N212: Chap. 52 - Nursing Management: Breast Disorders
B
11. A 33-year-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching? a. Take aspirin every 4 hours to reduce inflammation. b. Check wound drains for excessive blood or a foul odor. c. Wear a loose-fitting bra to decrease irritation of the sutures. d. Resume normal activities 2 to 3 days after the mammoplasty
D
1. The nurse teaching a young women's community service group about breast self-examination (BSE) will include that a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. annual mammograms should be scheduled in addition to BSE. d. performing BSE after the menstrual period is more comfortable.
D
1.ID: 809606525 The nurse teaches a 53-year-old patient about screening for early detection of breast cancer. Which statement by the patient requires an intervention by the nurse? a. "I should plan to have a mammogram every year." b. "I will see a health care provider every year for a breast examination." c. "A breast examination should be done right after my menstrual period." d. "Self-breast examination is a reliable way to detect breast cancer early."
C
1.ID: 809623572 The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? a. Keep affected arm flat at the patient's side. b. Apply an elastic bandage on the affected arm. c. Assess blood pressure only on unaffected arm. d. Restrict exercise of the affected arm for 1 week.
B
10. The nurse provides discharge teaching for a 61-year-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful? a. "I will need to use my right arm and to rest the left one." b. "I will avoid reaching over the stove with my left hand." c. "I will keep my left arm in a sling until the incision is healed." d. "I will stop the left arm exercises if moving the arm is painful."
B
13. The health care provider of a patient with a positive biopsy of a 2-cm breast tumor has recommended a lumpectomy with radiation therapy or a modified radical mastectomy as treatment. The patient says that she does not know how to choose and asks the female nurse what she would do if she had to make the choice. What is the best response by the nurse to this patient? a. "It doesn't matter what I would do. It is a decision you have to make for yourself." b. "There are advantages and disadvantages of both procedures. What do you know about these procedures?" c. "I would choose the modified radical mastectomy because it would ensure that the entire tumor was removed." d. "The lumpectomy maintains a nearly normal breast but the survival rate is not as good as it is with a mastectomy
A
13.ID: 809623558 A 72-year-old patient who had a mastectomy for breast cancer 6 months ago wants to have breast reconstructive surgery. The nurse knows that what is the most likely motivation for this patient seeking this surgery? a. Improve the woman's self-image b. Be able to experience sexual arousal c. To get a tummy tuck as well as the breast mound d. Restore the pre-mastectomy appearance of the breast
A
15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which item should the charge nurse suggest that the student nurse omit from the teaching topic list about breast cancer diagnostic testing? a. CA 15-3 level testing b. HER-2 receptor testing c. Estrogen receptor testing d. Oncotype DX assay testing
A, C, D, E
2.ID: 809652970 The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors (select all that apply)? a. Nulliparity (woman's condition of having not given birth) b. Age 30 or over c. Early menarche (1st occurrence of menstruation) d. Late menopause (ceasing of menstruation) e. Personal history of colon cancer
D
20. When the nurse is working in the women's health care clinic, which action is appropriate to take? a. Teach a healthy 30-year-old about the need for an annual mammogram. b. Discuss scheduling an annual clinical breast examination with a 22-year-old. c. Explain to a 60-year-old that mammography frequency can be reduced to every 3 years. d. Teach a 28-year-old with a BRCA-1 mutation about magnetic resonance imaging (MRI)
C
21. Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Check blood pressure (BP) on both right and left arms. b. Avoid isometric exercise on the right arm. c. Assist with application of a compression sleeve. d. Keep the right arm at or below the level of the hear
B
22. A 36-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with symptoms. Which is most important to report to the health care provider? a. There is yellow-green discharge from the patient's right nipple. b. There is an area on the breast that is hot, pink, and tender to touch. c. The lumps are firm and most are in the upper outer breast quadrants. d. The lumps are larger and painful before the patient's menstrual period
A
3. A 51-year-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that a. FNA is done in the outpatient clinic and results are available in 1 to 2 days. b. only a small incision is needed, resulting in minimal breast pain and scarring. c. if the biopsy results are negative, no further diagnostic testing will be needed. d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
A
3. When teaching a 24-year-old woman who desires to learn BSE, the nurse knows that it is important to do what? a. Provide time for a return demonstration. b. Emphasize the statistics related to breast cancer survival and mortality. c. Have the woman set a consistent monthly date for performing the examination. d. Inform the woman that professional examinations are not necessary unless she finds an abnormality.
C
3.ID: 809606527 The nurse performs a breast examination on a 68-year-old female patient. Which clinical manifestation, if assessed by the nurse, indicates that further evaluation for breast cancer is needed? a. Bilateral pendulous breasts b. Right breast is warm, painful to touch c. Irregular, nontender lump with induration d. Palpable lump that is tender and movable
B
3.ID: 809623566 The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which guidelines should the nurse provide to the audience? a. "Mammograms are necessary if you have a family history of breast cancer." b. "It's recommended that you get a mammogram each year after you turn 40." c. "If you are not able to perform breast self-examination (BSE), you should go for regular mammograms." d. "You should ensure that your primary care provider performs a breast exam each time you visit."
B
4. Which assessment finding in a 36-year-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation b. A breast nodule that is 1 cm in size, nontender, and fixed c. A breast lump that increases in size before the menstrual period d. A breast lump that is small, mobile, with a rubbery consistency
C
4.ID: 809606529 The nurse is caring for a 52-year-old woman with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make? a. Observe for alopecia. b. Determine visual acuity. c. Monitor cardiac rhythm. d. Assess mouth and throat.
C
4.ID: 809623564 A 29-year-old primiparous patient has a 3-week-old infant whom she is breastfeeding. The woman has sought care because of recent breast tenderness, redness, and fever. Which teaching point should the nurse prioritize when following up her care? a. Encourage patient to continue breastfeeding her infant. b. Refer patient for a mammogram as quickly as possible. c. Ensure patient adheres to her prescribed antibiotic regimen. d. Teach patient to use warm compresses and educate her about self-limiting nature of illness.
C
5. A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer
C
5.ID: 809606523 The nurse is caring for an obese 67-year-old woman after a right mastectomy with axillary lymph node dissection. Which should the nurse include in the discharge instructions? a. "Arm exercises should not be started for 4 to 6 weeks." b. "Discontinue arm exercises if you have discomfort or pain." c. "Special massage therapy can decrease swelling in your arm." d. "Keep your right arm in a sling to decrease pain and swelling."
D
5.ID: 809623556 A 51-year-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? a. Immobilize the patient's right arm until postoperative day 3. b. Maintain the patient's right arm in a dependent position when at rest. c. Administer diuretics prophylactically for the prevention of lymphedema. d. Promote gradually increasing mobility as soon as possible following surgery.
B
6. A 58-year-old woman tells the nurse, "I understand that I have stage II breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "Tell me what you understand about the surgical options that are available." c. "It would not be appropriate for me to make a decision about your health." d. "There is no need to make a decision rapidly; you have time to think about this."
B
9.ID: 809623569 A 24-year-old patient who has undergone breast augmentation earlier in the day will be discharged home in the early evening. What instructions should the nurse provide in order to minimize the patient's risk of complications in the immediate recovery period? a. Avoid wearing a bra until postoperative day 3. b. Ask the patient to avoid strenuous exercise during her recovery period. c. Sleep in a semi-Fowler's position until her scheduled follow-up appointment. d. Enlist a friend or family member to perform passive range-of-motion exercises.
B
S1. A woman at the health clinic tells the nurse that she does not do breast self-examination (BSE) because it just seems too much of a bother. What is the best response by the nurse about BSE? a. It reduces mortality from breast cancer in women under the age of 50. b. It is useful to help women learn how their breasts normally look and feel. c. BSE has little value in detection of cancer and is not recommended anymore. d. BSE is the most common way that malignant tumors of the breast are discovered.
A
S12. The best prognosis is indicated in the patient with breast cancer when diagnostic studies reveal a. negative axillary lymph nodes. b. aneuploid DNA tumor content. c. cells with high S-phase fractions. d. an estrogen receptor- and progesterone receptor-negative tumor.
C
2. During a well woman physical exam, a 43-year-old patient asks about her risk for breast cancer. Which question is most pertinent for the nurse to ask? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"
C
2.ID: 809606531 The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer? a. A 25-year-old female with fibrocystic breast disease b. A 59-year-old male who has inherited the APC gene c. A 72-year-old female with a family history of breast cancer d. A 43-year-old male who is obese and leads a sedentary lifestyle
B
23. The nurse notes bilateral enlargement of the breasts during examination of a 62-year-old man. Which action should the nurse take first?. a. Teach the patient how to palpate the breast tissue for lumps. b. Question the patient about medications being currently used. c. Refer the patient for mammography and biopsy of the breast tissue. d. Explain that this is a temporary condition due to hormonal changes.
B
23. The patient's breast cancer has metastasized. Which medication for metastasis is better tolerated and has fewer and milder side effects than other chemotherapy medications? a. Capecitabine (Xeloda) b. Vinorelbine (Navelbine) c. Doxorubicin (Adriamycin) d. Eribulin mesylate (Halaven)
D
24. A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Teaching the patient how to avoid injury to the left arm b. Assessing the patient's range of motion for the left arm c. Evaluating the patient's understanding of instructions about drain care d. Administering an analgesic 30 minutes before scheduled arm exercises
C
25. The nurse is caring for a 52-year-old patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which assessment finding is most important to communicate to the health care provider? a. The patient complains of fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell (WBC) count is 5000/µL
A
26. A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."
D
27. The outpatient clinic receives telephone calls from four patients. Which patient should the nurse call back first? a. 57-year-old with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching b. 21-year-old with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene c. 40-year-old who still has left side chest and arm pain 2 months after a left modified radical mastectomy d. 50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin) and has ankle swelling and fatigue
B
6.ID: 809623560 Which task could the registered nurse delegate to unlicensed assistive personnel (UAP) during the care of a patient who has had recent transverse rectus abdominis musculocutaneous (TRAM) flap surgery? a. Document the condition of the patient's incisions. b. Mobilize the patient in a slightly hunched position. c. Change the patient's abdominal and chest dressings. d. Change the parameters of the patient-controlled analgesic (PCA) pump.
D
7. The nurse will teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin) that a. hot flashes may occur with the medication. b. serum electrolyte levels will be drawn monthly. c. the patient will need frequent eye examinations. d. the patient should call if she notices ankle swelling
B
7.ID: 809623562 A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). What point should the nurse emphasize when teaching the patient about her new drug regimen? a. "You may find that your medication causes some breast sensitivity." b. "It's important that you let your care provider know about any changes in your vision." c. "You'll find that this drug often alleviates some of the symptoms that accompany menopause." d. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."
C
8. After a 48-year-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to teach the patient about a. estradiol (Estrace). b. raloxifene (Evista). c. tamoxifen (Nolvadex). d. trastuzumab (Herceptin)
C
8.ID: 809623552 A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants? a. Inappropriate lactation necessitates breast biopsy. b. Nipple discharge of any type is considered a precursor to cancer. c. Unexpected nipple discharge of any type warrants medical follow-up. d. Galactorrhea is a normal age-related change and a frequent perimenopausal symptom.
C
10.ID: 809623574 When doing breast self-examination, the female patient should report which findings to her physician? a. Palpable rib margins b. Denser breast tissue c. Left nipple deviation d. Different sized breasts
B
18. Which patient statement indicates that the nurse's teaching about tamoxifen (Nolvadex) has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will be taking the medication for 6 to 12 months."
D
10. Which patient probably has the highest risk of breast cancer? a. 60-year-old obese man b. 58-year-old woman with sedentary lifestyle c. 55-year-old woman with fibrocystic breast changes d. 65-year-old woman with a sister diagnosed with breast cancer
B
12. The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include? a. Saline-filled implants are placed under the pectoral muscles. b. Recovery from the TRAM surgery takes at least 6 to 8 weeks. c. Muscle tissue removed from the back is used to form a breast. d. TRAM flap procedures may be done in outpatient surgery centers.
D
12.ID: 809623550 The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care? a. Evaluate left arm lymphatic accumulation. b. Maintain joint flexibility and left arm function. c. Teach her about chemotherapy and radiation therapy. d. Assess the patient's response to the diagnosis of breast cancer.
C
13. A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. "There are several options that I can consider for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." d. "I can probably have reconstructive surgery at the same time as a mastectomy."
A
14. Which information will the nurse include in patient teaching for a 36-year-old patient who is scheduled for stereotactic core biopsy of the breast? a. A local anesthetic will be given before the biopsy specimen is obtained. b. You will need to lie flat on your back and lie very still during the biopsy. c. A thin needle will be inserted into the lump and aspirated to remove tissue. d. You should not have anything to eat or drink for 6 hours before the procedure
D
16. The nurse will anticipate teaching a 56-year-old patient who is diagnosed with lobular carcinoma in situ (LCIS) about a. lumpectomy. b. lymphatic mapping. c. MammaPrint testing. d. tamoxifen (Nolvadex).
B
17. Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be necessary. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.
D
19. The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph node dissection. Which action should the nurse take first? a. Teach the patient how to deep breathe and cough. b. Discuss options for postoperative pain management. c. Explain the postdischarge care of the axillary drains. d. Ask the patient to describe what she knows about the surgery.
A
S9. Which benign breast disorder occurs most often during lactation and is commonly caused by Staphylococcus aureus? a. Mastitis b. Ductal ectasia c. Fibroadenoma d. Senescent gynecomastia
C
9. Which nursing action should be included in the plan of care for a patient returning to the surgical unit following a left modified radical mastectomy with dissection of axillary lymph nodes? a. Obtain a permanent breast prosthesis before the patient is discharged from the hospital. b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes. c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. d. Insist that the patient examine the surgical incision when the initial dressings are removed.
D
S6. While examining a patient's breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate question by the nurse? a. "Do you have a high caffeine intake?" b. "When did you last have a mammogram?" c. "Is there a history of breast cancer in your mother or sisters?" d. "Do the size and tenderness of the lumps change with your menstrual cycle?"
B
S11. The nurse would be most concerned when the patient's breast examination reveals which finding? a. A large, tender, moveable mass in the upper inner quadrant b. An immobile, hard, nontender lesion in the upper outer quadrant c. A 2- to 3-cm, firm, defined, mobile mass in the lower outer quadrant d. A painful, immobile mass with reddened skin in the upper outer quadrant
D
S14. A patient undergoing either a mastectomy or a lumpectomy for treatment of breast cancer can also usually expect to undergo what other treatment? a. Chemotherapy b. Radiation therapy c. Hormonal therapy d. Sentinel lymph node dissection
C
S15. Lymphatic mapping with sentinel lymph node dissection (SLND) is planned for a patient undergoing a modified radical mastectomy for breast cancer. What does the nurse teach the patient and her family? a. If one sentinel lymph node is positive for malignant cells, all of the sentinel lymph nodes will be removed. b. If malignant cells are found in any sentinel nodes, a complete axillary lymph node dissection will be done. c. Lymphatic mapping indicates which lymph nodes are most likely to have metastasis and all of those nodes are removed. d. Lymphatic mapping with SLND provides metastatic lymph nodes to test for responsiveness to chemotherapy
A, C
S16. What describes the use of high-dose brachytherapy radiation (select all that apply)? a. May be completed in 5 days b. Follows local excision of tumor c. Alternative to traditional radiation therapy for early-stage breast cancer d. Used to treat possible local residual cancer cells following a mastectomy e. Used to reduce tumor size and stabilize metastatic lesions for pain relief
C
S17. A patient with a positive breast biopsy tells the nurse that she read about tamoxifen (Nolvadex) on the Internet and asks about its use. The best response by the nurse includes which information? a. Tamoxifen is the primary treatment for breast cancer if axillary lymph nodes are positive for cancer. b. amoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer. c. Tamoxifen is the treatment of choice after surgery if the tumor has receptors for estrogen and progesterone on its cells. d. Because tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment has
C
S18. During the immediate postoperative period following a mastectomy, the nurse initially institutes which exercises for the affected arm? a. Have the patient brush or comb her hair with the affected arm. b. Perform full passive range-of-motion (ROM) exercises to the affected arm. c. Ask the patient to flex and extend the fingers and wrist of the operative side. d. Have the patient crawl her fingers up the wall, raising her arm above her head
B
S19. Following a modified radical mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do? a. Avoid skin-softening agents on the arm. b. Protect the arm from any type of trauma. c. Abduct and adduct the arm at the shoulder hourly. d. Keep the arm positioned so that it is in straight and dependent alignment.
C
S20. A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absence of the breast. What is an appropriate nursing intervention for this patient? a. Provide the patient with information about surgical breast reconstruction. b. Restrict visitors and phone calls until the patient feels better about herself. c. Arrange for a Reach to Recovery visitor or similar resource available in the community. d. Encourage the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital
B
S21. A 56-year-old patient is undergoing a mammoplasty for breast reconstruction following a mastectomy 1 year ago. During the preoperative preparation of the patient, what is important for the nurse to do? a. Determine why the patient is choosing reconstruction surgery rather than the use of an external prosthesis. b. Ensure that the patient has realistic expectations about the outcome and possible complications of the surgery. c. Inform the patient that implants used for breast reconstruction have been shown to cause immune-related diseases. d. Let the patient know that although the shape will be different from the other breast, the nipple can be reconstructed from other erectile tissue
A
S22. A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. What should the nurse teach the patient about tissue expansion? a. Weekly injections of water or saline into the expander will be required. b. The expander cannot be placed until healing from the mastectomy is complete. c. This method of breast reconstruction uses the patient's own tissue to replace breast tissue. d. The nipple from the affected breast will be saved to be grafted onto the reconstructed breast
D
S4. Which diagnostic test is most accurate and advantageous in terms of time and expense in diagnosing malignant breast disorders? a. Surgical biopsy b. Mammography c. Fine-needle aspiration d. Core (core needle) biopsy
D
S5. A 24-year-old female patient has breast cancer with estrogen receptor-negative cells. Which genomic assay test can be used to provide information about the likely recurrence and need for chemotherapy? a. CA 27-29 b. TNM system c. Oncotype DX d. MammaPrint
C
S7. A patient has fibrocystic changes in her breast. The nurse explains to the patient that this condition is significant because it a. commonly becomes malignant over time. b. can be controlled with hormone therapy (HT). c. makes it more difficult to examine the breasts. d. will eventually cause atrophy of normal breast tissue.
D, E, F
S8. Which characteristics describe an intraductal papilloma (select all that apply)? a. Associated with breast trauma b. Occurs in 10% of women ages 15 to 40 c. Has multicolored, sticky nipple discharge d. Is associated with an increased cancer risk e. Is more common in women ages 40 to 60 f. Has wartlike growth in mammary ducts near nipple