Deck 17: Breast Surgery

Question 1

Review the list below and select the option that most accurately describes the action taken after a fine-needle aspiration biopsy (FNAB)of a suspicious breast mass.

A) The aspirate fluid is cytologically examined.
B) The aspirate fluid is histologically examined by frozen section.
C) The aspirate fluid is microscopically examined immediately by the procedural physician.
D) The patient undergoes an immediate excisional biopsy if the aspirate fluid is positive for malignancy.

Answer 1

A
Once a mass is identified,the physician has multiple techniques to establish a diagnosis.During an FNAB the physician or radiologist anesthetizes a small area of the breast with lidocaine.FNAB is mainly used for differentiation of solid from cystic masses but may also be performed when a new,dominant,unexplained mass is found in the breast.A 22- or 25-gauge needle attached to a 20-mL syringe is inserted into the mass,and a small amount of the contents is aspirated,then prepared on a slide for cytologic examination.

Question 2

Breast screening guidelines are developed and published by the American Cancer Society (ACS)for asymptomatic women of various age and risk groups.Select the statement that best reflects the ACS guidelines for women aged 40 to 44 years at average risk for breast cancer.

A) Biannual mammography with two views of each breast and clinical breast exam (CBE) is recommended.
B) Cancer screening with mammograms is optional.
C) Annual clinical breast exam, mammography, and bimonthly breast self-exam (BSE) is recommended.
D) Annual mammography is recommended.

Answer 2

B
The American Cancer Society states that at age 40 to 44,women should have the choice to start annual breast cancer screening with mammograms.

Question 3

An experienced nurse in the breast surgery service is preparing the OR for a radical mastectomy procedure on a 72-year-old patient with invasive breast cancer.The nurse realizes that judicious use of electrosurgery will be important to maintain adequate hemostasis for this patient.She has assigned this patient a nursing diagnosis of risk for injury related to use of electrosurgery and is determined to achieve the desired relevant nursing outcome.What appropriate nursing interventions will provide a safe environment for both the patient and the intraoperative team?

A) Position the dispersive pad far from the incision site to prevent contact with prep solution.
B) Activate the electrosurgical unit (ESU) before the dispersive pad and active electrode are connected.
C) Set power settings as low as possible to achieve the desired effect.
D) Use a trifolded green towel pocket for active electrode safety on the sterile field.

Answer 3

C
An ESU or a surgical laser is used to provide both hemostasis and tissue dissection.Safe practices when using devices that generate surgical smoke require the use of a smoke evacuation system and accessories in both open and laparoscopic procedures.Set power setting as low as possible to achieve the desired effect.Position the dispersive pad as close to the operative site as possible.Select a site that is clean and dry,with good muscle mass; note and document the condition of the skin at the selected site.Use holster for active electrode on the sterile field.

Question 4

Identify the marginal boundaries of the breasts.

A) Second to fifth rib horizontally, lateral edge of sternum to midclavicular line
B) Second to sixth rib horizontally, midsternum to midclavicular line
C) Second to sixth rib horizontally, lateral edge of sternum to anterior axillary line
D) Second to fifth rib horizontally, lateral edge of sternum to midaxillary line

Question 5

Before surgery,the perioperative nurse should procure the necessary medical and surgical supplies,instruments,and equipment for the planned operation.Mammograms,ultrasound,MRI,or other imaging studies should be available in the operating room (OR)for the surgeon's review.The reason for the imaging studies' availability in the OR is to:

A) provide tools for teaching other surgery team members and students.
B) confirm the correct surgical site and location of pathology.
C) identify and confirm the correct patient.
D) confirm the correct surgical site and location of pathology, and identify and confirm the correct patient.

Question 6

The Centers for Disease Control and Prevention (CDC)wound classification system considers breast surgery as "clean." The Surgical Site Infection (SSI)rate for clean surgical procedures is projected to be less than 2%.Olsen (2015)looked at the SSI rate for mastectomies performed between 2004 and 2011.What key information impacts the perioperative team?

A) In mastectomy or lumpectomy, SSI is the most common complication.
B) Of the mastectomies studied, the SSI rate was 8.1%.
C) Bilateral mastectomies have higher SSI rates than unilateral mastectomies.
D) The SSI rate is reduced in incisions with drains.

Question 7

An 82-year-old woman was referred to the breast surgery service by her gerontologist because of a large inflammatory mass in her left breast.The patient stated that the lump has existed for several years,and she believed it was just part of old age.The surgeon examined her and found tumor nodules growing into the skin of the breast,with breast swelling and redness.Diagnostic imaging results described a tumor that had grown into the chest wall and may have spread to axillary lymph nodes and to other lymph nodes behind the breastbone and below the collarbone.Based on this description,what is the patient's probable cancer stage?

A) Stage IIa
B) Stage IIIc
C) Stage IIIb
D) Stage IV

Question 8

A 39-year-old mother of five children was recently diagnosed with early-stage,noninvasive DCIS.She has decided to have a bilateral preemptive modified radical mastectomy to minimize her risk of metastatic disease.She is calm and confident that she has made the right decision but she is concerned about the length of her recovery.The perioperative nurse recognizes the patient's concern and assigns her a nursing diagnosis of:

A) knowledge deficit related to unfamiliarity with the hospital environment.
B) knowledge deficit related to ineffective preoperative preparation.
C) knowledge deficit related to unfamiliarity with perioperative routines and anxiety about her future.
D) knowledge deficit related to delayed discharge teaching.

Question 9

Which factors are considered high increased risk for breast cancer?

A) Nulliparity, dense breasts
B) Family history, early menarche
C) Age greater than 60, genetic factors
D) History of hormone replacement therapy, obesity

Question 10

Breast cancer is usually staged to measure the extent of the disease and to design a specific treatment plan,using the TNM (T = tumor; N = node; M = metastasis)classification system.Review the list below and select the option that most closely describes a stage 0 carcinoma in situ (CIS).

A) Lobular carcinoma in situ (LCIS) has abnormal cells lining the lobule and often becomes invasive.
B) Ductal carcinoma in situ (DCIS) is defined as abnormal cells lining the ductal system and is not invasive.
C) LCIS has abnormal cells infiltrating the lobule and often does not become invasive.
D) DCIS has abnormal cells lining the ductal system and is often invasive.

Question 11

Ductal ectasia is a benign breast disorder that is difficult to distinguish from cancer,primarily because it presents with:

A) bilateral tenderness, mottled skin patterns of the breast, and fullness.
B) bilateral multicentric nodules and nipple discharge.
C) mottled skin patterns of the breast and edema.
D) nipple discharge, dilation of the ducts and intraductal mass.

Question 12

A breast biopsy,performed after the patient has received a local anesthetic,will require adjunct sedation and monitoring equipment.What is the highest priority consideration for the nurse to note during the preoperative assessment?

A) Skin assessment
B) Allergies
C) American Society of Anesthesiologists (ASA) physiologic status
D) Risks for injury

Question 13

A 46-year-old woman is in the phase II postanesthesia care unit (PACU)after an excisional biopsy with sentinel lymph node (SLN)dissection.She is receiving her patient education as she prepares for discharge.The perioperative nurse has asked her to teach back the complications and side effects that could be observed after sentinel lymph node dissection.What information does the nurse expect to hear?

A) "The dye will make my urine blue for a few hours."
B) "I could have an allergic reaction to the dye, tingling, weakness, numbness, or pain in my arm."
C) "I could set off the security door alarms at the mall from the radioactive dye left in my veins."
D) "I will possibly be nauseous and could vomit from riding in the car on the way home."

Question 14

The catheter component of an infusion port system is inserted into which structure(s)?

A) Left mammary or subclavian vein
B) Right atrium by way of the jugular vein
C) Subclavian or jugular vein
D) Inferior vena cava

Question 15

Fibrocystic change in the breast is an all-encompassing term used to describe many different breast changes.These changes affect almost all women at some time in their lives.Nipple discharge is more commonly associated with benign lesions than with cancer; however,discharge is usually significant only if it is spontaneous,persistent,and:

A) chronic.
B) bilateral.
C) painful.
D) milky white.

Question 16

The internal thoracic lymph nodes,which drain the inner half of the breast,can also be a channel for the:

A) secretion of estrogen.
B) spread of metastasis.
C) drainage of the outer half of the breast.
D) spread of infections.

Question 17

A 35-year-old mother of twins was scheduled for a left breast lumpectomy.This is her third lumpectomy in 6 years for benign fibrocystic disease.The patient shared her concerns with the perioperative nurse,worrying about her breast's appearance after three similar surgeries in the same breast.The nurse noticed,on assessment,how much smaller the left breast was in comparison with the right.An appropriate action for the nurse to take in response to the patient's concern would be to:

A) demonstrate warmth and acceptance of the patient's anxiety.
B) reinforce the patient's understanding of the proposed surgical procedure.
C) encourage her to discuss her feelings regarding body image and resulting changes.
D) encourage her to have this discussion when the surgeon returns to do the site marking.

Question 18

In 2012,pertuzumab was approved for use in combination with trastuzumab and with the chemotherapy agent docetaxel.These agents are specifically indicated for which patients?

A) Patients who are not responsive to adriamycin and tamoxifin.
B) Patients treated with cancer antibodies made from their own stem cells.
C) Patients with metastatic HER-2-positive breast cancer who have not had chemotherapy.
D) Patients who are not candidates for bilateral salpingo-oophorectomy.

Question 19

A 27-year-old patient,who had a lumpectomy for early-onset breast cancer,arrived at the ambulatory surgery center for infusion port insertion.She is scheduled to begin adjuvant chemotherapy next week.The patient is very nervous because during the previous lumpectomy,performed using a local anesthetic,she was not entirely sedated.The patient tells the perioperative nurse that she was uncomfortable and heard everything in the room but admitted that she did not feel pain.The nurse recognized the patient's anxiety related to the surgical intervention and prepared to implement corrective actions in the OR.What nursing intervention best reflects one that would ensure support or contribute to the patient realizing her expected outcome?

A) Ensure a quiet and calm environment of care.
B) Share the patient's concerns with the anesthesia provider.
C) Have the patient wear a headset that plays classical, nonlyrical music during the procedure.
D) Ask each team member individually to be quiet during the procedure.

Question 20

The mammary glands are affected by physiologic changes throughout a woman's life span.Select the option that best reflects the life cycle events that impact the anatomy and physiology of the breasts.

A) Growth and development, menstruation, and menopause
B) Menstruation, pregnancy, and lactation
C) Hormone development, pregnancy, and menopause
D) Growth and development, menstruation, and pregnancy and lactation

Question 21

Many breast cancer patients subscribe to various complementary and alternative (CAM)and integrative therapies to provide relief from anxiety,depression,pain,and the complications and side effects associated with chemotherapy and radiation therapy.Quality-of-life issues become important in providing comfort and life balance.Breast cancer patients who are interested in the benefits of CAM and integrative therapies would most likely seek assistance for their cancer care from which group of providers?

A) Reiki practitioners
B) Nutritionists and dietitians
C) Homeopathy practitioners
D) Genetic counselors

Question 22

Which breast surgery procedure is also called the nipple-sparing technique (NSM)?

A) Subcutaneous mastectomy
B) Breast conservation surgery
C) Nipple reconstruction
D) Simple mastectomy

Question 23

A patient undergoing breast surgery will likely be extremely apprehensive about the possibilities of having a malignancy,losing a body part,facing a negative reaction from her spouse and family,and experiencing a negative change in self-image.The preoperative interview of the breast surgery patient should consider:

A) the patient's level of anxiety and possible causes.
B) the patient's understanding of her perioperative procedure.
C) if the patient has ever lost a friend or family member to cancer.
D) if the patient has misunderstandings about her disease or treatment plan.

Question 24

A 65-year-old recently retired nurse was scheduled for a modified radical mastectomy.It has been over 40 years since she worked as a perioperative nurse,and she vividly remembers the mutilating radical mastectomies of the past.She asks the perioperative nurse to describe the appearance of her incision at the end of the procedure.What description of the incision will the perioperative nurse explain to the patient?

A) A crescent incision extends from the midaxillary line to the medial fourth rib attachment to the sternum. The incision will likely be closed with interrupted nylon sutures.
B) A horizontal elliptic incision with lateral extension toward the axilla is made through the subcutaneous tissue. The incision will likely be closed with subcuticular uninterrupted polypropylene sutures.
C) An oblique elliptic incision with lateral extension toward the axilla is made through the subcutaneous tissue. The incision may be closed with interrupted nonabsorbable sutures, staples, or a running subcuticular stitch.
D) A vertical elliptic incision extends along the midclavicular line. The incision may be closed with interrupted nonabsorbable sutures, staples, or a running subcuticular stitch.