Prep U- Chapter 58: Assessment & Management of Patients With Breast Disorders

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? - increased age -obesity -not giving birth -All options are correct.

All options are correct.

A client has just had a left radical mastectomy, and the nurse is providing information on complications that may arise due to removing the axillary lymph nodes. Which would not be included? - reduced range of motion - tissue necrosis - All would be included in the discussion. - infection

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 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 - Exemestane -Anastrozole -Letrozole

Tamoxifen

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 -Lower outer -Lower inner -Upper inner

Upper outer

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: - is lucky that the cancer was caught in time. -should schedule a follow-up appointment in 6 months. -will have irregular menses. -should continue to perform breast self-examination on her right breast.

should continue to perform breast self-examination on her right breast.

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. -Checking level of pain first upon the clients return from the operating room. -Checking the dressing, drain, and amount of drainage. -Checking for urinary retention and the need to void.

Assessing the vital signs and oxygen saturation levels.

Based on her knowledge of the most common site of metastatic spread for breast cancer, the nurse would recommend periodic assessments of the: -Bone -Liver -Lungs -Brain

Bone

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

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 lump is soft. - The lump is irregularly shaped. - The lump is mobile. - The client reports tenderness during the palpation.

The lump is irregularly shaped. - 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 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 -Pain control -Incisional alignment -Fluid drainage

Tissue expansion -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.

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.

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 lower quadrant near the nipple. -painless mass in the breast, most often in the upper outer quadrant. -painful mass in the breast, most often in the lower quadrant near the nipple. -painful mass in the breast, most often in the upper outer quadrant.

painless mass in the breast, most often in the upper outer quadrant.

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? -"Anytime I need blood drawn, they should get the sample from my right arm." -"I can lift with my right arm objects that weigh as much as 15 pounds." -"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 need to use an electric shaver when shaving my right armpit."

Which statement demonstrates that a client has understood instructions about breast self-examination? - "I should move the palm of my hand around the breast in a diagonal fashion." -"I should perform the exam on the first day of my menstrual period." -"I don't need to check the nipple area of the breast or under my arm." -"I need to use the pads of three fingers to apply pressure when checking each breast."

"I need to use the pads of three fingers to apply pressure when checking each breast." -Performing breast self-examination- examine the breasts 3 days after the end of menstrual period -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.

A client is being discharged to home following a modified radical mastectomy. The nurse is providing discharge instructions and making arrangements for home care. Which interventions will be included in the instructions? Select all that apply. - Advise the client to use a disposable razor for shaving axillary hair. -Recommend wearing gloves while doing yard or housework. -Encourage the client to wear restrictive clothing on the affected side. -Advise the client that blood pressure measurements, injections, blood donations, and IV infusions are lifelong restrictions on the side of the mastectomy.

-Recommend wearing gloves while doing yard or housework. -Advise the client that blood pressure measurements, injections, blood donations, and IV infusions are lifelong restrictions on the side of the mastectomy. -Because of impaired lymphatic flow, blood pressure measurements, injections, blood donations, and IV infusions in the affected arm are contraindicated.

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 menarche -Alcohol use -Cesarean deliveries -Age at first pregnancy

Age at first pregnancy Risk factors -Early menarche (before 12 years) -Nulliparity -Late age at first full-term pregnancy -Alcohol intake of 2 to 5 drinks daily.

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? -Peau d'orange skin -Nipple retraction -Breast symmetry -Painless mass

Breast symmetry -Signs- include a bloody discharge from the nipple -Dimpling of the skin over the lesion -Retraction of the nipple -Peau d'orange (orange peel) appearance of the skin -Difference in size between the breasts.

How can breast cancer prevention programs best serve at-risk women from lower socioeconomic backgrounds? -Increase support services. -Increase access to health care. -Develop screening and educational programs. -Provide access to health insurance.

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? - First full-term pregnancy at age 34 years -Menarche at age 14 years -One of three living children born prematurely -Menopause at age 50 years

First full-term pregnancy at age 34 years

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 -Pain at the site -Tightness of the skin -Bruising of the skin

Gross swelling

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 -Medullary carcinoma -Infiltrating lobular carcinoma

Infiltrating ductal carcinoma -Infiltrating ductal carcinoma—the most common histologic type of breast cancer accounts for 80% of all cases.

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 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 not uncommon and is significant only when of recent origin. -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.

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? - Breast abscess -Fibroadenoma -Fibrocystic breast disease -Lymphedema

Lymphedema -Lymphedema occurs in some women after breast cancer surgery. It causes disfigurement and increases the lifetime potential for infection and poor healing.

Sentinel lymph node mapping is done to validate the lack of lymph node metastasis. Which complication does this technique help avoid? - Fibroadenoma -Mastalgia -Lymphedema -Breast cancer

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? -Delaying childbearing until after age 30 -Maintaining an ideal weight -Opting for estrogen only replacement therapy during menopause -Increasing the intake of caffeinated drinks

Maintaining an ideal weight

A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies? - Ultrasound -Breast biopsy -Mammogram -Mastopexy

Mammogram

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? - Segmental mastectomy -Modified radical mastectomy -Radical mastectomy -Total mastectomy

Modified radical mastectomy -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.

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? -Eversion of the right nipple and mobile mass -Mobile mass that is soft and easily delineated -Nonpalpable right axillary lymph nodes -Nonmobile mass with irregular edges

Nonmobile mass with irregular edges -Breast cancer tumors are fixed, hard, and poorly delineated with irregular edges.

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 she should take every measure available to her to prevent this disease. -Inform the patient that medication should not be used prophylactically due to the many side effects.

Provide the patient with information regarding the benefits, risks, and possible side effects.

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? - Tell the client's spouse or partner to be supportive while she recovers. -Encourage the client to proceed with the next phase of treatment. -Recommend that the client remain cheerful for the sake of her children. -Refer the client to the American Cancer Society's Reach for Recovery program or another support program.

Refer the client to the American Cancer Society's Reach for Recovery program or another support program.