Deck 57: Assessment and Management of Patients With Breast Disorders

Question 1

A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make?

A) Evaluate the patients milk production.
B) Palpate the area for a breast mass.
C) Assess the patients knowledge of breast cancer.
D) Assure the patient that this likely an age-related change.

Answer 1

Palpate the area for a breast mass.

Question 2

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the womens group to raise their arms and inspect their breasts in a mirror. A member of the womens group asks the nurse why raising her arms is necessary. What is the nurses best response?

A) It helps to spread out the fat that makes up your breast.
B) It allows you to simultaneously assess for pain.
C) It will help to observe for dimpling more closely.
D) This is what the American Cancer Society recommends.

Answer 2

It will help to observe for dimpling more closely.

Question 3

A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The woman asks the nurse when her teenage daughters should begin mammography. What is the nurses best advice?

A) Age 28
B) Age 35
C) Age 38
D) Age 48

Answer 3

Age 38

Question 4

A woman scheduled for a simple mastectomy in one week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period?

A) Limit her intake of green leafy vegetables.
B) Increase her water intake to 8 glasses per day.
C) Stop taking aspirin.
D) Have nothing by mouth for 6 hours before surgery.

Question 5

The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work?
What would be the nurses best response?

A) Yes, its known to have a slight protective effect.
B) Yes, but studies also show an increased risk of osteoporosis.
C) You wont need to worry about getting cancer as long as you take Tamoxifen.
D) Tamoxifen is known to be a highly effective protective measure.

Question 6

A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention?

A) More aggressive chemotherapy
B) Left mastectomy
C) Radiation therapy
D) Bilateral mastectomy

Question 7

During a recent visit to the clinic a woman presents with erythema of the nipple and areola on the right breast. She states this started several weeks ago and she was fearful of what would be found. The nurse should promptly refer the patient to her primary care provider because the patients signs and symptoms are suggestive of what health problem?

A) Peau dorange
B) Nipple inversion
C) Pagets disease
D) Acute mastitis

Question 8

A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurses admission assessment, the nurse observes that the patient is distracted and tense. What is it important for the nurse to do?

A) Acknowledge the fear the patient is likely experiencing.
B) Describe the support groups that exist in the community.
C) Assess the patients stress management skills.
D) Document a nursing diagnosis of ineffective coping.

Question 9

A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment?

A) Lumpectomy and radiation
B) Partial mastectomy and radiation
C) Partial mastectomy and chemotherapy
D) Total mastectomy and chemotherapy

Question 10

A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what?

A) Supervised breast self-examination
B) Mammography
C) Fine-needle aspiration
D) Chest x-ray

Question 11

A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patients lump is cancerous?

A) Eversion of the right nipple and mobile mass
B) A nonmobile mass with irregular edges
C) A mobile mass that is soft and easily delineated
D) Nonpalpable right axillary lymph nodes

Question 12

A patient in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The patient shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well to her diagnosis and surgery. What nursing intervention is most appropriate to support this patients coping?

A) Encourage the patients spouse or partner to be supportive while she recovers.
B) Encourage the patient to proceed with the next phase of treatment.
C) Recommend that the patient remain optimistic for the sake of her children.
D) Arrange a referral to a community-based support program.

Question 13

The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend?

A) Avoid exercise of the arm for next 2 months.
B) Keep cuticles clipped neatly.
C) Avoid lifting objects heavier than 10 pounds.
D) Use a sling until healing is complete.

Question 14

A new mother who is breastfeeding calls the clinic to speak to a nurse. The patient is complaining of pain in her left breast and describes her breast as feeling doughy. The nurse tells her to come into the clinic and be checked. The patient is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend?

A) Apply cold compresses as ordered.
B) Avoid wearing a bra until the infection clears.
C) Avoid washing the breasts.
D) Perform gentle massage to stimulate neutrophil migration.

Question 15

When planning discharge teaching with a patient who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the patient that she should report what sign or symptom to the physician immediately?

A) Fatigue
B) Temperature greater than $98.5 \mathrm{~F}$
C) Sudden cessation of output from the drainage device
D) Gradual decline in output from the drain

Question 16

A patient newly diagnosed with breast cancer states that her physician suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the patient has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis?

A) The patient is not a surgical candidate.
B) The patients breast cancer is considered highly treatable.
C) There is a $10 \%$ chance that the patients cancer will self-resolve.
D) The patient has a $15 \%$ chance of 5 -year survival.

Question 17

The nurse is performing a comprehensive health history of a patient who is in her 50 s. The nurse should identify what risk factor that may increase this patients risk for breast cancer?

A) The patient breastfed each of her children.
B) The patient gave birth to her first child at age 38 .
C) The patient experienced perimenopausal symptoms starting at age 46 .
D) The patient experienced menarche at age 13.

Question 18

A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patients diagnosis?

A) The patient will be scheduled for radiation therapy.
B) The patient might be referred for a biopsy.
C) The patients breast mass is considered an age-related change.
D) The patients diagnosis is likely related to her use of oral contraceptives.

Question 19

The nurse is reviewing the physicians notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic?

A) Nontenderness
B) A size of $5 \mathrm{~mm}$
C) Softness and a regular shape
D) Mobility

Question 20

A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram?

A) It does not use radiation.
B) Radiation levels are safe as long as mammograms are performed only once per year.
C) The negative effects of radiation do not accumulate until late in life.
D) Radiation from a mammogram is equivalent to an hour of sunlight.

Question 21

For which of the following population groups would an annual clinical breast examination be recommended?

A) Women over age 21
B) Women over age 25
C) Women over age 40
D) All post-pubescent females with a family history of breast cancer

Question 22

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time?

A) At the time of menses
B) At any convenient time, regardless of cycles
C) Weekly
D) Between days 5 and 7 after menses

Question 23

A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor?

A) Womens knowledge of how their breasts normally look and feel
B) The rapport that exists between the woman and her primary care provider
C) Synchronizing womens routines around BSE with the performance of mammograms
D) Womens knowledge of the pathophysiology of breast cancer

Question 24

A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor?

A) Age-related physiologic changes
B) Medication adverse effects
C) Poor nutrition
D) Fluid overload

Question 25

A woman is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the patient is aware of what potential consequence?

A) Chronic breast pain
B) Unclear mammography results
C) Increased risk of breast cancer
D) Decreased nipple sensation

Question 26

A patient is to undergo an ultrasound-guided core biopsy. The patient tells the nurse that a friend of hers had a stereotactic core biopsy. She wants to understand the differences between the two procedures. What would be the nurses best response?

A) An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation.
B) An ultrasound-guided core biopsy is a little more expensive, but it doesnt use radiation and it is faster.
C) An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster.
D) An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less
Expensive.

Question 27

A patient at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurses best response?

A) An incisional biopsy is performed because its known to be less painful and more accurate than other forms of testing.
B) An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment.
C) An incisional biopsy is performed to assess the potential for recovery from a mastectomy.
D) An incisional biopsy is performed on patients who are younger than the age of 40 and who are otherwise healthy.

Question 28

A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply.

A) Patient must understand when she can begin ambulating
B) Patient must have someone to accompany her home
C) Patient must understand activity restrictions
D) Patient must understand care of the biopsy site
E) Patient must understand when she can safely remove her urinary catheter

Question 29

A patient has just been told she needs to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this patient for specific educational, physical, or psychosocial needs she might have?

A) By encouraging her to verbalize her questions and concerns
B) By discussing the possible findings of the biopsy
C) By discussing possible treatment options if the diagnosis is cancer
D) By reviewing her medical history

Question 30

A patient has just returned to the postsurgical unit from post-anesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this patients immediate plan of care?

A) Acute pain related to tissue manipulation and incision
B) Ineffective coping related to surgery
C) Risk for trauma related to post-surgical injury
D) Chronic sorrow related to change in body image

Question 31

A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this patient knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this patients fears?

A) Provide written material on the procedure that has been scheduled for the patient.
B) Provide the patient with relevant information about expected recovery.
C) Give the patient current information on breast cancer survival rates.
D) Offer the patient alternative treatment options.

Question 32

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements?

A) Modified tendons and ligaments
B) Connective tissue and smooth muscle
C) Lobules and ducts
D) Endocrine glands and sebaceous glands

Question 33

A nurse has assessed that a patient is not yet willing to view her mastectomy site. How should the nurse
Best assist the patient is developing a positive body image?

A) Ask the woman to describe the current appearance of her breast.
B) Help the patient to understand that many women have gone through the same unpleasant experience.
C) Explain to the patient that her body image does not have to depend on her physical appearance.
D) Provide the patient with encouragement in an empathic and thoughtful manner.

Question 34

A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond?

A) Not until the drain is removed
B) On the second postoperative day
C) Now, if you wash gently with soap and water
D) Seven days after your surgery

Question 35

A patient has been discharged home after a total mastectomy without reconstruction. The patient lives alone and has a home health referral. When the home care nurse performs the first scheduled visit this patient, what should the nurse assess? Select all that apply.

A) Adherence to the exercise plan
B) Overall psychological functioning
C) Integrity of surgical drains
D) Understanding of cancer
E) Use of the breast prosthesis

Question 36

A patient has just been diagnosed with breast cancer and the nurse is performing a patient interview. In assessing this patients ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask this patient?

A) What is your level of education?
B) Are you feeling alright these days?
C) Is there someone you trust to help you make treatment choices?
D) Are you concerned about receiving this diagnosis?

Question 37

A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patients husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurses best response?

A) Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really arent necessary anymore.
B) According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial.
C) Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence.
D) According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.

Question 38

A patient who has had a lumpectomy calls the clinic to talk to the nurse. The patient tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone drew a line with a red marker. What would the nurse suspect is the womans problem?

A) Mondor disease
B) Deep vein thrombosis (DVT) of the breast
C) Recurrent malignancy
D) An area of fat necrosis

Question 39

A woman calls the clinic and tells the nurse she has had bloody drainage from her right nipple. The nurse makes an appointment for this patient, expecting the physician or practitioner to order what diagnostic test on this patient?

A) Breast ultrasound
B) Radiography
C) Positron emission testing (PET)
D) Galactography