Deck 52: Nursing Management: Breast Disorders

Question 1

A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to

A) teach the patient about the need to monitor serum electrolyte levels.
B) ask the patient to call the health care provider before using any over-the-counter (OTC) pain relievers.
C) instruct the patient to call if she notices ankle swelling.
D) have the patient schedule frequent eye examinations.

Answer 1

instruct the patient to call if she notices ankle swelling.

Question 2

While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent?

A) "Do you currently smoke cigarettes?"
B) "Have you ever had any breast injuries?"
C) "Is there any family history of fibrocystic breast changes?"
D) "At what age did you start having menstrual periods?"

Answer 2

"At what age did you start having menstrual periods?"

Question 3

A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse's response to the patient is based on the knowledge that the most likely cause of the breast lump is

A) fibrocystic complex.
B) fibroadenoma.
C) breast abscess.
D) adenocarcinoma.

Answer 3

fibroadenoma.

Question 4

During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. The nurse's first action should be to

A) palpate the breasts for the presence of any discrete lumps.
B) explain that this is a temporary condition caused by hormonal changes.
C) refer the patient for mammography and biopsy of the breast tissue.
D) teach the patient about dietary changes to reduce the breast size.

Question 5

When teaching a 22-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that

A) BSE will reduce the risk of dying from breast cancer.
B) performing BSE right after the menstrual period will improve comfort.
C) BSE should be done daily while taking a bath or shower.
D) annual mammograms should be scheduled in addition to BSE.

Question 6

After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that no further teaching is needed?

A) "I will avoid reaching over the stove with my left hand."
B) "I will need to do breast self-examination on my right breast monthly."
C) "I will keep my left arm elevated until I go to bed."
D) "I will remember to use my right arm and to rest the left one."

Question 7

Following a modified radical mastectomy, the health care provider recommends chemotherapy even though the lymph nodes were negative for cancer cells. The patient tells the nurse that she does not know what to do about chemotherapy because she has heard that she may not even need chemotherapy and that the side effects are uncomfortable. The nursing diagnosis that best reflects the patient's problem is

A) anxiety related to prospect of additional cancer therapy.
B) fear related to uncomfortable side effects of chemotherapy.
C) decisional conflict related to lack of knowledge about prognosis and treatment options.
D) risk for ineffective health maintenance related to reluctance to consider additional treatment.

Question 8

A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate intervention for the nurse to include in implementing postoperative care for the patient includes

A) teaching the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes for the best pain relief.
B) insisting that the patient examine the surgical incision when the dressings are removed.
C) posting a sign at the bedside warning against blood pressures or venipunctures in the right arm.
D) encouraging the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.

Question 9

A 33-year-old patient tells the nurse that she has fibrocystic breasts but reducing her sodium and caffeine intake and other measures have not made a difference in the fibrocystic condition. An appropriate patient outcome for the patient is

A) calls the health care provider if any lumps are painful or tender.
B) states the reason for immediate biopsy of new lumps.
C) monitors changes in size and tenderness of all lumps in relation to her menstrual cycle.
D) has genetic testing for BRCA-1 and BRCA-2 to determine her risk for breast cancer.

Question 10

A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. When discussing this issue with the patient, the nurse explains that

A) HRT does not appear to increase the risk for breast cancer unless there are other risk factors.
B) she and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer.
C) HRT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes.
D) alternative therapies with herbs and natural drugs are as effective as estrogen in relieving the symptoms of menopause.

Question 11

A patient with a small breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that

A) only a small incision is necessary, resulting in minimal breast pain and scarring.
B) if the specimen is positive for malignancy, the patient can be told at the visit.
C) if the specimen is negative for malignancy, the patient's fears of cancer can be put to rest.
D) FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

Question 12

A patient has a permanent breast implant inserted in the outpatient surgery area. Which instructions will the nurse include in the discharge teaching?

A) Resume normal activities 2 to 3 days after the mammoplasty.
B) Check wound drains for excessive blood or any foul odor.
C) Wear a loose-fitting bra to decrease irritation of the sutures.
D) Take aspirin every 4 hours to reduce inflammation.

Question 13

A 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure. She says she does breast self-examination (BSE) monthly and asks whether it is necessary to have an annual mammogram. The nurse's best response to the patient is,

A) "If your mammogram was painful, it is especially important that you have it done annually."
B) "An ultrasound examination of the breasts, which is not painful or a source of radiation, can be substituted for a mammogram."
C) "Because of your age, it is even more important for you to have annual mammograms."
D) "Unless you find a lump while examining your breasts, a mammogram every 2 years is recommended after age 60."

Question 14

At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that

A) her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer.
B) changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer.
C) because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes.
D) genetic mutations increase cancer risk only in combination with other risk factors such as obesity.

Question 15

A 34-year-old woman has undergone a modified radical mastectomy for a breast tumor. The pathology report identified the tumor as a stage I, estrogen-receptor-positive adenocarcinoma. The nurse will plan on teaching the patient about

A) raloxifene (Evista).
B) estradiol (Estrace).
C) trastuzumab (Herceptin).
D) tamoxifen (Nolvadex).

Question 16

A patient with a breast biopsy positive for cancer is to undergo lymphatic mapping and sentinel lymph node dissection (SLND). The nurse explains that this procedure

A) can identify specific lymph nodes that have malignant cells, so only involved nodes need to be excised.
B) reduces the need for extensive lymph node dissection for pathologic examination.
C) eliminates the need for excision of more than one lymph node for staging of breast cancer.
D) will confirm the absence of tumor spread if the sentinel lymph node is negative for malignant changes.

Question 17

A woman with a positive biopsy for breast cancer is considering whether to have a modified radical mastectomy or breast conservation surgery (lumpectomy) with radiation therapy. Which information should the nurse provide?

A) The postoperative survival rate for each is about the same, but there is a decreased rate of cancer recurrence after mastectomy.
B) The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity.
C) The hair loss associated with post-lumpectomy chemotherapy is not acceptable to some patients.
D) The treatment period for the mastectomy is shorter, and breast reconstruction can provide a normal-appearing breast.

Question 18

The nurse provides discharge teaching for a patient who has had a left modified radical mastectomy and axillary lymph node dissection. The nurse determines that teaching has been successful when the patient says,

A) "I should keep my left arm supported in a sling when I am up until my incision is healed."
B) "I may expose my left arm to the sun for several hours each day to increase circulation and promote healing."
C) "I can do whatever exercises and activities I want as long as I do not elevate my left hand above my head."
D) "I will continue to exercise my left arm with finger-walking up the wall or combing my hair."

Question 19

A 38-year-old woman is scheduled for a breast-conservation therapy with a lumpectomy. As the nurse prepares her for surgery, she begins to cry and says, "I just do not know how to handle all of this." An appropriate response to the patient by the nurse is,

A) "Would you like to talk about how you are feeling right now?"
B) "I can see you are really upset. Would you like to be alone for a while?"
C) "The important thing is that the tumor was found and is going to be removed."
D) "With this surgery you will have very little change in the appearance of your breast."

Question 20

When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a

A) cousin who was diagnosed with breast cancer at age 38.
B) mother who was diagnosed with breast cancer at age 42.
C) sister who died from ovarian cancer at age 56.
D) grandmother who died from breast cancer at age 72.

Question 21

A patient with an abnormal mammogram is scheduled for stereotactic core biopsy. Which information will the nurse include when teaching the patient about the procedure?

A) "You will need to avoid eating or drinking anything for 6 hours before the procedure."
B) "Any discomfort after the biopsy may be treated with mild pain relievers such as aspirin."
C) "The core biopsy is evaluated immediately and you will get the results before leaving."
D) "Several samples of tissue in the abnormal area will be obtained during the procedure."

Question 22

Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and an axillary lymph node dissection is appropriate to assign to an LPN/LVN?

A) Administering an analgesic 30 minutes before the scheduled arm exercises
B) Teaching the patient how to avoid injury to the right arm
C) Assessment of the patient's range of motion for the right arm
D) Evaluation of the patient's understanding of discharge instructions about drain care

Question 23

Following a modified radical mastectomy, a patient tells the nurse the health care provider has recommended a flap procedure for breast reconstruction but that she did not understand how this was done. The nurse explains that the most common procedure, a transverse rectus abdominis musculocutaneous (TRAM) flap, involves

A) relocating muscle tissue from the back and using it to form a breast.
B) removing a portion of an abdominal muscle to use as breast tissue.
C) pulling part of the abdominal muscle up to the breast area through a tunnel in the chest.
D) relocating the arteries from the abdominal muscle to improve circulation to the implant.

Question 24

Which statement by a 32-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that the goals of therapy are being met?

A) "I am not sure how my husband will react when I tell him about this cancer."
B) "I am ready to die if that is God's plan for me."
C) "I need to know all the options before making a decision about treatment."
D) "I will do whatever the doctor thinks is best."