Pearson Breast Cancer
The nurse is reviewing care instructions for a client who had a radical mastectomy of the right breast. Which instructioni is appropriate for the nurse to include in the teaching session? (Select all that apply.)
"Sleep with the right arm elevated on a pillow." "Do not allow anyone to take your blood pressure in the right arm."
A client prescribed tamoxifen (Nolvadex) for breast cancer treatment asks the nurse how the medication works. What is the best response by the nurse
"Tamoxifen works by blocking estrogen receptors on breast tissue."
The nurse assesses a client with dimpling of the skin in the left upper outer quadrant of the right breast and nipple discharge. Which question should the nurse ask to learn if the client is experiencing other clinical manifestations of breast cancer?
"Have you noticed a rash or skin irritation around the nipple area?"
The nurse instructs a client recovering from a mastectomy on ways to prevent lymphedema. Which client statement indicates that teaching has been successful?
"I should do the exercises on my affected arm every day."
Mrs. Walters states that she is worried about taking such an important medication for so long, because she occasionally forgets to take her current medications when she is supposed to. How would you respond?
"Take your dose as soon as you remember, but if it is almost time for your next dose, then skip that dose and wait for the next dose."
A client with breast cancer asks which medication will most likely be used for chemotherapy before having surgery. Which medication should the nurse explain as the most common hormone therapy used to treat breast cancer?
tamoxifen
A client with breast cancer is scheduled for radiation prior to surgery. Which situation supports the use of radiation prior to surgery?
tumor is unusually large
A client with metastatic breast cancer asks where the cancer has spread. Which site should the nurse include in the response? (Select all that apply.)
Bone, Liver, Brain, Lungs
Next, Mrs. Walters asks you how long she will have to take tamoxifen. Her prescription has refills for 6 months, but she isn't sure if she'll need to take more than that. How many years do you tell her she may need to take tamoxifen?
2, 3, 5, or 10 years
A client has a mass that has been identified by a mammogram. Which test may be ordered to further differentiate the mammogram results?
Breast biopsy
The nurse reviews a list of clients scheduled for women's health visits. For which age range should the nurse emphasize the importance of early detection and treatment of breast cancer?
75-79
A client with breast cancer asks how a modified radical mastectomy differs from a radical mastectomy. What should the nurse respond to this client?
A modified radical mastectomy removes the breast tissue and lymph nodes but leaves the chest wall intact."
The nurse is updating the care plan for a client recovering from a mastectomy. Which should the nurse include to prevent infection?
A. Change dressings and IV tubing using aseptic technique. Observe incision and IV sites for pain, redness, swelling, and drainage. Assess surgical dressings for bleeding, drainage, color, and odor every 4 hours for 24 hours. Tell the client to avoid deodorant and talcum powder on the affected side until the incision is completely healed.
The nurse is caring for a client who is scheduled for a biopsy of a suspicious mass in the breast. The client is crying and is tachycardic and tachypneic. Based on this assessment data, which problem is a priority?
anxiety
The nurse is discussing early detection of breast cancer with a group of teenage women. Which information should the nurse include to decrease the risk for mortality and promote positive client outcomes?
encourage monthly self breast exams
The nurse is caring for a 78-year-old woman who was recently diagnosed with breast cancer. What consideration may the nurse need to make for this woman that she may not need to make for younger women with breast cancer?
Arranging transportation to appointments
The nurse is providing community teaching related to risk factors for breast cancer for a group of young women. Which woman might the nurse identify as being at a higher risk for developing breast cancer at a young age?
A 26-year-old woman who had a 32-year-old brother with breast cancer
Why should the nurse tell a client who has undergone surgery for breast cancer to avoid wearing deodorant on the affected side?
Deodorant can irritate the skin and slow the healing process.
Which intervention promotes optimal circulation after a surgical intervention for breast cancer?
Encouraging range-of-motion exercises in the affected arm
A college-age client asks the nurse about the relationship between breast cancer and alcohol use. Which response by the nurse provides the most accurate information for this client?
Evidence indicates that to decrease your risk for breast cancer, you should limit alcohol use to one drink per day."
The nurse is instructing a group of women between the ages of 40 and 50 about early detection of breast cancer. What should the nurse include in this teaching?
Have a yearly mammogram.
The nurse is providing care to a client who was recently diagnosed with breast cancer. The nurse is providing education regarding the possible treatment options. Which options will the nurse include in the teaching session? Select all that apply.
Hormone therapy Mastectomy Radiation Lumpectomy
Mrs. Walters states that she understands she may need to take tamoxifen for up to 10 years depending on her oncologist's orders. She then asks, "So after the tamoxifen, I'm done with treatment?" How should you respond?
If you take tamoxifen for only 2 to 5 years, you may need to take another drug called an aromatase inhibitor for another 5 years."
Which form of breast cancer is the most malignant form?
Inflammatory carcinoma of the breast
What is the mechanism of action of tamoxifen?
Inhibits binding of estradiol to estrogen receptors, resulting in decreased cellular responses to estrogen
Mrs. Walters responds, "If hair loss isn't a common side effect of tamoxifen, what are common side effects?" What side effects should you include in your answer? Select all that apply.
NV, Vaginal dryness, discharge, or bleeding. hot flashes
The nurse evaluates teaching provided to a group of community members on breast cancer awareness. Which statement indictates that teaching on risk factors has been effective? (Select all that apply.)
Not breastfeeding increases the risk of breast cancer." Having children after age 30 increases the risk of breast cancer." "Having previous irradiation of the chest increases the risk of breast cancer." "Having harmful mutations in BRCA1 or BRCA2 suppression increases the risk of breast cancer."
The nurse prepares to visit the home of a client recovering from a mastectomy for breast cancer. Which should be included in the ongoing care of this client? (Select all that apply.)
Postmastectomy exercises Signs and symptoms of infection Importance of adequate rest periods Possible participation in a support group
The nurse prepares a teaching poster for placement in a women's health clinic. Which activity should the nurse identify to help prevent breast cancer? (Select all that apply.)
Refraining from smoking Engaging in physical activity Limiting hormone therapy in duration and dose Avoiding exposure to environmental pollution and radiation
While completing a physical examination, the nurse suspects a client has breast cancer. What did the nurse assess in this client? Select all that apply.
Scaliness near the right nipple, Palpable lump in the upper outer right quadrant, Left nipple retraction
You note from Mrs. Walters' pathology report that her tumor is ER-positive and HER2-negative. How might her treatment change if her tumor was HER2-positive?
She would likely be prescribed a drug such as trastuzumab (Herceptin). Trastuzumab inhibits the activation of HER2 receptors. Therefore, it is often prescribed for patients with HER2-positive breast cancers.
The nurse is reviewing data collected during a health history and physical assessment and determines that a client is at risk for developing breast cancer. Which data supports this client's risk for developing breast cancer? Select all that apply.
Sister had breast cancer Menopause at age 58 Age 60
Mrs. Walters states that her oncologist didn't give her much information about tamoxifen, so she isn't sure what to expect. You agree to answering several of Mrs. Walters' questions. Mrs. Walters says, "I've always heard that cancer treatments make you lose your hair. Will tamoxifen make me lose my hair?" How would you respond?
Some people lose their hair after taking tamoxifen, but only a small percentage. It is not a common side effect of tamoxifen."
A client with breast cancer receives diagnostic testing and scan results that indicate a tumor that is 4.2 cm in size with evidence of metastasis to movable ipsilateral axillary nodes only. According to the TNM staging system, how should this client's breast cancer be staged?
T2 N1 M0 This client's breast cancer would be staged as T2 N1 M0. T2 indicates a tumor no larger than 5 cm, N1 indicates metastasis to movable ipsilateral axillary nodes, and M0 indicates no distant metastasis. T1 indicates a tumor no larger than 2 cm. This indicates a tumor in situ. T3 indicates a tumor larger than 5 cm. N0 indicates no regional lymph node metastasis. N2 indicates metastasis to ipsilateral fixed axillary nodes. M1 indicates distant metastasis.
As you begin preparing Mrs. Walters for her last radiation treatment, she tells you that her oncologist has prescribed tamoxifen for her. She hands you the prescription. What notation on the prescription would require you to notify the oncologist of an error?
Take 40 mg once per day by mouth Tamoxifen is usually prescribed at a total dose of 20-40 mg daily, given once or twice per day, with a max of 40 mg daily. Any total dose over 20 mg should be split into two doses, taken once in the morning and once in the evening. A prescription for 40 mg once per day by mouth is outside these prescribing guidelines. If a dose of 40 mg per day is given, the dose should be split into two 20 mg doses.
A client is diagnosed with adenocarcinoma of the breast. Based upon this diagnosis, where should the nurse expect the source of the cancer to be?
Terminal section of the breast ductal tissue
Mrs. Walters tells you that she will definitely notify her oncologist if she has vaginal bleeding, because she is post-menopausal and hasn't had her period in years. How might Mrs. Walters' treatment for breast cancer differ if she was pre-menopausal?
The oncologist would likely add ovarian ablation by surgery, radiation, or drugs like goserelin (Zoladex) to her treatment regimen.
The nurse is providing health counseling to a 32-year-old woman whose mammogram indicates that she has dense breast tissue. Which information should the nurse provide to this client concerning this finding and breast health?
The presence of dense breast tissue increases the risk of breast cancer before the age of 45.
A woman has a family history of breast cancer, and genetic testing has revealed a mutation in BRCA2. If this woman develops breast cancer, what is the most likely mechanism for why the cancer developed?
The cells' ability to suppress tumor growth was impaired.
The nurse is caring for a client with breast cancer who is having chemotherapy treatments. The client tells the nurse, "I am always tired, cannot concentrate, and am so forgetful." Which statement made by the nurse in response to the client is true? (Select all that apply.)
This is also called chemo-brain "You might want to make notes if needed as a memory aid." "This may last up to 2 years after completion of chemotherapy."
Before she leaves, Mrs. Walters asks you if there's any medication that would help heal her radiation burn, as evidenced by her red, itchy skin with dry desquamation. What drug class do you identify that would help relieve Mrs. Walters' symptoms?
Topical Corticosteroids
Mrs. Walters tells you that she had horrible hot flashes and night sweats when she was going through menopause. She asks, "What can I do to reduce hot flashes if I get them from tamoxifen?" What non-pharmacological measures would you include in your reply?
Wear loose-fitting, light-weight cotton clothing, Use a fan and open windows to keep air circulating in the house, Use relaxation exercises such as deep breathing
Based on your assessment of Mrs. Walters, you note that she has dyspnea, dry cough, and chest pain, which are all symptoms of radiation pneumonitis. You realize these symptoms may require pharmacological treatment. What should you do to advocate for proper treatment for Mrs. Walters?
You notify Mrs. Walters' provider that Mrs. Walters may need steroids to treat her symptoms. Her provider states that he will monitor her symptoms and prescribe steroids if needed.
