Deck 54: Nursing Management: Breast Disorders

Question 1

Following a modified radical mastectomy for cancer of the breast in a 39-year-old woman,the physician 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 the side effects from the drugs are very uncomfortable.What nursing diagnosis would the nurse document that best reflects the patient's problem?

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 treatment options and prognosis risks
D) Risk for ineffective therapeutic regimen management related to reluctance to consider additional treatment

Answer 1

Decisional conflict related to lack of knowledge about treatment options and prognosis risks

Question 2

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.She asks the nurse what she should do.What information should the nurse provide in response?

A) The survival rate for each is about the same,but the mastectomy prevents recurrence of the tumour in that breast.
B) The lumpectomy and radiation will preserve the breast,but this method can cause changes in breast sensitivity.
C) Arm mobility is not affected with the lumpectomy and radiation,and recovery is more rapid than with a mastectomy.
D) The treatment period for the mastectomy is shorter,and breast reconstruction can provide a normal-appearing breast.

Answer 2

The lumpectomy and radiation will preserve the breast,but this method can cause changes in breast sensitivity.

Question 3

A woman asks the nurse which area of the breast most commonly develops breast cancer.The nurse's response is based upon knowledge that about 50% of all breast cancers occur in which quadrant of the breast?

A) Upper inner quadrant
B) Upper outer quadrant
C) Lower inner quadrant
D) Lower outer quadrant

Answer 3

Upper outer quadrant

Question 4

A 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure.She says she examines her breasts monthly and asks whether it is necessary to have an annual mammogram.What is the best response to the patient?

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 the incidence of breast cancer increases markedly after the age of 60,it is very 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 50."

Question 5

Which one of the following statements is true regarding nipple-areolar reconstruction?

A) All breast reconstructive surgery requires nipple-areolar reconstruction.
B) The function of lactation is maintained.
C) It is not possible to have the nipples project away from the breast.
D) It is usually completed a few months after breast reconstructive surgery.

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

Which surgical procedure for breast cancer has a prolonged postoperative recovery period?

A) Modified radical mastectomy
B) Lumpectomy with radiation
C) Tissue expansion and breast implants
D) Breast reconstruction flap procedures

Question 8

A 20-year-old university student comes to the student health centre because she has discovered a small lump in her right breast.She is very worried that she may have cancer because her mother had cervical cancer.The nurse's response to the patient is based on the knowledge that what is the most common cause of breast lumps in women her age?

A) Breast cysts
B) Fibroadenoma
C) Breast abscesses
D) Adenocarcinoma

Question 9

Which stage of breast cancer is depicted by the TNM designation of T2 N0 M0?

A) Stage I
B) Stage IIA
C) Stage IIB
D) Stage IIIA

Question 10

During examination of a 33-year-old patient's breasts,the nurse feels several movable,tender nodules.The 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 her breast pain and lumps.What is an appropriate patient outcome for the nurse to establish with the patient?

A) Performs daily breast self-examination
B) Arranges for immediate examination and biopsy of any new lesion
C) Monitors changes in the size and tenderness of all lumps in relation to her menstrual cycle
D) Consults with her physician about having a bilateral simple mastectomy to prevent the cysts from becoming malignant

Question 11

A 52-year-old woman has found a small lump in her breast during self-examination of her breasts.While obtaining a nursing history from the patient,which of the following risk factors for breast cancer should the nurse question the patient about?

A) Smoking
B) Trauma to the breasts
C) Fibrocystic breast changes
D) Age at onset of menarche and menopause

Question 12

A patient with a small breast lump is advised to have a fine-needle aspiration (FNA)biopsy.What should the nurse explain is an advantage to this procedure?

A) Only a small incision is necessary,resulting in minimal 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) A mammogram is used to guide the extraction of a sample of tissue,ensuring that cells are taken from the lesion.

Question 13

A patient has a permanent breast implant inserted in an outpatient surgery area.What should 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 odour.
C) Wear a loose-fitting bra to decrease irritation of the sutures.
D) Take aspirin every 4 hours to reduce inflammation.

Question 14

A patient with a breast biopsy positive for cancer is to undergo lymphatic mapping and sentinel lymph node biopsy.What should the nurse explain about this procedure?

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

Question 15

When counselling a patient about breast cancer prevention,the nurse considers that the patient has a significant family history of breast cancer if she has which of the following?

A) A sister who died from ovarian cancer at the age of 29
B) A paternal grandmother who died from breast cancer at the age of 72
C) A cousin who was diagnosed with breast cancer at the age of 60 and ovarian cancer at the age of 68
D) A mother who was diagnosed with breast cancer at the age of 42

Question 16

A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes.Postoperative orders include diet as tolerated,up to ad libitum,Hemovac drain,and patient-controlled analgesia (PCA)at 1 mg morphine every 10 minutes.What is an appropriate intervention for the nurse to include in implementing postoperative care for the patient?

A) Teaching the patient to use the 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 on the right arm
D) Encouraging the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital

Question 17

During examination of a 67-year-old man,the nurse notes bilateral enlargement of the breasts.What should the nurse do?

A) Palpate the breasts for any discrete,circumscribed masses.
B) Explain that this is not unusual in older men and is no reason for concern.
C) Refer the patient to a primary physician for mammography and biopsy of the breast tissue.
D) Explain to the patient that this is normal in older men because of conversion of androgens to estrogens.

Question 18

A 64-year-old woman has undergone a modified radical mastectomy for a breast tumour.The pathology report identified the tumour as a stage II,estrogen receptor-positive adenocarcinoma.What would the nurse expect the first choice of treatment for the patient following the mastectomy to be?

A) Chemotherapy
B) Biological therapy
C) Radiation therapy
D) Hormone therapy with tamoxifen

Question 19

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.What should the nurse explain?

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 due to mutated genes.
D) BRCA1 and BRCA2 are genes that promote cancer growth,although only a small percentage of women with breast cancer have this genetic abnormality.

Question 20

The nurse provides discharge teaching for a patient who has had a left modified radical mastectomy and axillary lymph node dissection.When teaching the patient about care of the affected arm,the nurse determines that teaching has been successful when the patient gives which of the following responses?

A) "I should keep my right arm supported in a sling when I am up and around until my incision is healed."
B) "I may expose my 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 right hand above my head."
D) "I should continue to exercise my arm several times a day with finger-walking up the wall or combing my hair."

Question 21

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."

Question 22

Following a modified radical mastectomy,a patient tells the nurse the physician has recommended a flap procedure for breast reconstruction,but she did not understand how this is done.The nurse explains that the most common procedure,a transverse rectus abdominis musculocutaneous (TRAM)flap,involves which of the following?

A) Relocating muscle tissue from the back to form a breast
B) Removing a portion of an abdominal muscle and using it as breast tissue
C) Pulling part of the rectus abdominis muscle up to the breast area through a tunnel in the chest
D) Relocating the arteries from the rectus abdominis muscle to the breast area to promote growth of implanted muscle tissue

Question 23

Which breast disorder is most common between the ages of 35 and 50?

A) Lactational mastitis
B) Fibrocystic changes
C) Fibroadenoma
D) Duct ectasia