Deck 16: Breast Surgery

Question 1

Talia Mendelson,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.Talia is very nervous because during the previous lumpectomy,performed using a local anesthetic,she was not entirely sedated.Talia 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 Talia'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 Talia realizing her expected outcome?

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

Answer 1

A
Maintain a quiet,calm environment.Encourage Talia's questions and allow her time to verbalize fears,distress,and anxiety.Continue to assess Talia's verbal and nonverbal signs of anxiety during the port insertion.

Question 2

Identify the marginal boundaries of the breasts.

A) Second to fifth rib horizontally,lateral edge of sternum to mid-clavicular line
B) Second to sixth rib horizontally,mid-sternum to mid-clavicular 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 mid-axillary line

Answer 2

C
The breasts extend from the second to the sixth rib horizontally and from the lateral edge of the sternum to the anterior axillary line.

Question 3

A breast biopsy,performed after the patient has received a local anesthetic,will require adjunct sedation and monitoring equipment.What relevant considerations should the nurse note during the preoperative assessment?

A) Skin assessment
B) Allergies
C) ASA physiologic status
D) Risks for injury

Answer 3

B
Patient allergies should be reviewed to avoid allergic or toxic reactions to local anesthetics.When adjunct sedation is also scheduled,monitoring equipment (e.g.,electrocardiogram [ECG],pulse oximeter,blood pressure apparatus)should also be readied.

Question 4

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.Apply the description of a stage 0 carcinoma in situ to the appropriate disease description listed below.

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

Question 5

Research and understanding of the immune system,the development of methods to evaluate aspects of the immune response,and ongoing development of monoclonal antibodies are transforming the field of immunotherapy and breast cancer treatment.The ability for a breast cancer to bind with estrogen and progesterone identifies a patient with a hormone-dependent tumor.An alternative therapy for a patent who might not be able to receive trastuzumab (Herceptin)or lapatinib,which targets epidermal growth factor,would be:

A) adriamycin and tamoxifen in postmenopausal women.
B) cancer antibodies made from the patient's own stem cells.
C) nonsteroidal aromatase inhibitors.
D) bilateral salpingo-oophorectomy.

Question 6

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 at high risk for breast cancer.

A) Biannual mammography with two views of each breast and clinical breast exam
B) An individualized screening plan
C) Biannual clinical breast exam,mammography,and bimonthly breast self-exam
D) Annual mammography,ultrasonography,and MRI with CT

Question 7

Women of high socioeconomic status and higher education also have a high incidence of breast cancer,most likely due to:

A) high-fat diet.
B) lifestyle-related genetic mutations.
C) later age at first birth.
D) better compliance with regular screening.

Question 8

Before surgery,the perioperative nurse should procure the necessary medical and surgical supplies,instruments,and equipment for the planned operation.Mammograms,ultrasound and MRI,or other imaging studies should be available in the 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 9

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) a hard and irregular mass,nipple discharge,and enlarged axillary nodes.

Question 10

Select the statement that best describes fine needle aspiration 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) If the aspirate fluid is positive,the excisional biopsy can be done immediately.

Question 11

The goal of breast cancer surgery is removal of the mass with a margin of normal tissue and a good cosmetic result.The choice of procedure depends on the size and site of the mass,the characteristics of the cells,the stage of the disease,and the patient's choice.Select the statement that best reflects the difference between minimally invasive excisional breast biopsy with stereotactic image-guided location and removal of tissue.

A) The stereotactic biopsy produces a specimen for cytologic study,while the excisional biopsy produces a histologic specimen.
B) The excisional biopsy is performed under direct visualization,while the stereotactic approach is image-guided.
C) The excisional approach requires drain placement,while stereotactic biopsy rarely requires a drain.
D) Stereotactic biopsy is recommended for lesions in the areola,high in the axilla,or chest wall while excisional biopsy is not appropriate for these areas.

Question 12

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 13

Denise Corson,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.Denise 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 Denise's concern would be:

A) recommend a plastic surgery practice associated with the ambulatory center.
B) assure her that the size difference is not as significant as she believes.
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 14

Fibrocystic changes in the breast 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) unilateral.
C) bloody.
D) All of the options are significant.

Question 15

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 postoperative wound care.
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 16

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 17

Maureen Gilroy,a 39-year-old mother of 5 children,was recently diagnosed with early stage,noninvasive ductal carcinoma in situ.She is an athletic woman who is very involved with her children and community activities.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 is concerned about the length of her recovery.The perioperative nurse recognizes Maureen's concern and assigns her a nursing diagnosis of:

A) Knowledge Deficit related to unfamiliarity with perioperative routines.
B) Knowledge Deficit related to ineffective preoperative preparation.
C) Knowledge Deficit related to anxiety about her future.
D) Knowledge Deficit related to delayed discharge teaching.

Question 18

Sarah Pergines,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.Sarah stated that the lump has existed for several years and she believed it was just part of old age.The surgeon examined Sarah 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 Sarah Pergines' probable cancer stage?

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

Question 19

In the past,radical procedures,which involved removal of the affected breast and all axillary and thoracic lymph nodes,were used to treat breast cancer.These procedures did not significantly lower mortality.What factor(s)may have contributed to mortality after these procedures?

A) Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection.
B) Early pathology techniques for frozen section and histology microexamination could not define margins.
C) Breast cancer was believed to spread by direct extension from its initial site in the breast to adjacent lymph nodes.
D) Tumor size was not usually correlated with involvement of lymph nodes and cancer spread.

Question 20

Janice Coswell,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.This patient also has periods of atrial fibrillation,which is moderately controlled by antidysrhythmic medications.The patient is also taking anticoagulant medication.Janice 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.Appropriate nursing interventions for this patient would include:

A) position the dispersive pad far from the incision site to prevent contact with prep solution.
B) activate electrosurgical unit before dispersive pad and active electrode are connected.
C) set power setting as low as possible to achieve desired effect.
D) use a trifolded green towel pocket for active electrode safety on the sterile field.

Question 21

Many breast cancer patients subscribe to various complementary and integrative therapies to provide relief from anxiety,depression,pain,and chemotherapy and radiation therapy related complications and side effects.Quality of life issues become important in providing comfort and life balance.In addition to their oncology physicians and nurses,patients may also receive therapeutic assistance for their cancer care from which group of providers?

A) Pharmacists
B) Nutritionists and dietitians
C) Wound ostomy care nurses
D) Genetic counselors

Question 22

The catheter component of Talia's port system is inserted into what 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 23

Marsha Borden is in the phase II PACU after an excisional biopsy with sentinel lymph node dissection.She is receiving her patient education as she prepares for discharge.The perioperative nurse has asked Marsha 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 24

Gertrude Marshall,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 Gertrude?

A) A crescent incision extends from the mid-axillary 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 mid-clavicular line.The incision may be closed with interrupted nonabsorbable sutures,staples,or a running subcuticular stitch.