Question 1

The nurse is conducting a breast assessment on a female client. Which of the following findings is most indicative of a need for further evaluation?

Accepted Answer

Painless and fixed lumps suggest breast cancer; a nodule that is 1 cm in size, firm, and painless suggests breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.

Question 2

The nurse is caring for a client who returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. Which of the following nursing actions should be included in the plan of care?

Accepted Answer

The client is at risk for lymphedema and infection if blood pressures or venipunctures are done on the right arm. The client is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the client to examine the incision and participate in care when the client feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.

Question 3

When the nurse is working in the women's health care clinic, which of the following actions is appropriate to take?

Accepted Answer

MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A 52-year-old client should have a mammography every 2 years.
Mammography screening is recommended for women starting at age 40 if they are considered high risk for the development of breast cancer. For healthy older women, an individualized plan of care should be discussed with her health care provider.

Question 4

Which of the following information should the nurse include when teaching a client about the transverse rectus abdominis musculo-cutaneous (TRAM) procedure?

Accepted Answer

Clients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.

Question 5

The nurse has completed teaching a client who has breast cancer about the newly prescribed tamoxifen. Which of the following client statements indicate that the teaching has been effective?

Accepted Answer

Blurred and cloudy vision should be immediately reported because it is likely that the client is developing cataracts and the tamoxifen will be discontinued or decreased.
Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected adverse effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the client should immediately notify the health care provider if pain occurs.

Question 6

The nurse is teaching a client about breast self-examination (BSE) who has had a right-sided mastectomy. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

It is recommended, postmastectomy, that the client perform monthly BSE on the remaining breast and the surgical site. The most common site of local recurrence of breast cancer is at the surgical site. The woman should undergo appropriate breast imaging at regular intervals (usually 6 months to 1 year), as determined by her risk of recurrence and breast cancer history.

Question 7

A client has a saline breast implant inserted in the outpatient surgery area. Which of the following instructions should the nurse include in the discharge teaching?

Accepted Answer

The client should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

Question 8

After a client is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that client teaching may be needed about which of the following topics?

Accepted Answer

Tamoxifen is used as a chemopreventive therapy in some clients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

Question 9

The nurse is caring for a client who is scheduled for stereotactic core biopsy of the breast. Which of the following information should the nurse include in client education?

Accepted Answer

A local anaesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The client is placed in the prone position. A biopsy gun is used to obtain the specimens.

Question 10

Which of the following statements by a client newly diagnosed with stage I breast cancer indicates to the nurse that client teaching may be needed?

Accepted Answer

The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other client statements indicate a good understanding of stage I breast cancer treatment.

Question 11

The nurse is preparing a client with a small immobile breast lump for a fine-needle aspiration (FNA) biopsy. Which of the following information about the procedure should the nurse explain to the client?

Accepted Answer

FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound, but not by mammogram. Since the immobility of the breast lump suggests cancer, further testing will be done if the FNA is negative.

Question 12

The nurse is caring for a client who is at menopause and considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. Which of the following information should the nurse include when discussing HRT with the client?

Accepted Answer

Because HRT has been linked to increased risk for breast cancer, the client and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increases the risk for both
non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

Question 13

Which of the following actions should the nurse take first when caring for a client who has been admitted for lumpectomy and axillary lymph node dissection?

Accepted Answer

Before teaching, the nurse should assess the client's current knowledge level. The other teaching may also be appropriate, depending on the assessment findings.

Question 14

The nurse is caring for a client following breast augmentation surgery. Which of the following information should the nurse include in client teaching?

Accepted Answer

The client's temperature should be monitored. Breast augmentation clients have drains in place in the surgical site to prevent hematoma formation and then removed 2 to 3 days after surgery or when drainage is less than 20 to 30 mL per day. The drainage must be examined for colour and odour to detect postoperative infection or hemorrhage. A compression dressing is not kept in place for 5-7 days; dressings should be changed as necessary with sterile technique and prescribed. Depending on the extent of the operation, most women can resume normal activities within 2 to 3 weeks. Strenuous exercise may not be appropriate until several weeks later.

Question 15

The nurse is assessing a client at the clinic who has metastatic breast cancer and has a new prescription for trastuzumab. Which of the following findings is a reason for the administration of this medication?

Accepted Answer

For clients who are HER-2 positive, trastuzumab is a monoclonal antibody to HER-2. After the antibody attaches to the antigen, it is taken into the cancer cells and eventually kills them.

Question 16

To determine the risk for breast cancer in a client who has found a small lump in the left breast, which of the following questions is most pertinent for the nurse to ask?

Accepted Answer

Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

Question 17

A student nurse prepares a list of teaching topics for a client with a new diagnosis of breast cancer. Which of the following topics indicate that the student needs more education about breast cancer diagnostic testing?

Accepted Answer

A firm, moveable mass is characteristic of fibroadenoma, not breast cancer. The other tests are likely to be used for additional diagnostic testing in a client with breast cancer.

Question 18

The nurse is caring for a client who has had a right mastectomy and the client asks the nurse how long the biannual mammography will have to continue. Which of the following time frames should the nurse inform the client is recommended for mammography postmastectomy?

Accepted Answer

The client should undergo appropriate breast imaging at regular intervals (usually 6 months to 1 year) for two consecutive years.

Question 19

The pathology report for a client who has had a modified radical mastectomy identifies the tumour as an estrogen-receptor positive adenocarcinoma. Which of the following medications should the nurse include when teaching the client?

Accepted Answer

Tamoxifen is used for estrogen-dependent breast tumours in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumours.
Trastuzumab is used to treat tumours that have the HER-2 receptor.

Question 20

Aclient with stage II breast cancer tells the nurse, "I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What do you think I should do?" Which of the following responses by the nurse is best?

Accepted Answer

This response indicates the nurse's willingness to assist the client with the decision-making process without imposing the nurse's values or opinions. It is not appropriate to say that it is not the nurse's decision to make as this would close the conversation and indicates that the nurse is not willing to help the client with the decision about treatment. Because treatment decisions for breast cancer do need to be made relatively quickly, it is not alright to tell the client that the decision does not need to be made rapidly. Since the nurse's values and situation are not the same as the client's, imposing the nurse's opinions during this emotionally vulnerable time is not appropriate.

Quiz 54: Nursing Management Breast Disorders