Chapter 58: Assessment and Management of Patients With Breast Disorders
Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid?
Lymphedema Explanation: Validating the lack of lymph node metastasis allows the surgeon to preserve more breast and axillary tissue and chest muscle. Leaving more normal lymph nodes intact reduces the potential for complications, such as lymphedema caused by the extensive disruption of lymphatic circulation.
A nurse is preparing a presentation for a health fair about preventing breast cancer. Which of the following would the nurse include?
Maintaining an ideal weight Explanation: Maintaining an ideal weight decreases the risk of breast cancer. Having no children or having children after age 30 is associated with an increased risk for breast cancer. Some breast tumors are hormone dependent, such that estrogen (or progesterone) enhances tumor growth. Women are advised to avoid the consumption of alcohol, not caffeine, because alcohol correlates with an increased risk of breast cancer
Which term refers to breast pain?
Mastalgia Explanation: Mastalgia refers to breast pain. Mastitis is an inflammation or infection of the breast. Gynecomastia refers to overdeveloped breast tissue typically seen in adolescent boys. Mammoplasty refers to a surgical procedure to reconstruct or change the size or shape of the breast.
Which is an early sign of Paget disease?
Nipple erythema Explanation: Early signs of Paget disease include nipple and areola erythema. Late signs include thickening, scaling, and erosion of the nipple and areola.
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?
Recurrence within 2 years of the original diagnosis Explanation: Local recurrence may be an indicator that systemic disease will develop in the future, particularly if it occurs within 2 years of the original diagnosis. Local recurrence in the absence of systemic disease is treated aggressively with surgery, radiation, and hormonal therapy. Overall prognosis and optimal treatment are determined by a variety of factors such as the time to recurrence from the original diagnosis and treatment history.
Which of the following would the nurse expect to find when assessing the breasts of a client with fibrocystic breast disease?
Soft mass Explanation: The characteristic breast mass of fibrocystic disease is soft to firm, movable, and unlikely to cause nipple retraction. Nipple retraction, enlarged lymph nodes, and skin dimpling are more commonly associated with breast cancer.
A female client is diagnosed with breast abscess. She would like to continue to breast-feed her newborn. Which of the following would be most appropriate in this situation?
Assist the client to pump the breasts to remove breast milk. Explanation: The nurse should help the client pump the breasts and remove breast milk to prevent engorgement. Because the client has decided to continue breastfeeding, the client should wear a loose-fitting bra. Including protein content in the diet would be unrelated to the client's current situation. Frequency of dressing changes does not play a role in the intervention.
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 Explanation: A green discharge could indicate an infection. Any discharge that is spontaneous, persistent, or unilateral is of concern. Although bloody discharge can indicate a malignancy, it is often caused by a benign wart-like growth on the lining of the duct called an intraductal papilloma.
A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous?
Nonmobile mass with irregular edges Explanation: Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction — not eversion — may be a sign of cancer.
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?
The procedure removes all cancer from the body. Explanation: Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.
A client who is scheduled to have a modified radical mastectomy to remove an aggressive breast tumor is concerned about having agreed to the surgery before considering alternative options. Which statement is the nurse's best response?
"Tell me more about your fears and concerns." Explanation: The type of surgery recommended depends on the stage of the tumor and the client's informed decision about treatment options; a less invasive procedure may not remove all of the affected tissue. The client should be encouraged to express concerns. Surgery should not be performed until the client is comfortable with the scheduled procedure. The nurse should not share personal opinions with the client, but rather support the client in making the best decision.
A 28-year-old woman is learning about breast self-examination. The nurse teaches the woman that the best time of each month to examine her breasts is during the:
First week after menstruation. Explanation: It is recommended that a woman examine the breasts during the first week after menstruation. During this period, the breasts are least likely to be tender or swollen because the secretion of estrogen, which prepares the uterus for implantation, is at its lowest level.
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?
Tamoxifen Explanation: Deep vein thrombosis, pulmonary embolism, and superficial phlebitis are all thromboembolic events that are adverse reactions to tamoxifen.
A nurse is obtaining health histories from clients at a busy low-income clinic. Which clients should the nurse follow more closely as being at the highest risk for developing breast cancer? Select all that apply.
The client who has relatives with the BRCA1 mutated gene The client with a mother who had breast cancer Explanation: There are several risk factors that the nurse must identify; however, the most important risk factor to be identified is the presence of the mutated BRCA1 gene, which makes the client "very likely" to develop breast cancer. Breast cancer family history is another significant risk factor. Other risk factors include being female and being older than 50 years, but these clients are not at as high a risk for the development of breast cancer. Males are not a high-risk group. White women are at a higher risk than African Americans.
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?
The lump is round and movable. Explanation: When assessing a breast with fibrocystic disease, the lumps typically are different from cancerous lumps. The characteristic breast mass of fibrocystic disease is soft to firm, circular, movable, and unlikely to cause nipple retraction. A cancerous mass is typically irregular in shape, firm, and immovable. Lumps typically do not make one breast larger than the other. Nipple retractions are suggestive of cancerous masses.
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. Explanation: A simple cyst often disappears on aspiration, and the fluid is usually discarded.
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. Explanation: The use of a supportive bra following surgery is encouraged to limit movement of the breast and reduce discomfort.
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?
They lower the level of estrogen in the body blocking the tumor's ability to use it. Explanation: Aromatase inhibitors lower the level of estrogen in the body thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogestin drug, such as mifepristone, blocks progesterone-dependent breast cancers. The monoclonal antibody, trastuzumab attaches to protein receptors to slow the growth of cancer cells. A breast cancer vaccine is under investigation in Italy. This vaccine stimulates the immune system to attack a protein called mammaglobin-A, which is found in 80% of breast cancer tumors.
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?
Tissue expansion Explanation: Before an implant for breast reconstruction can produce an optimum cosmetic appearance, the skin and tissue on the chest wall are expanded to provide a large enough space to fill and approximate the size of the remaining breast. The other options are not correct.
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 Explanation: The tail of Spence is an area of breast tissue that extends from the upper outer quadrant of the breast into the axilla. The upper and lower inner quadrants are closer to the midline. The lower outer quadrant is below the upper outer quadrant.
What is the most common location for breast cancer?
Upper outer quadrant of the breast Explanation: Most breast cancers are found in the upper outer quadrant of the breast, where most breast tissues are located.
During a teaching demonstration on breast self-examination (BSE), the nurse should always explain that the majority of breast cancers are found in the:
Upper, outer quadrant. Explanation: Breast cancers are usually found in the upper outer quadrant where the majority of breast tissue is located.
During a follow-up visit, a female client who underwent a mastectomy presents with an infection that requires an antibiotic. She admits she has been doing some gardening. What further instruction and reinforcement of teaching is needed?
Wear gloves and protective clothing to avoid any injuries. Explanation: The nurse should recommend that the client wear gloves when doing backyard work or housework to prevent injuries that may heal slowly or become infected. Working, whether it is in the backyard or doing some household chores, can be helpful in promoting feelings of usefulness, thereby, enhancing the client's coping abilities and self-esteem. She could be advised to follow up more frequently; however, this would not help prevent any untoward injury.
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 Explanation: The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.
The nurse is providing health education regarding disorders that affect breast tissue. Which symptom is least suggestive of a breast disorder?
differences in breast size Explanation: It is not uncommon for women to have one breast larger than the other. Common disorders that affect breast tissue generally manifest with one or more of the following symptoms: breast tenderness or pain, breast mass, nipple discharge, and change in breast appearance.
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 Explanation: The most common malignancy is ductal carcinoma (80%); followed by infiltrating lobular carcinoma (10%); medullary carcinoma, mucinous carcinoma, and tubular ductal carcinoma; and inflammatory breast cancer, the rarest but most aggressive form of breast cancer.
A client is concerned with lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What would the physician indicate is the client's condition?
fibrocystic breast disease Explanation: Fibrocystic breast disease is a benign breast condition that affects women primarily between the ages of 30 and 50 years. When fibrocystic disease develops, single or multiple breast cysts appear in one or both breasts.
A nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
fine needle aspiration. Explanation: Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
At a public health fair, a nurse teaches a group of women about breast cancer awareness. Possible signs of breast cancer include:
nipple discharge and a breast nodule. Explanation: Nipple discharge, breast nodules, nipple retraction, and lymphadenopathy may be signs of breast cancer and should be reported. Mammary duct ectasia may cause fever, nipple discharge, breast nodules, erythema of the breast, and itching. Breast changes during menstruation are normal; for this reason, women should examine their breasts 4 to 7 days after menses ends, when the breasts are least congested. Fever and erythema of the breast may indicate a breast abscess.
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. Explanation: 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. This procedure doesn't affect breast reconstruction and may actually make postoperative recovery more difficult.
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. Explanation: Having breast cancer on her left side puts the client more at risk for cancer on the opposite side and chest wall. Therefore, the nurse should stress the importance of monthly breast self-examinations and annual mammograms. Although the tumor was found, it was large enough to require a mastectomy, and could put the patient at risk for metastasis. Follow-up appointments should be monthly for the first few months and then scheduled at the direction of her health care provider. Modified radical mastectomy shouldn't affect the menstrual cycle.
A nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women of average risk for breast cancer get mammograms:
yearly starting no later than age 45. Explanation: The American Cancer Society (ACS) recommends a mammogram yearly for women age 45 and older but states that women age 40-44 should have the choice to start screening with yearly mammograms. Women can change to having mammograms every 2 years starting at age 55 if they want. Some guidelines recommend that women between ages 20 and 44 have a professional breast examination (not a mammogram) every 3 years, but the ACS no longer recommends a clinical breast exam or breast self-exam as screening methods for women in the U.S.
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. Explanation: The primary sign of breast cancer is a painless mass in the breast, most often in the upper outer quadrant.
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?
"Does the tenderness occur around the same time each month?" Explanation: The breasts are part of the female reproductive system, and they respond to the hormonal cycle associated with ovulation, menstruation, and pregnancy. Because the hormonal cycle is monthly, it is best to ask the client if the tenderness occurs at the same time each month. The other options are also important questions to ask.
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." Explanation: To prevent complications after a right modified radical mastectomy and axillary lymph node dissection, the client should shave her right axillary area with an electric razor rather than a straight razor to reduce the risk of trauma to or breaks in the skin. Blood sampling should be done with the client's left arm, not the right one. The client should not lift objects more than 5 to 10 pounds with the right arm, and cuticles on the affected hand should be pushed back, not cut.
Which statement demonstrates that a client has understood instructions about breast self-examination?
"I need to use the pads of three fingers to apply pressure when checking each breast." Explanation: When performing breast self-examination, the client should examine the breasts 3 days after the end of her menstrual period, use light medium, and firm pressure applied with the pads of three fingers, move the fingers in circles, spokes of a wheel, or rows, and feel every part of the breast, including the nipple area and the armpit to the collar bone.
Atypical hyperplasia increases a women's risk for breast cancer about how many times compared with that of the general population?
4 Explanation: Atypical hyperplasia increases a women's risk for breast cancer about four to five times compared with that of the general population.
The nurse is educating a patient about the best time to perform breast self-examination (BSE). When does the nurse inform her is the best time after menses to perform BSE?
5 to 7 days Explanation: Most women notice increased tenderness and lumpiness before their menstrual periods; therefore, BSE is best performed after menses (day 5 to day 7, counting the first day of menses as day 1).
A suspicious breast lump is noted on a mammogram. The client asks the nurse which diagnostic test confirms if the lump is cancerous or benign. Which response by the nurse is most correct?
A biopsy Explanation: To confirm whether a breast lump is cancerous or benign, a tissue sample must be obtained to examine the cells. Although an ultrasound, MRI, and clinical breast exam provides data on the characteristics of the lump, only examining the tissue can specifically identify if and what type of cancer is present.
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 client with stage IV cancer receiving palliative care Explanation: The client with stage IV cancer, indicating metastasis, and receiving palliative care, which includes comfort measures, is in highest life-threatening condition. A client with a stage I tumor and no lymph node involvement has a good prognosis as the cancer has been caught at an early stage. A low blood count is common when the client is receiving chemotherapy. It is common to have chemotherapy and radiation is a treatment regimen. Clients have experienced good prognosis with estrogen receptor positive tumor treatment of oral chemotherapy.
A group of students are reviewing material in preparation for a test on the male and female breasts. The students demonstrate understanding of the material when they identify which of the following?
A primary function of the female breast is to produce milk. Explanation: A primary function of the female breast is to produce milk, a process called lactation. The breasts contain an abundant supply of blood vessels and lymphatics. Estrogen is the hormone primarily responsible for the growth and development of breast tissue. Smooth muscle in the nipples contracts, causing them to become erect when cold, touched, or sexually stimulated.
Which is part of the education for a client undergoing a stereotactic core biopsy?
A small titanium clip is placed at the biopsy site. Explanation: Clients undergoing a stereotactic core biopsy will have a small titanium clip placed at the biopsy site. The client lies prone on the stereotactic table. Local anesthetic is injected into the entry site on the breast. Use of a titanium clip does not preclude subsequent MRIs.
A nurse is reviewing a female client's history, which includes the following information: Age at menarche: 14 years Cesarean delivery: 2 pregnancies Age at first pregnancy: 35 years Alcohol use: approximately 1 to 2 glasses of wine/month The nurse identifies which as a possible risk factor for the client to develop breast cancer?
Age at first pregnancy Explanation: Risk factors for breast cancer include an early menarche (before 12 years), nulliparity, late age at first full-term pregnancy, and an alcohol intake of 2 to 5 drinks daily.
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. Explanation: 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 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. Explanation: The nurse prioritizes vital signs and breathing based on principles of ABCs.
The most common route of regional spread is to which area?
Axillary lymph nodes Explanation: The most common route of regional spread is to the axillary lymph nodes. Other sites of lymphatic spread include the internal mammary and supraclavicular nodes.
The nurse is educating a group of women at the YMCA about breast cancer. What does the nurse understand is the current trend that should be focused on rather than BSE?
Breast self-awareness Explanation: Current practice is shifting from educating about BSE to promoting breast self-awareness, which is a woman's attentiveness to the normal appearance and feel of her breasts.
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?
Breast symmetry Explanation: The primary sign of breast cancer is a painless mass in the breast. Other signs of breast cancer include a bloody discharge from the nipple, a dimpling of the skin over the lesion, retraction of the nipple, peau d'orange (orange peel) appearance of the skin, and a difference in size between the breasts.
A 33-year-old female 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 Explanation: Chemoprevention is a primary prevention modality that aims at preventing the disease before it starts.
The nurse has identified the following nursing diagnosis on the plan of care for a client who has undergone breast cancer surgery: Disturbed sensory perception related to nerve irritation in the affected breast area. Which of the following indicates that the outcome has been achieved?
Client states that feeling in her breast area will gradually subside with time. Explanation: After breast surgery, the nerves in the skin and axilla are often cut or injured, leading the client to experience various sensations, including tenderness, soreness, numbness, tightness, pulling, and twinges. These sensations are normal and usually persist for several months and then subside. Therefore, acknowledging that the feeling in her breast area will gradually subside indicates that she understands why the sensation is occurring and that it is normal. The report of the sensation of pulling indicates that the client is feeling the sensation, but it does not indicate whether the nursing diagnosis was addressed. Analgesics usually would not be required for these sensations. These sensations are not associated with lymphedema.
A group of students is reviewing information about breast cancer and metastasis in preparation for an examination. The students demonstrate the need for additional study when they identify which of the following as a common site for metastasis?
Colon Explanation: Breast cancer typically does not metastasize to the colon. The four major sites of metastasis include the skeletal and pulmonary systems, brain, and liver.
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 Explanation: Mottling or an obvious decrease in skin temperature may signify flap loss and needs to be reported to the surgeon immediately. The vital signs presented are within acceptable range for a postoperative client. Throat discomfort immediately following surgery is an expected effect of airway management during surgery. A small amount of bloody drainage is an expected finding 12 hours postoperatively.
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?
Encouraging coughing and deep breathing exercises Explanation: A client who has undergone a TRAM flap procedure has incisions at both the mastectomy and abdominal donor sites. In addition, the breathing and leg exercises are essential because the client is more limited in her activity and is at greater risk for respiratory complications and deep vein thrombosis. Mottling at the newly created breast site must be reported to the surgeon immediately. Elevating the head of the bed 45 degrees and flexing the client's knees help to reduce tension on the abdominal incision during the first postoperative week.
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 Explanation: Excisional biopsy is the standard procedure for complete pathologic assessment of a palpable breast mass. The entire mass, plus a margin of surrounding tissue, is removed. Incisional biopsy surgically removes a portion of a mass. Core needle biopsy is similar to FNA, except a larger-gauge needle is used (usually 14 gauge). A local anesthetic is applied, and tissue cores are removed via a spring-loaded device. The principles for ultrasound-guided core biopsy are similar to those of stereotactic core biopsy, but by using ultrasound guidance, computer coordination and mammographic compression are not necessary.
Which psychosocial nursing diagnoses are common in the client with breast cancer? Select all that apply.
Fear Body image disturbance Hopelessness Explanation: Fear, anxiety, body image disturbance, hopelessness, and powerlessness are all common psychosocial nursing diagnoses for clients with breast cancer.
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 Explanation: 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 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?
Genetic counseling Explanation: The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and three-generational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society will provide the client with information about cancer but the organization won't help assess the client's risk for developing cancer.
Hematoma and seroma formation are complications of breast surgery. Which of the following is the indicator that should be reported to the surgeon?
Gross swelling Explanation: The presence of gross swelling or increased bloody output from the drain are abnormal and should be immediately reported to the surgeon.
A client who has undergone a surgical biopsy of a suspected breast lesion is being prepared for discharge from the ambulatory surgical center. The client is alert and oriented. Which criterion would be of least importance in determining her readiness for discharge?
Having a bowel movement Explanation: For the client to be discharged, she must be able to tolerate fluids, ambulate, and void. Bowel movements would not determine the woman's readiness for discharge.
The nurse is assessing the breast of a female patient and observes a prominent venous pattern on the left breast. What does the nurse understand that this can be indicative of?
Increased blood supply required by a tumor Explanation: A prominent venous pattern can signal increased blood supply required by a tumor.
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. Explanation: The client should notify the physician immediately because a breast lump may be a sign of breast cancer. The client shouldn't squeeze the nipple to check for drainage until the physician examines the area. The client shouldn't wait until after the next menstrual period to inform the physician of the breast lump because prompt treatment may be necessary. Placing a heating pad on the area would have no effect on a breast lump.
When a female client demonstrates a wart-like growth near the nipple, causing bloody nipple discharge, the client is exhibiting signs of which disease process
Intraductal papilloma Explanation: Intraductal papilloma is a wart-like growth that often involves the large milk ducts near the nipple, causing bloody nipple discharge. Surgery usually involves removal of the papilloma and a segment of the duct where the papilloma is found. Paget disease is a malignancy of mammary ducts with early signs of erythema of nipple and areola. Acute mastitis is demonstrated by nipple cracks or abrasions along with reddened and warm breast skin and tenderness. Fibroadenoma is characterized as the occurrence of a single, nontender mass that is firm, mobile, and not fixed to breast tissue or chest wall.
The nurse is assessing an older adult female who has not seen her 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, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. Explanation: Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange peel appearance (peau d'orange)—a classic sign of advanced breast cancer.
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?
Lymphedema Explanation: Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing. Fibrocystic breast disease and fibroadenoma are two benign breast conditions that occur usually in premenopausal woman. Breast abscess is the infectious and inflammatory breast condition that is common among breast-feeding mothers.
A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies?
Mammogram Explanation: When caring for a client considering breast augmentation, the nurse should provide her with a general guideline to have a mammogram to verify that there are no malignancies. Mastopexy involves a breast lift for drooping breasts. Ultrasound or breast biopsy would not be necessary unless there was evidence of a problem.
A 45-year-old woman has a family history of breast cancer. She herself was diagnosed with breast cancer 2 months ago. During a routine visit, the physician informs her that she has to undergo radiation as soon as possible to avoid spreading of the cancer. Which symptom would prompt radiation therapy?
Massive swelling in her arm Explanation: The massive swelling in the arm is indicative of edema, which occurs as a result of advanced nodal involvement. With radiation therapy, ionizing radiation stops cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present, and it can be used prophylactically to prevent spread. The other symptoms of breast cancer may include nipple retraction, scaly skin around the nipple, skin changes, erythema, and clear, milky, or bloody discharge. These symptoms will, however, not prompt the physician to order immediate radiation therapy.
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 Explanation: A modified radical mastectomy leaves the pectoralis major and minor muscles intact. In a segmental mastectomy, varying amounts of breast tissue are removed, including the malignant tissue and some surrounding tissue to ensure clear margins. In a total mastectomy, breast tissue only is removed. Radical mastectomy includes removal of the pectoralis major and minor muscles in addition to breast tissue and axillary lymph node dissection.
The nurse recognizes which statement as accurately reflecting a risk factor for breast cancer?
Mother affected by cancer before 60 years of age Explanation: 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 Explanation: Nulliparity is a risk factor for breast cancer, along with late menopause, older age, and family history of breast cancer, among others.
The client is receiving adjuvant chemotherapy for breast cancer. Which is most likely her node status and tumor size?
Node negative, tumor size 1.2 cm Explanation: Adjuvant chemotherapy is recommended for clients who have positive lymph nodes or who have invasive tumors greater that are 1 cm in size, regardless of nodal status.
A 49-year-old woman reports that her 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 Explanation: There are a number of risk factors associated with breast cancer. This client's history indicates nulliparity, which is a risk factor for breast cancer. Late menopause (after 55 years of age) is also a risk for breast cancer, but this client experienced her last menstrual period at age 48, so this is not a risk factor for this client. Family history of breast cancer is a risk factor, but this client's history only indicates family histories of hypertension and diabetes. Other risk factors associated with breast cancer include increasing age, personal history of breast cancer, genetic mutations to BRCA1 and BRCA2, early menarche (before 12 years of age), late age at first full-term pregnancy (after 30 years of age), hormone therapy, exposure to ionizing radiation during adolescence or early adulthood, history of benign proliferative breast disease, obesity, and alcohol intake of more than one drink per day.
The nurse teaches a premenopausal female client to perform breast self-examination (BSE) at which interval?
On day 5 to day 7, counting the first day of menses as day 1 Explanation: BSE is best performed after menses, when less fluid is retained. Because most women notice increased tenderness, lumpiness, and fluid retention before their menstrual period, BSE is not recommended with the onset of menses. Because these symptoms generally continue through menses, BSE is not recommended during that time. BSE is best performed at a time that takes menses into account.
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?
Others disapprove Explanation: The rationale for a reduction mammoplasty most often comes from the client herself as she is experiencing a complication due to the size of the breast. Back pain, low self-esteem and a self-consciousness, and skin irritation are common rationales.
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?
Provide the patient with information regarding the benefits, risks, and possible side effects. Explanation: Nurses can help women who are considering chemoprevention by providing them with information about the benefits, risks, and possible side effects of both tamoxifen and raloxifene.
The nurse is caring for a client following breast reconstruction surgery using autogenous tissue. When assessing wounds from the surgical procedure, in which area would the nurse assess the wound from which tissue was taken?
Rectus abdominis Explanation: The area in which tissue is taken for breast reconstruction surgery is from the rectus abdominis muscle in a manner similar to a "tummy tuck." The nurse must assess this site for healing or complications.
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. Explanation: The client is instructed about postoperative activity limitation. In general, heavy lifting (more than 5 to 10 pounds) is avoided for about 4 to 6 weeks, after which light household and work-related activities are promoted to maintain muscle tone. Brisk walking, the use of stationary bikes and stepping machines, and stretching exercises may begin as soon as the client feels comfortable. Once the drain is removed, the client may begin to drive if she has full arm range of motion and is no longer taking opioid analgesic agents. General guidelines for activity focus on the gradual introduction of previous activities (e.g., bowling, weight training) once fully healed.
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?
Sloshing of fluid Explanation: Signs and symptoms of a seroma include swelling, heaviness, discomfort, and a sloshing of fluid. Bruising of the skin and tightness would suggest a hematoma. Fever would suggest an infection.
