Question 1

A patient who has breast cancer has been taking toremifene for 2 weeks.She tells her primary care NP that she thinks her tumor has grown larger.The NP should:&#10;A) schedule her for a breast ultrasound.&#10;B) reassure her that this is common and will subside.&#10;C) tell her she may need an increased dose of this medication.&#10;D) contact her oncologist to discuss adding another medication.

Accepted Answer

Toremifene can cause tumor flare in the first few weeks of therapy,but the tumor later regresses.An ultrasound is unnecessary at this stage.The NP does not need to notify the oncologist unless this continues to worsen.

Question 2

A woman who is being treated with radiotherapy for breast cancer asks her primary care nurse practitioner (NP)about using dietary supplements to improve her chance of recovery.The NP should tell her that:

A) vitamin E is not harmful but has not been shown to change outcomes.
B) no supplements have been shown to alter outcomes or response to therapy.
C) folic acid and other B vitamins may improve ability to tolerate chemotherapy.
D) vitamin C, taken at least 6 days per week, may lower her risk of cancer recurrence.

Accepted Answer

Women with early-stage breast cancer who took supplements of vitamin C or vitamin E at least 6 days per week had a lower risk of cancer recurrence with vitamin C but no differences with vitamin E.B vitamins are not listed as effective.

Question 3

A primary care NP sees a 60-year-old woman for a physical examination.The woman tells the NP she is taking tamoxifen for treatment of breast cancer.To monitor her response to this medication,the NP should order:

A) a chest radiograph.
B) bone mineral density testing.
C) serum bilirubin and creatinine.
D) liver enzymes and a complete blood count (CBC).

Accepted Answer

Patients taking antiestrogens,such as tamoxifen,should have periodic monitoring of liver enzymes and a CBC.A chest radiograph is not indicated.Bilirubin,creatinine,and bone mineral density testing are part of routine testing for patients taking aromatase inhibitors.

Question 4

A 50-year-old woman who is postmenopausal is taking an aromatase inhibitor as part of a breast cancer treatment regimen.She calls her primary care NP to report that she has had hot flashes and increased vaginal discharge but no bleeding.The NP should:

A) schedule her for a gynecologic examination.
B) recommend that she use a barrier method of contraception.
C) tell her to stop taking the medication and call her oncologist.
D) reassure her that these are normal side effects of the medication.

Accepted Answer

Any abnormal vaginal discharge should be reported immediately and should be evaluated with a gynecologic examination to rule out carcinoma.She is not showing signs of ovulation,so contraception is not necessary.She should not stop taking the medication unless the gynecologic examination is positive.These are common side effects but are not always normal.

Question 5

A postmenopausal woman has metastatic breast cancer that is estrogen receptor negative.She is scheduled to begin chemotherapy the following week and asks her primary care NP what other medications her oncologist may prescribe to treat her cancer.The NP should expect the oncologist to prescribe:

A) toremifene (Fareston).
B) tamoxifen (Nolvadex).
C) fulvestrant (Faslodex).
D) anastrozole (Arimidex).

Accepted Answer

Anastrozole (Arimidex)is a selective aromatase inhibitor and is useful in postmenopausal women who have estrogen receptor-negative breast cancer.The other medications are antiestrogens and treat estrogen receptor-positive cancer.

Deck 56: Drugs for Breast Cancer