSE) at which interval? a. Any time during the month b. On day 5 to day 7, counting the first day of menses as day 1 c. On day 2 to day 4, counting the first day of menses as day 1 d. With the onset of menstruation
On day 5 to day 7, counting the first day of menses as day 1
The nurse is completing the admission history for a client who is admitted for a reduction mammoplasty. Which of the following client statements is uncommon when explaining the rationale for the procedure? a. Skin irritation b. Low self-esteem c. Back pain d. Others disapprove
Others disapprove
When a client demonstrates thickening, scaling, and erosion of the nipple and areola, the nurse recognizes that the client is exhibiting signs of which disease process? a. Acute mastitis b. Fibroadenoma c. Peau d'orange (edema) d. Paget disease
Paget disease
Which is an inaccurate manifestation of a fibroadenoma? a. Are not round or lobular b. Biopsy is not indicated for definitive diagnosis c. Premenstrual changes do not occur d. Usually tender
Premenstrual changes do not occur
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? a. Provide the client with relevant information about expected recovery. b. Provide written material on the procedure that has been scheduled for the client. c. Give the cli
Provide the client with relevant information about expected recovery.
A client is considering use of chemoprevention because she is at high risk for developing breast cancer. What can the nurse do to assist the patient with her decision? a. Inform the patient that medication should not be used prophylactically due to the many side effects. b. Inform the patient that she should take every measure available to her to prevent this disease. c. Provide the patient with information regarding the benefits, risks, and possible side effects. d. Provide the patient with inf
Provide the patient with information regarding the benefits, risks, and possible side effects.
At a follow-up visit, the client is informed that her breast cancer has recurred. The nurse knows that which situation places the client at risk for developing bone metastases? a. Previous therapeutic response to chemotherapy b. Aggressive treatment, including surgery, radiation, and hormonal therapy c. Recurrence within 2 years of the original diagnosis d. No maternal family history of breast cancer
Recurrence within 2 years of the original diagnosis
A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping? a. Recommend that the client remain cheerful for the sake of her children. b. Tell the client's spouse or partner to be supportive while she recovers. c. Encourage the client to proceed with the next phase of
Refer the client to the American Cancer Society's Reach for Recovery program or another support program.
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? a. Brisk walking and stretching exercises can be introduced. b. Resume light household work. c. Wear tight-fitting shirts for support. d. Exercise only the unaffected side until seen by the healthcare provider.
Resume light household work.
The nurse is assessing the surgical site of a client who has had a mastectomy. Which of the following would lead the nurse to suspect that the client is developing a seroma? a. Fever b. Bruising of the skin c. Sloshing of fluid d. Tightness
Sloshing of fluid
A nurse who works in an oncology practice prepares patients for the side effects of adjuvant hormonal therapy to treat breast cancer. Which of the following is the hormonal agent that has an increased risk of pulmonary embolism and deep vein thrombosis? a. Tamoxifen b. Letrozole c. Exemestane d. Anastrozole
Tamoxifen
Students are reviewing information about the use of adjuvant hormonal therapy for breast cancer. They demonstrate understanding of this information when they identify which of the following as an example of a selective estrogen receptor modulator (SERM)? a. Anastrozole b. Letrozole c. Exemestane d. Tamoxifen
Tamoxifen
The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease? a. Nipple retractions are noted. b. The lump is firm and immovable. c. One breast is larger than the other. d. The lump is round and movable.
The lump is round and movable.
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? a. The patient has developed a cyst. b. The patient has developed lymphedema. c. The patient has developed a hematoma. d. The patient has developed an infection.
The patient has developed a hematoma.
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? a. The patient should avoid the use of a bra for 24 hours after the procedure. b. The patient will not be able to wear a bra until the sutures are removed. c. The patient should wear a supportive bra after the procedure. d. The patient may wear a bra as long as it is
The patient should wear a supportive bra after the procedure.
The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction? a. The procedure includes minimal surrounding tissue damage. b. The procedure removes all cancer from the body. c. The procedure allows for conservation of breast tissue. d. The procedure allows for an understanding of the spread of cancer cells.
The procedure removes all cancer from the body.
A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which of the following best reflects the rationale for using this group of drugs? a. They block progesterone dependent tumors from growing. b. They attach to endogenous protein receptors to slow the growth of cancerous cells. c. They stimulate the immune system to attack a protein common in many tumors. d. They lower the level of estrogen in the body blocking the tumor's ability to use it.
They lower the level of estrogen in the body blocking the tumor's ability to use it.
A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors.Which rationale does the nurse give for the use of this group of drugs? a. They prevent prehormones from becoming estrogen, blocking the tumor's ability to use it. b. They stimulate the immune system to attack a protein common in many tumors. c. They attach to endogenous protein receptors to slow the growth of cancerous cells. d. They block progesterone-dependent tumors from growing.
They prevent prehormones from becoming estrogen, blocking the tumor's ability to use it.
A patient is receiving chemotherapy for breast cancer. Her most recent laboratory test results are as follows:Erythrocytes 4,500,000/cu mmHemoglobin 12.0 gm/dLHematocrit 35%Leukocytes 4,600 gm/dLThrombocytes 125,000/cu mmWhich results suggests some evidence of bone marrow suppression? a. Thrombocyte count b. Erythrocyte count c. Hemoglobin level d. Leukocyte count
Thrombocyte count
A client complains of having tender and painful breasts, often feeling multiple lumps within her breast tissue. The nurse would need to gather additional information about which of the following? a. Alcohol and caffeine consumption b. Client's workplace in relation to the surroundings c. Bathing frequency and living surroundings d. Timing of symptoms in relation to the menstrual cycle
Timing of symptoms in relation to the menstrual cycle
During a teaching demonstration on breast self-examination (BSE), the nurse should always explain that the majority of breast cancers are found in the: a. Lower, inner quadrant. b. Upper, inner quadrant. c. Upper, outer quadrant. d. Lower, outer quadrant.
Upper, outer quadrant.
During a follow-up visit, a client who underwent a mastectomy presents with an infection that requires an antibiotic. They admit they have been doing some gardening. What further instruction and reinforcement of teaching is needed? a. Avoid household chores for at least 6 to 9 months. b. Avoid working in the garden or yard altogether. c. Increase the frequency of follow-up visits if they perform work. d. Wear gloves and protective clothing to avoid any injuries.
Wear gloves and protective clothing to avoid any injuries.
A client had a left radical mastectomy and the nurse is providing information on complications that may arise due to removing the axillary lymph nodes. What information should the nurse include in the teaching? Select all that apply. a. Lymphedema b. Reduced range of motion c. Skin changes d. Infection e. Tissue necrosis
a. Lymphedema b. Reduced range of motion c. Skin changes d. Infection e. Tissue necrosis
A nurse advises a client scheduled for external beam radiation that side effects are minimal and usually well tolerated. What are side effects should the nurse include in the teaching? Select all that apply. a. Pneumonitis b. Breast fibrosis c. Fatigue d. Erythema e. Breast edema
c. Fatigue d. Erythema e. Breast edema
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? a. caffeine b. nicotine c. cyclical hormonal changes d. progesterone
cyclical hormonal changes
The nurse is providing health education regarding disorders that affect breast tissue. Which symptom is least suggestive of a breast disorder? a. differences in breast size b. breast mass c. nipple discharge d. breast tenderness
differences in breast size
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? a. infiltrating lobular b. inflammatory c. ductal d. medullary
ductal
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: a. painful mass in the breast, most often in the upper outer quadrant. b. painful mass in the breast, most often in the lower quadrant near the nipple. c. painless mass in the breast, most often in the upper outer quadrant. d. painless mass in the breast, most
painless mass in the breast, most often in the upper outer quadrant.
A client will be having surgery to remove a mass in the left breast. The client is told that the procedure will include removing the tumor and some breast tissue as well as some of the surrounding lymph nodes. Which surgical procedure has been chosen for this client? a. simple mastectomy b. subcutaneous mastectomy c. segmental mastectomy d. modified radical mastectomy
segmental mastectomy
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: a. should schedule a follow-up appointment in 6 months. b. will have irregular menses. c. is lucky that the cancer was caught in time. d. should continue to perform breast self-examination on her right breast.
should continue to perform breast self-examination on her right breast.
After teaching a group of students about the signs and symptoms of breast cancer, the instructor determines that additional teaching is needed when the group identifies which of the following? a. Painless mass b. Breast symmetry c. Peau d'orange skin d. Nipple retraction
Breast symmetry
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? a. Long-term surveillance b. Prophylactic mastectomy c. Chemoprevention d. Radiation therapy
Chemoprevention
The nurse is caring for a client who will be having artificial implants for breast reconstruction. The client is arriving at the physician's office for which procedure to be completed before the surgery can be done? a. Pain control b. Incisional alignment c. Tissue expansion d. Fluid drainage
Tissue expansion
The nurse instructs a client on self-care after having a mastectomy with lymph node removal. Which client statement indicates that teaching has been effective? a. "I will shave under my arms with an electric razor." b. "I can lift objects up to 25 pounds (11.4 kg) with my affected arm." c. "I can resume all activities of daily living after the wound heals." d. "I will limit sun exposure to 15 minutes a day on the affected arm."
"I will shave under my arms with an electric razor."
In which stage of breast development does breast budding occur? a. 1 b. 2 c. 3 d. 4 e. 5
2
