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) have the patient schedule frequent eye examinations.
B) instruct the patient to call if she notices ankle swelling.
C) remind the patient that hot flashes may occur with the medication.
D) teach the patient about the need to monitor serum electrolyte levels.

Answer 1

instruct the patient to call if she notices ankle swelling.

Question 2

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 teaching has been successful?

A) "I will need to use my right arm and to rest the left one."
B) "I will avoid reaching over the stove with my left hand."
C) "I will keep my left arm in a sling until the incision is healed."
D) "I will stop the left arm exercises if moving the arm is painful."

Answer 2

"I will avoid reaching over the stove with my left hand."

Question 3

Which statement by a 52-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that patient teaching may be needed?

A) "There are several options available for treating the cancer."
B) "I will probably need radiation to the breast after having the surgery."
C) "I can probably have reconstructive surgery at the same time as a mastectomy."
D) "Mastectomy will be the best choice to decrease the chance of cancer recurrence."

Answer 3

"Mastectomy will be the best choice to decrease the chance of cancer recurrence."

Question 4

When a patient is scheduled for stereotactic core biopsy of the breast, which information will the nurse include in patient education?

A) A local anesthetic will be given before the biopsy specimen is obtained.
B) You will need to lie flat on your back and lie very still during the biopsy.
C) A thin needle will be inserted into the lump and aspirated to remove tissue.
D) You should not have anything to eat or drink for 6 hours before the procedure.

Question 5

To determine the risk for breast cancer in a 52-year-old patient who has found a small lump in her breast, which question is most pertinent for the nurse to ask?

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

Question 6

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. Which information will the nurse include when discussing HRT with the patient?

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

Question 7

Following a lumpectomy, a patient is scheduled for external beam radiation to the right breast. Which information should the nurse include in patient teaching?

A) The radiation therapy will take a week to complete.
B) Careful skin care in the radiated area will be necessary.
C) Visitors are restricted until the radiation therapy is completed.
D) Wigs may be used until the hair regrows after radiation therapy.

Question 8

When teaching a 28-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) BSE should be done daily while taking a bath or shower.
C) annual mammograms should be scheduled in addition to BSE.
D) performing BSE right after the menstrual period will improve comfort.

Question 9

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

A) FNA is done in the outpatient clinic, and results are available in 1 to 2 days.
B) only a small incision is needed, resulting in minimal breast pain and scarring.
C) if the biopsy results are negative, no further diagnostic testing will be needed.
D) FNA is guided by a mammogram, ensuring that cells are taken from the lesion.

Question 10

The pathology report for a 42-year-old who has had a modified radical mastectomy identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan on teaching the patient about

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

Question 11

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

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

Question 12

Which action should the nurse take first when caring for a patient who has been admitted for lumpectomy and axillary lymph node dissection?

A) Teach the patient how to deep breathe and cough.
B) Discuss options for postoperative pain management.
C) Explain the postdischarge care of the axillary drains.
D) Ask the patient to describe what she knows about the surgery.

Question 13

After the nurse has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen (Nolvadex), which patient statement indicates that the teaching has been effective?

A) "I will expect to have leg cramps with this drug."
B) "I will call the clinic if I develop any hot flashes."
C) "I will be taking the medication for at least a year."
D) "I will call immediately if I have any eye problems."

Question 14

Which information will the nurse include when teaching a patient about the transverse rectus abdominis musculocutaneous (TRAM) procedure?

A) Saline-filled implants are placed under the pectoral muscles.
B) Recovery from the TRAM surgery takes at least 6 to 8 weeks.
C) Muscle tissue is removed from the back and used to form a breast.
D) TRAM flap procedures may be done in outpatient surgery centers.

Question 15

A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. Which nursing action should be included in the plan of care?

A) Insist that the patient examine the surgical incision when the dressings are removed.
B) Teach the patient to use the ordered patient-controlled analgesia ( PCA ) every 10 minutes.
C) Post a sign at the bedside warning against blood pressures or venipunctures in the right arm.
D) Obtain a permanent breast prosthesis for the patient before she is discharged from the hospital.

Question 16

A patient with stage II breast cancer tells the nurse, "I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What do you think I should do?" Which response by the nurse is best?

A) "I would have a lumpectomy, but you need to decide what is best for you."
B) "Tell me what you understand about the surgical options that are available."
C) "It would not be appropriate for me to make the decision about your health."
D) "There is no need to make a decision rapidly; you have time to think about this."

Question 17

When the nurse is working in the women's health care clinic, which of these actions is appropriate to take?

A) Educate a healthy 36-year-old about the need for an annual mammogram.
B) Discuss the need for a clinical breast examination every year with a 22-year-old.
C) Talk about magnetic resonance imaging (MRI) with a 26-year-old with a BRCA-1 mutation.
D) Teach an active 70-year-old that mammography frequency can be reduced to every 3 years.

Question 18

After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about

A) lumpectomy.
B) lymphatic mapping.
C) MammaPrint testing.
D) tamoxifen (Nolvadex).

Question 19

A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which topic indicates that the student needs more education about breast cancer diagnostic testing?

A) CA 15-3 level testing
B) HER-2 receptor testing
C) Estrogen receptor testing
D) Oncotype DX assay testing

Question 20

When the nurse is assessing the breasts of a 31-year-old, which finding is most indicative of a need for further evaluation?

A) Bilateral nodules that are tender with palpation
B) A nodule that is 1 cm in size, painless, and fixed
C) A lump that increases in size before the menstrual period
D) A lump that is small, mobile, and has a rubbery consistency

Question 21

A 33-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which is most important to report to the health care provider?

A) There is yellow-green discharge from one of the patient's nipples.
B) There is an area on the breast that is hot, pink, and tender to touch.
C) The lumps are firm feeling and most are in the upper outer breast quadrants.
D) The lumps are larger and more painful before the patient's menstrual period.

Question 22

When the nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), which assessment finding is most important to communicate to the health care provider?

A) The patient's apical pulse is irregular.
B) The patient has complaints of fatigue.
C) The patient eats only 15% of food on meal tray.
D) The patient's white blood cell ( WBC ) count is 5000/mm³.

Question 23

During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. Which action should the nurse take first?

A) Question the patient about any medications being currently used.
B) Teach the patient about how to palpate the breast tissue for lumps.
C) Refer the patient for mammography and biopsy of the breast tissue.
D) Explain that this is a temporary condition due to hormonal changes.

Question 24

When the nurse is caring for a patient with left arm lymphedema, which action will be included in the plan of care?

A) Check BP on both right and left arms.
B) Avoid isometric exercise on the left arm.
C) Assist with application of compression dressings.
D) Keep the left arm at or below the level of the heart.

Question 25

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

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