NCLEX Breast Cancer
A modified radical mastectomy with an axillary lymph node dissection has been scheduled for your patient with breast cancer. What will you do postoperatively to restore arm function on the affected side? A. Apply heating pads or blankets to increase circulation. B. Place daily ice packs to minimize the risk of lymphedema. C. Teach passive exercises with the affected arm in a dependent position. D. Emphasize regular exercise for the affected shoulder to increase range of motion.
D. Emphasize regular exercise for the affected shoulder to increase range of motion. Restoring arm function on the affected side after mastectomy and axillary lymph node dissection is a key nursing goal. Place the woman in a semi-Fowler's position, with the arm on the affected side elevated on a pillow. Flexing and extending the fingers should begin in the recovery room, with progressive increases in activity encouraged. Postoperative arm and shoulder exercises are instituted gradually under a surgeon's direction. These exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks. Reference: 1320, 1323
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. Improve the woman's self-image The most likely motivation for this patient to seek breast reconstructive surgery is to improve her self-esteem. With this surgery, she will not be able to experience sexual arousal or restore the pre-mastectomy appearance of the breast. The abdominoplasty (tummy tuck) effect will only be a possibility with the transverse rectus abdominis musculocutaneous (TRAM) flap, not with a breast implant or tissue expansion.
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 B. Age 30 or over C. Early menarche D. Late menopause E. Personal history of colon cancer
A. Nulliparity C. Early menarche D. Late menopause E. Personal history of colon cancer Women are at an increased risk for development of breast cancer if they are over the age of 50; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen with early menarche or late menopause; and have had a first full-term pregnancy after the age of 30 or are nulliparous.
A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. For the other tests done to determine the risk for cancer recurrence or spread, what results support a more favorable prognosis (select all that apply)? A. Well-differentiated tumor B. Estrogen receptor-positive tumor C. Involvement of two to four axillary nodes D. Overexpression of the HER2 protein E. High DNA proliferative index
A. Well-differentiated tumor B. Estrogen receptor-positive tumor In general, the more well differentiated the tumor, the less aggressive it is. Poorly differentiated tumors appear morphologically disorganized and are more aggressive. Other information useful for treatment decisions and determining the prognosis is the patient's estrogen and progesterone receptor status. Receptor-positive tumors (1) commonly show histologic evidence of being well differentiated, (2) frequently have a diploid (more normal) DNA content and low proliferative indices, (3) have a lower chance for recurrence, and (4) are frequently hormone dependent and responsive to hormonal therapy. Reference: 1314
What are the current guidelines for breast cancer screening? A. Yearly mammograms starting at age 40 B. Breast self-examination (BSE) monthly for women starting at age 20 C. Breast ultrasound every 5 years after age 50 D. Clinical breast examination (CBE) yearly starting at age 20
A. Yearly mammograms starting at age 40 Yearly mammograms should start at age 40 and continue for as long as a woman is in good health. BSE is considered optional, but if done, it should start at age 20. Breast ultrasound is used with mammography to differentiate a solid mass from a cystic mass, to evaluate a mass in a pregnant or lactating woman, or to locate and biopsy a suspicious lesion seen on magnetic resonance imaging (MRI). It is not used in screening. CBE preferably is done at least every 3 years for women between the ages of 20 and 30 years and every year for women beginning at age 40. Reference: 1306-1307
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."
B. "It's important that you let your care provider know about any changes in your vision." Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.
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. "It's recommended that you get a mammogram each year after you turn 40." Annual mammograms are recommended after age 40. They are recommended for all women, not solely those with a family history of breast cancer. BSE is not a replacement for mammography, and clinical breast examinations are not necessary at each office visit, but recommended at least every 3 years for women in their 20s and 30s, and then every year beginning at age 40.
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.
B. Mobilize the patient in a slightly hunched position. Mobilization of a postsurgical patient may be delegated, and the patient who has had a TRAM flap should not stand or walk fully erect, in order to minimize strain on the incisions. Changing dressings, assessing wounds, and reprogramming a PCA pump are not appropriate tasks to delegate to UAP.
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."
C. "Special massage therapy can decrease swelling in your arm." Decongestive therapy may be used for acute lymphedema and includes a massage-like technique to mobilize the subcutaneous accumulation of fluid. Arm exercises should be performed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The arm exercises should be initiated after surgery and increased gradually. Pain medications should be administered 30 minutes before arm exercises. The operative arm should be kept at the level of the heart but not in a sling; a sling discourages use of the arm.
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
C. A 72-year-old female with a family history of breast cancer The risk factors most associated with breast cancer are female gender, advancing age, and family history. The incidence of breast cancer increases dramatically after age 60. Mutations in BRCA genes may cause 5% to 10% of breast cancers; APC gene is associated with colon cancer. Obesity and physical inactivity increase the risk for breast cancer. Fibrocystic breast disease is not associated with the development of breast cancer.
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.
C. Assess blood pressure only on unaffected arm. Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended and gradually increased starting in the recovery room to reduce fluid volume in the arm.
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
C. Irregular, nontender lump with induration Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to touch, indurated, and painful. Atrophy of the mammary glands associated with aging may result in pendulous breasts. Manifestations of fibrocystic breast changes include palpable lumps that are round, well delineated, and freely movable. The lump is usually tender and increases in size and tenderness before menstruation.
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
C. Left nipple deviation Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other problem and should be reported to the health care provider. Dense breast tissue, palpable rib margins, and different sized breasts are all normal findings.
You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. What would you include to best promote learning and adherence of the participants (select all that apply)? A. Short audiotape on the BSE procedure B. Packet of articles from the medical literature C. Written guidelines for mammography and CBE D. Discussion of the value of early breast cancer detection E. Need to get mammogram starting at age 35
C. Written guidelines for mammography and CBE D. Discussion of the value of early breast cancer detection When teaching women about breast cancer screening guidelines, include information about potential benefits, limitations, and harm (chance of a false-positive result). Allow time for questions about the procedure and a return demonstration. At every periodic health examination, ask the woman who is performing BSE to demonstrate her technique. Demonstration of BSE and provision of written guidelines are appropriate teaching methods. Reference: 1307
Preoperatively, to meet the psychologic needs of a woman scheduled for a modified radical mastectomy, you would A. discuss the limitations of breast reconstruction. B. include her significant other in all conversations. C. promote an environment for expression of feelings. D. explain the importance of regular follow-up screening.
C. promote an environment for expression of feelings. Throughout interactions with a woman with breast cancer, you should be aware of the extensive psychologic impact of the disease. Effective care includes sensitivity to the woman's efforts to cope with a life-threatening disease. You should provide a safe environment for the expression of the full range of feelings. Reference: 1323
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."
D. "Self-breast examination is a reliable way to detect breast cancer early." Screening for the early detection of breast cancer includes yearly mammograms starting at age 40 and clinical breast examination every year at age 40. An alternative suggestion is to begin screening mammograms at age 50. Breast self-examination has benefits and limitations and may not be a reliable method for early detection of breast cancer. BSE is optional but should be done in premenopausal women right after the menstrual period when the breasts are less lumpy and tender.
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. Incorrect 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.
D. Assess the patient's response to the diagnosis of breast cancer. Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care for this patient. The approach for the care of the left arm and teaching the patient about further therapy will be based on this assessment.
A young woman was just told by her physician that she has breast cancer. What is your most appropriate action? A. Offer to answer questions. B. Call the chaplain. C. Leave her alone to give her privacy. D. Encourage her to talk about her feelings.
D. Encourage her to talk about her feelings. In a crisis, talking about feelings and letting the patient take the lead is the best approach. Reference: 1323
In teaching a patient who wants to perform BSE, you inform her that the technique involves palpation of the breast tissue and A. palpation of cervical lymph nodes. B. hard squeezing of the breast tissue. C. a mammogram to evaluate breast tissue. D. inspection of the breasts for any changes.
D. inspection of the breasts for any changes. BSE is performed by palpation of breast tissue with three levels of pressure. Breasts also should be inspected for size, shape, redness, scaliness, or dimpling of the breast skin or nipple. Reference: 1307
When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is A. being a woman older than 60 years. B. experiencing menstruation for 40 years or longer. C. using hormone replacement therapy during menopause. D. having a paternal grandmother with postmenopausal breast cancer.
A. being a woman older than 60 years. The identifiable risk factors most associated with breast cancer include female gender and advancing age. The incidence of breast cancer in women under 25 years of age is very low and increases gradually until age 60. After age 60 the incidence increases dramatically. Reference: 1311
The 60-year-old woman comes to the clinic 3 years after her last regular appointment. She reports occasional diffuse breast tenderness, aching, and soreness. What do you anticipate will happen first? A. Magnetic resonance imaging (MRI) B. Mammography C. Teaching the patient to take vitamin E D. Teaching continual wearing of a support bra
B. Mammography Although these symptoms can indicate benign mastalgia, mammography is anticipated to exclude cancer and provide information on the cause of mastalgia. Usually, mastalgia improves after menopause, and the current recommendation for mammograms is yearly after age 40. MRI is used for screening in high-risk women, including those whose mammography or ultrasound result is suspicious for malignancy and women who previously had an occult breast cancer detected by mammography. Self-help measures to treat mastalgia are considered after cancer has been excluded.
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. E. Assess mouth and throat.
C. Monitor cardiac rhythm. Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The nurse should monitor for cardiac dysrhythmias, electrocardiogram changes, and clinical manifestations of heart failure. Other adverse effects of doxorubicin include stomatitis and alopecia, but these effects are not as serious as cardiac problems. Tamoxifen may cause visual changes.
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.
D. Promote gradually increasing mobility as soon as possible following surgery. Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery, and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.
