Question 1

A client's oncologist has just finished explaining the diagnostic workup results to her,and she still has questions.The woman states,"The physician says I have a slow-growing cancer.Very few cells are dividing.How does she know this?" What is the name of the test that gave the health care provider this information?

Accepted Answer

The S-phase index measures the number of cells in the synthesis phase of cell development.If the number of cells noted is high,then the cancer is growing at a fast rate.In this client's case,her S-phase index is assumed to be low.Tumor ploidy is the amount of deoxyribonucleic acid (DNA)in a tumor cell,compared with that in a normal cell.Nuclear grade describes the degree of abnormalities present in the cancer cell tubules,the nuclei morphologic features,and mitotic rates.Estrogen and progesterone receptors are proteins found in the cell cytoplasm and surface of some breast cancer cells.

Question 2

A nurse is providing breast care education to a client after mammography.Which information regarding fibrocystic changes in the breast is important for the nurse to share?

Accepted Answer

Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness.The pain and tenderness fluctuate with the menstrual cycle.Fibrocystic changes are not premalignant changes; this information is inaccurate.Tenderness most often occurs before menses.

Question 3

The most conservative approach for early breast cancer treatment involves lumpectomy followed by which procedure?

Accepted Answer

Radiation therapy,in the form of either brachytherapy or accelerated breast radiation,is the standard therapy after lumpectomy for the treatment of early-stage breast cancer.Chemotherapy administered soon after surgical removal of the tumor is referred to as adjuvant chemotherapy.Not all women are candidates for hormonal therapy.After the entire tumor or portion is removed by excision,a receptor assay must be performed.Chemotherapy with multiple-drug combinations is used in the treatment of recurrent and advanced breast cancer with positive results.

Question 4

A nurse is providing education to a support group of women newly diagnosed with breast cancer.It is important for the nurse to discuss which factor related to breast cancer with the group?

Accepted Answer

The exact cause of breast cancer is unknown.Between 15% and 20% of these cancers are related to genetic mutations.Breast cancer is the second leading cause of cancer death in woman ages 45 to 55 years.One in eight women in the United States will develop breast cancer in her lifetime.

Question 5

A client has been prescribed adjuvant tamoxifen therapy.What common side effect might she experience?

Accepted Answer

Common side effects of tamoxifen therapy include hot flashes,weight gain,and blood clots.Weight loss,hair loss,diarrhea,and headaches are not common side effects of tamoxifen.

Question 6

A client is concerned because she has been experiencing some milky,sticky breast discharge.Which nonmalignant condition is exhibited with this finding?

Accepted Answer

Galactorrhea bilaterally exhibits a spontaneous,milky,and sticky discharge and is a normal finding during pregnancy; however,it may also occur as the result of elevated prolactin levels.Prolactin can become elevated as a result of a thyroid disorder,pituitary tumor,stress,coitus,trauma,or chest wall surgery.

Question 7

A health care provider performs a clinical breast examination on a woman diagnosed with fibroadenoma.How would the nurse explain the defining characteristics of a fibroadenoma?

Accepted Answer

Fibroadenomas are characterized by discrete,usually solitary lumps smaller than 3 cm in diameter.Fibroadenomas increase in size during pregnancy and shrink as the woman ages.Inflammation of the milk ducts and glands behind the nipples is associated with mammary duct ectasia,not fibroadenoma.Thick,sticky discharge from the nipple of the affected breast is associated with galactorrhea,not fibroadenoma.Lumpiness in both breasts that develops 1 week before menstruation is associated with fibrocystic changes of the breast,not fibroadenoma.

Question 8

Having a genetic mutation may create an 85% chance of developing breast cancer in a woman's lifetime.Which condition does not increase a client's risk for breast cancer?

Accepted Answer

Paget disease originates in the nipple and causes nipple carcinoma and exhibits bleeding,oozing,and crusting of the nipple.BRCA1 or BRCA2,Li-Fraumeni syndrome,and Cowden syndrome are all genetic mutations that have different family pedigrees and increase the risk of breast cancer.

Question 9

What important,immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?

Accepted Answer

The affected arm should not be used for BP readings,IV therapy,or venipuncture.The affected arm should be elevated with pillows above the level of the right atrium.

Question 10

Which client is most at risk for fibroadenoma of the breast?

Accepted Answer

Although it may occur at any age,fibroadenoma is most common in the teenage years.Ductal ectasia and intraductal papilloma become more common as a woman approaches menopause.Fibrocystic breast changes are more common during the reproductive years.

Question 11

After a mastectomy,which activity should the client be instructed to avoid?

Accepted Answer

The woman should not be advised to wear snug clothing.She should be advised to avoid tight clothing,tight jewelry,and other apparel that might cause decreased circulation in the affected arm.As part of the teaching plan,the woman should be instructed to empty the surgical drains twice a day,to avoid lifting more than 4.5 kg (10 lb)or reaching above her head until given permission by her surgeon,and to report immediately any inflammation that develops at the incision site or in the affected arm.

Question 12

A woman has a breast mass that is not well delineated and is nonpalpable,immobile,and nontender.Which condition is this client experiencing?

Accepted Answer

Intraductal papilloma is the only benign breast mass that is nonpalpable.Fibroadenoma is well delineated,palpable,and movable.Lipoma is palpable and movable.Mammary duct ectasia is not well delineated and is immobile,but it is palpable and painful.

Question 13

Fibrocystic changes in the breast most often appear in women in their 20s and 30s.Although the cause is unknown,an imbalance of estrogen and progesterone may be the cause.The nurse who cares for this client should be aware that treatment modalities are conservative.Which proven modality may offer relief for this condition?

Accepted Answer

Diuretic administration plus a decrease in sodium and fluid intake are recommended.Although not supported by research,some advocate eliminating dimethylxanthines (caffeine)from the diet.Smoking should also be avoided,and alcohol consumption should be reduced.Vitamin E supplements are recommended; however,the client should avoid megadoses because vitamin E is a fat-soluble vitamin.Pain relief measures include applying heat to the breast,wearing a supportive bra,and taking nonsteroidal antiinflammatory drugs.

Question 14

A client is scheduled for surgery after a recent breast cancer diagnosis.The nurse is discussing the procedure with the client.To allay her fears,which explanation best describes a skin-sparing mastectomy?

Accepted Answer

A skin-sparing mastectomy is a special procedure that keeps the outer breast of the skin intact.The breast,nipple,and areola are removed.A tissue expander may be placed for later reconstruction.A modified radical mastectomy also removes the axillary lymph nodes.The nipple-sparing mastectomy is reserved for a small number of women during which the areola is removed leaving the nipple intact.Women who test positive for the BRCA1 or BRCA2 gene mutation may have both breasts removed to reduce the risk of cancer and is most commonly known as a prophylactic or preventative mastectomy.

Question 15

A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic.She is due for a mammogram.At her first visit,her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town.She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure.What is the most appropriate statement for the nurse to make to this client?

Accepted Answer

Offering to make an appointment for the client at the neighborhood location is nonjudgmental and gives her options as to where she may have her mammogram.Furthermore,it is an innocuous way to investigate the reasons the client missed her previous appointment.Mortality rates from breast cancer remain high for African-American women.Rather than reminding this woman that she has "missed her appointment," discussing the evidence behind the recommendations for a mammogram might be preferable for the nurse.The nurse can offer to reschedule should the client agree to return for the test.Telling the client that it is dangerous to skip mammograms can be perceived as judgmental and derogatory and may alienate and embarrass the client.

Question 16

Breast pain occurs in many women during their perimenopausal years.Which information is a priority for the nurse to share with the client?

Accepted Answer

Breast pain is unusual in breast cancer.Solid masses are generally benign and described as smooth,round,mobile,and painless.Distinguishing between cyclical and noncyclical pain is important to determine whether the cause is hormonal.Idiopathic pain is most often treated with nonsteroidal antiinflammatory medications.

Question 17

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?

Accepted Answer

When a suspicious mammogram is noted or a lump is detected,diagnosis is confirmed by either a core-needle biopsy or a needle-localization biopsy.Mammography is a clinical screening tool that may aid in the early detection of breast cancers.Transillumination,thermography,and ultrasound breast imaging are being explored as methods for detecting early breast carcinoma.An MRI is useful in women with masses that are difficult to find (occult breast cancer).

Question 18

Which client should the nurse refer for further testing?

Accepted Answer

A small dimple is an abnormal finding and should be further evaluated.Nipple retraction and a dimpling or pitting of the skin is suggestive of a locally advanced,aggressive form of breast cancer.In many women,one breast is smaller than the other,and eversion of both nipples is a normal finding.Faintly visible venous network is also a normal finding.

Question 19

Macromastia,or breast hyperplasia,is a condition in which women have very large and pendulous breasts.Breast hyperplasia can be corrected with a reduction mammoplasty.Which statement regarding this procedure is the most accurate?

Accepted Answer

If breast reduction surgery is performed,then establishing breastfeeding at a later date may be difficult.Macromastia may not be covered by all insurance companies.A consequence of surgery may be decreased sensation and pain,secondary to scar tissue.Reduction mammoplasty will relieve chronic neck and back pain.

Question 20

What is the correct name describing a benign breast condition that includes dilation and inflammation of the collecting ducts?

Accepted Answer

Generally occurring in women approaching menopause,mammary duct ectasia results in a firm irregular mass in the breast,enlarged axillary nodes,and nipple discharge.Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows,it causes trauma or erosion within the ducts.Chronic cystic disease causes pain and tenderness.The cysts that form are multiple,smooth,and well delineated.Fibroadenoma is evidenced by fibrous and glandular tissues.They are felt as firm,rubbery,and freely mobile nodules.

Quiz 10: Problems of the Breast