Hinkle 58 Assessment and Management of Patients With Breast Disorders
Which of the following options are available to women with an increased risk of developing breast cancer?
Long-term follow-up
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?
Bone mineral density
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? -Lower outer -Upper inner -Upper outer -Lower inner
Upper outer 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.
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
A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which finding most strongly suggests that a client has breast cancer? -Nonpalpable right axillary lymph nodes -Mobile mass that is soft and easily delineated -Nonmobile mass with irregular edges -Eversion of the right nipple and mobile mass
A fixed nodular mass with dimpling of the overlying skin
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
How can breast cancer prevention programs best serve at-risk women from lower socioeconomic backgrounds?
Develop screening and educational programs.
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? -Menopause at age 50 years -One of three living children born prematurely -First full-term pregnancy at age 34 years -Menarche at age 14 years
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.
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
Which of the following would be inconsistent as a risk factor for breast cancer?
Multiparity
An early sign of Paget's disease includes which of the following?
Nipple erythema
A patient is scheduled to receive radiation therapy for 6 weeks after her lumpectomy. The patient states she is worried about the side effects of the radiation. What can the nurse inform her about the side effects of the radiation?
"The radiation can cause some skin breakdown towards the end of treatment in the axillary folds."
The nurse is assisting a patient with breastfeeding. The patient said that with her last baby, she had a problem with her nipples becoming irritated. What can the nurse suggest to the patient to prevent this problem? (Select all that apply.)
-Daily washing with water -Massage with breast milk or lanolin -Exposure to air
The nurse is discussing mammography with a female patient at the clinic. The patient asks at what age she should begin getting yearly mammograms. What answer should the nurse provide to the patient?
40
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.
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 -Thrombus formation -Ulceration of the nipple -Infection
Increased blood supply required by a tumor A prominent venous pattern can signal increased blood supply required by a tumor.
The nurse is monitoring a client with metastatic breast cancer who is receiving morphine for pain control. The nurse would be alert for which of the following? -Bone marrow depression, granulocytopenia, and anemia -Excessive sedation, confusion, and weakness -Central nervous system (CNS) depression, amenorrhea, and anemia -Malaise, diarrhea, and stomatitis
Excessive sedation, confusion, and weakness Clients taking morphine, an opioid analgesic, should be monitored for adverse reactions that include excessive sedation, confusion, weakness, hypotension, constipation, dry mouth, nausea, vomiting, and anorexia. Although CNS depression may occur, amenorrhea and anemia are not associated with morphine. Malaise, diarrhea, stomatitis, bone marrow depression, granulocytopenia, and anemia are often associated with antineoplastic agents.
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.
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? -Infiltrating ductal carcinoma -Mucinous carcinoma -Infiltrating lobular carcinoma -Medullary carcinoma
Infiltrating ductal carcinoma Infiltrating ductal carcinoma—the most common histologic type of breast cancer accounts for 80% of all cases. The tumors arise from the duct system and invade the surrounding tissues. They often form a solid irregular mass in the breast.
The nurse is caring for a client who is beginning doxorubicin (Adriamycin) therapy for breast cancer. When preparing the client for probable side effects, which would the nurse include?
Information regarding wigs from the American Cancer Society
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? -This finding is not uncommon and is significant only when of recent origin. -It may result from inflammation due to mastitis while the patient is breastfeeding. -It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. -This finding is most likely related to benign cysts of the breast in the nipple area.
It may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance, a classic sign of advanced breast cancer. 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.
A female patient is receiving paclitaxel (Taxol), as part of her treatment regimen for a larger, node-negative cancer. The nurse recognizes the possible side effects related to paclitaxel (Taxol) when the patient is diagnosed with which of the following conditions.
Joint pain
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 health care provider about which of the following? -Nausea or vomiting occurring beyond 9 days after discontinuing the drug. -Constipation occurring 90 days after discontinuing the drug. -Inability to sleep after discontinuing the drug. -Lack of return of regular menses within 90 days after discontinuing the drug.
Lack of return of regular menses within 90 days after discontinuing the drug. The nurse should tell the client to inform the healthcare provider if regular menses do not resume within 90 days after discontinuing the drug. Nausea, constipation, and sleep are not associated with danazol or its discontinuation.
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 -Mastopexy -Ultrasound -Breast biopsy
Mammogram 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.
Which term refers to breast pain? -Mammoplasty -Mastalgia -Gynecomastia -Mastitis
Mastalgia 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.
A client is scheduled to undergo a procedure to lift her breasts that have drooped because of significant weight loss. The nurse identifies this procedure as which of the following?
Mastopexy
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
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? -Tightness -Bruising of the skin -Fever -Sloshing of fluid
Sloshing of fluid 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.
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? -Anastrozole -Letrozole -Exemestane -Tamoxifen
Tamoxifen Deep vein thrombosis, pulmonary embolism, and superficial phlebitis are all thromboembolic events that are adverse reactions to tamoxifen.
A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer? -The client reports tenderness during the palpation. -The lump is mobile. -The lump is soft. -The lump is irregularly shaped.
The lump is irregularly shaped. Generally, breast cancer lesions are nontender, fixed rather than mobile, and hard with irregular borders. Diffuse breast pain and tenderness with menstruation are usually associated with benign breast disease.
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. -The lump is firm and nonmovable. -Nipple retractions are noted. -One breast is larger than the other
The lump is round and movable
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 an infection. -The patient has developed a cyst. -The patient has developed lymphedema. -The patient has developed a hematoma.
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 assesses for signs and symptoms of hematoma at the surgical site, which may include swelling, tightness, pain, and bruising of the skin.
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 allows for an understanding of the spread of cancer cells. -The procedure removes all cancer from the body. -The procedure allows for conservation of breast tissue. -The procedure includes minimal surrounding tissue damage.
The procedure removes all cancer from the body. 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 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?
Timing of symptoms in relation to the menstrual cycle
During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate?
Wear gloves and protective clothing to avoid any injuries.
-Wear gloves and protective clothing to avoid any injuries. -Avoid working in the garden or yard altogether. -Avoid household chores for at least 6 to 9 months. -Increase the frequency of follow-up visits if she does works.
Wear gloves and protective clothing to avoid any injuries. 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 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 should tell my manucurist that it is okay to trim the cuticles on my right hand." - "I need to use an electric shaver when shaving my right armpit." - "I can lift with my right arm objects that weigh as much as 15 pounds." - "Anytime I need blood drawn, they should get the sample from my right arm."
"I need to use an electric shaver when shaving my right armpit."
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? -"You have a very competent surgeon and you should move forward as planned." - "If I were you, I would consider a second opinion." -"You might want to consider a less invasive surgical procedure." -"Tell me more about your fears and concerns."
"Tell me more about your fears and concerns." The type of surgery recommended depends on the stage of the tumor and the client's informed decision about treatment options. The client should be encouraged to express her concerns. Surgery should not be performed until the client is comfortable with the scheduled procedure. The type of surgery recommended depends on the stage of the tumor. A less invasive procedure may not remove all of the affected tissue. The nurse should not share her opinion with the client but rather support the client in making the best decision.
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? -8 to 9 days -After the 10th day -3 to 4 days -5 to 7 days
5 to 7 days 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 54-year-old woman presents to her healthcare provider's office where you practice nursing. She is very concerned that she might have breast cancer, especially after caring for her sister that recently died from the disease. Included in your discussion is the primary and most common sign of breast cancer. Which of the following would meet this criterion?
A painless mass in the breast, most often in the upper outer quadrant
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. -Striated muscle in the nipples contract causing them to become erect. -The breasts contain a limited supply of blood vessels. -Progesterone is primarily responsible for the growth of breast tissue.
A primary function of the female breast is to produce milk. 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.
A nurse is reviewing a female patient'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 of the following as a possible risk factor for developing breast cancer? -Alcohol use -Cesarean deliveries -Age at first pregnancy -Age at menarche
Age at first pregnancy 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.
Kara Carpenter is a 54-year-old woman who just had a left radical mastectomy. The nurse caring for her is providing information on complications that may arise due to removing the axillary lymph nodes. Which of the following would not be included? -tissue necrosis -infection -All would be included in the discussion. -reduced range of motion
All would be included in the discussion. Impaired lymphatic circulation predisposes to disfigurement, reduced range of motion, heaviness of the limb, skin changes, infection, and, in severe cases, tissue necrosis that may require amputation of the limb.
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? -Checking for urinary retention and the need to void. -Checking level of pain first upon the clients return from the operating room. -Checking the dressing, drain, and amount of drainage. -Assessing the vital signs and oxygen saturation levels.
Assessing the vital signs and oxygen saturation levels. The nurse prioritizes vital signs and breathing based on principles of ABCs.
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
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
The nurse working on a woman's cancer treatment floor performs nursing assessments on her assigned patients. It is most important for the nurse to report which of the following assessment findings?
Coolness and mottling of a newly constructed breast site
A 32-year-old client is concerned with the lumps that have developed in her breasts and is fearful of cancer. She reports variability in the size of the lumps. What could be causing her condition? -caffeine -cyclical hormonal changes -nicotine -progesterone
Cyclical hormonal changes The likely cause is fibrocystic disease, which results from hormonal changes during the menstrual cycle.
The nurse is caring for a group of breast cancer survivors post mastectomy. Which teaching point should the nurse include? -Sleep on the affected side -Wear tight-fitting shirts -Do not lift objects greater than 15 lb -When using cream, be careful to avoid the affected breast
Do not lift objects greater than 15 lb The nurse should instruct post mastectomy clients to avoid lifting objects greater than 15 lb. Tight-fitting or constrictive clothing is to be avoided. The client is encouraged to place cream on any area of the breast which is dry, and discouraged to sleep on the affect side.
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? -Ultrasound-guided core biopsy -Core biopsy -Excisional biopsy -Incisional biopsy
Excisional biopsy 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.
The nurse advises a patient scheduled for external beam radiation that side effects are minimal and usually well tolerated. The most common and annoying side effect is:
Fatigue.
Which of the following is a characteristic of a breast cancer mass?
Firm, hard, embedded in surrounding tissue
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
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 -Fibroadenoma -Fibrocystic breast disease -Breast abscess
Lymphedema 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.
Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which of the following complications does this technique help avoid? -Mastalgia -Breast cancer -Fibroadenoma -Lymphedema
Lymphedema 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? -Increasing the intake of caffeinated drinks -Opting for estrogen only replacement therapy during menopause -Maintaining an ideal weight -Delaying childbearing until after age 30
Maintaining an ideal weight 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
The nurse recognizes which of the following statements as accurately reflecting a risk factor for breast cancer? -Onset of menses before 14 years of age -Multiparity -No alcohol consumption -Mother affected by cancer before 60 years of age
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.
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 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 teaches the female patient who is premenopausal to perform breast self-examination (BSE) at which time frame?
On day 5 to day 7, counting the first day of menses as day 1
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 about bilateral mastectomy for the prevention of this disease. -Provide the patient with information regarding the benefits, risks, and possible side effects. -Inform the patient that medication should not be used prophylactically due to the many side effects. -Inform the patient that she should take every measure available to her to prevent this disease.
Provide the patient with information regarding the benefits, risks, and possible side effects. 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.
On a follow-up visit, the patient is informed that her breast cancer has recurred. The nurse knows which of the following situations places the patient at risk for developing bone metastases? -Previous therapeutic response to chemotherapy -Recurrence within 2 years of the original diagnosis -No maternal family history of breast cancer -Aggressive treatment, including surgery, radiation, and hormonal therapy
Recurrence within 2 years of the original diagnosis 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.
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?
Refer the client to the American Cancer Society's Reach for Recovery program or another support program.
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)? -Anastrozole -Letrozole -Exemestane -Tamoxifen
Tamoxifen Tamoxifen is an example of a SERM. It acts by competing for estrogen-receptor binding sites. Anastrozole, letrozole, and exemestane are examples of aromatase inhibitors, drugs that block estrogen production.
During a teaching demonstration on BSE, the nurse should always explain that the majority of breast cancers are found in the: -Lower, outer quadrant. -Lower, inner quadrant. -Upper, outer quadrant. -Upper, inner quadrant.
Upper, outer quadrant Breast cancers are usually found in the upper outer quadrant where the majority of breast tissue is located.
