Chapter 70: Care of Patients with Breast Disorders

Question 1

The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the client indicates a lack of understanding?

Answer 1

This condition will become malignant over time

Fibrocystic breast condition does not increase a womans chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult
to examine the breasts because of fibrotic changes and lumps.

Question 2

The nurse is examining a womans breast and notes multiple small mobile lumps. Which question would be the most appropriate for the nurse to ask?

Answer 2

Do the small lumps seem to change with your menstrual period?

The most appropriate question would be one that relates to benign lesions that usually change in response to hormonal changes within a menstrual cycle.

Question 3

A client is diagnosed with a fibrocystic breast condition while in the hospital and is experiencing breast discomfort. What comfort measure would the nurse delegate to the unlicensed assistive personnel (UAP)?

Answer 3

Obtain a cold pack to temporarily relieve the pain

Question 4

Which finding in a female client by the nurse would receive the highest priority of further diagnostics?
diagnostics?
a. Tender moveable masses throughout the breast tissue
b. Nipple discharge without a palpable mass
c. Nontender immobile/fixed mass in the upper outer quadrant of the breast
d. Small, painful mass under warm reddened skin and nipple discharge

Answer 4

Nontender immobile/fixed mass in the upper outer quadrant of the breast

Malignant lesions are hard, nontender, and usually located in the upper outer quadrant of the breast and would be the priority for further diagnostic study

Question 5

The nurse is taking the history of a client who is scheduled for breast augmentation surgery. The client reveals that she took two aspirin this morning for a headache. Which action by nurse is best?

Answer 5

Notify the surgeon about the aspirin ingestion by the client.

The surgeon must be notified immediately since the aspirin could cause increased bleeding during the procedure.

Question 6

A 68-year-old male client is embarrassed about having bilateral breast enlargement. Which statement by the nurse is the most appropriate?

Answer 6

It is good that you came to be carefully evaluate

The most appropriate statement is the one that is supportive of the client.

Question 7

With a history of breast cancer in the family, a 48-year-old female client is interested in learning about the modifiable risk factors for breast cancer. After the nurse explains this information, which statement made by the client indicates that more teaching is needed?

Answer 7

I am glad that we can still have wine with every evening meal.

Modifiable risk factors can help prevent breast cancer. The client should lessen alcohol intake and not have wine 7 days a week.

Question 8

A (young) 37-year-old Nigerian (unfamiliar culture) woman is at high risk for breast cancer and is considering a prophylactic
mastectomy and oophorectomy. What action by the nurse is most appropriate?

Answer 8

Include support people, such as the male partner, in the decision making.

The cultural aspects of decision making need to be considered. In the Nigerian culture, the man often makes the decisions for care of the female. Women with a high risk for breast cancer can consider prophylactic surgery. If reconstructive surgery is considered, the procedure is more complex and will have more
complications compared to a breast augmentation. There is a small risk that breast cancer can still develop in the remaining mammary tissue.

Question 9

A 35-year-old woman is diagnosed with stage III breast cancer. She seems to be extremely anxious. What action by the nurse is best?

Answer 9

Explore the idea of a referral to a breast cancer support group

Support for the diagnosis would be best with a referral to a breast cancer support group. The Internet may be a good source of information, but the day of diagnosis would be too soon

Question 10

A client has just returned from a right radical mastectomy. Which action by the unlicensed assistive
personnel (UAP) would the nurse consider unsafe (require the nurse to intervene)?

Answer 10

Taking the blood pressure on the right arm

Health care professionals need to avoid the arm on the side of the surgery for blood pressure measurement, injections, or blood draws. Since lymph nodes are removed, lymph drainage would be compromised. The pressure from the blood pressure cuff could promote swelling.

Question 11

A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which
statement by the client would indicate that further teaching is needed?

Answer 11

I am glad that these tubes will fall out at home when I finally shower.

The drainage tubes (such as a Jackson-Pratt drain) lie just under the skin but need to be removed by the health care professional in about 1 to 3 weeks at an office visit. Drainage should be less than 25 mL in a days time. The client should be aware of her positioning to prevent kinking of the tubing. A foul odor from the drainage may indicate an infection; the doctor should be contacted immediately.

Question 12

What comfort measure can only be performed by a nurse, as opposed to an unlicensed assistive personnel
(UAP), for a client who returned from a left modified radical mastectomy 4 hours ago?

Answer 12

Administering morphine for pain at a 4 on a 0-to-10 scale

Only the nurse is authorized to administer medications, but the UAP could inform the nurse about the rating of pain by the client. The UAP could position the bed to 30 degrees and elevate the clients arm on a pillow to facilitate lymphatic fluid drainage return. The clients arm should be supported while walking at first but then allowed to hang straight by the side. The UAP could support the arm while walking the client.

Question 13

During dressing changes, the nurse assesses a client who has had breast reconstruction. Which finding would cause the nurse to take immediate action?

Answer 13

Dusky color of the flap

A dusky color of the breast flap could indicate poor tissue perfusion and a decreased capillary refill. The nurse should notify the surgeon to preserve the tissue. It is normal to have a slightly reddened incision as the skin heals.

Question 14

A client is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What
information needs to be explained by the nurse regarding the action of this drug?

Answer 14

It selectively blocks estrogen in the breast.

Tamoxifen (Nolvadex) reduces the estrogen available to breast tumors to stop or prevent growth. This drug
does not block the release of luteinizing hormone to prevent the ovaries from producing estrogen; leuprolide (Lupron) does this. Chemotherapy agents such as ixabepilone (Ixempra) interfere with cancer cell division, and
doxorubicin (Adriamycin) inhibits DNA synthesis in susceptible cells.

Question 15

A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and
fluorouracil (5-FU) for breast cancer. Which side effect seen in the client should the nurse report to the
provider immediately?

Answer 15

Shortness of breath

Doxorubicin (Adriamycin) can cause cardiac problems with symptoms of extreme fatigue, shortness of breath, chronic cough, and edema. These need to be reported as soon as possible to the provider.

Question 16

A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is
best?

Answer 16

A risk factor for lymphedema is infection, so wear gloves when gardening outside.

Infection can create lymphedema; therefore, the client needs to be cautious with activities using the affected arm, such as gardening

Question 17

A woman diagnosed with breast cancer had these laboratory tests performed at an office visit:

Alkaline phosphatase 125 U/L
Total calcium 12 mg/dL
Hematocrit 39%
Hemoglobin 14 g/dL
Which test results indicate to the nurse that some further diagnostics are needed?

Answer 17

Elevated alkaline phosphatase and calcium suggests bone involvement

The alkaline phosphatase (normal value 30 to 120 U/L) and total calcium (normal value 9 to 10.5 mg/dL) levels are both elevated, suggesting bone metastasis

Question 18

The nurse is taking a history of a 68-year-old woman. What assessment findings would indicate a high risk for the development of breast cancer? (Select all that apply.)

Answer 18

Age greater than 65 years
Increased breast density
Genetic factors
Early menarche

The high risk factors for breast cancer are age greater than 65 with the risk increasing until age 80; an increase in breast density because of more glandular and connective tissue; and inherited mutations of BRCA1 and/or BRCA2 genes.

Risk factors for breast cancer include advancing age, family and genetic history, early
menarche, late menopause, postmenopausal obesity, physical inactivity, combined hormonal
therapies, alcohol consumption, and lack of breast feeding.

Question 19

The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods should be included in the plan? (Select all that apply.)

Answer 19

Annual mammogram
Breast self-awareness
Clinical breast examination

Guidelines recommend a screening annual mammogram for women ages 40 years and older, breast self-awareness, and a clinical breast examination.

Question 20

After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the clients electronic medical record? (Select all that apply.)

Answer 20

Peau dorange
Nipple retraction
Mobile mass at 2 o’clock
Skin ulceration

In the documentation of a breast mass, skin changes such as dimpling (peau dorange), nipple retraction, and whether the mass is fixed or movable are charted. The location of the mass should be stated by the face of a clock.Mobile mass at two o’clock. Skin ulceration is also a common sign.

Question 21

A woman has been using acupuncture to treat the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which conditions would cause the nurse to recommend against further use of acupuncture? (Select all that apply.)

Answer 21

Lymphedema
Bleeding tendencies
Low white blood cell count

Acupuncture could be unsafe for the client if there is poor drainage of the extremity with lymphedema or if
there was a bleeding tendency and low white blood cell count. Coagulation would be compromised with a bleeding disorder, and the risk of infection would be high with the use of needles.

Question 22

The nurse is working with a male client who has gynecomastia. What action by the nurse is most appropriate?

a. Teach the client to perform self-breast examination.
b. Review the plan for chemotherapy after surgery.
c. Educate him on the side effects of tamoxifen.
d. Assess his usual daily alcohol intake.

Answer 22

Educate him on the side effects of tamoxifen

Gynecomastia is enlarged breast tissue in men. It is from an enlarged ridge of glandular breast tissue and is benign.

Question 23

A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best?

Answer 23

“Be careful not to injure that arm or get any infection in that arm.”

Injury and infection are risk factors for lymphedema; therefore, the client needs to be cautious
with activities using the affected arm.

Question 24

A woman is interested in alternative and complementary treatments for the nausea and
vomiting caused by the side effects of chemotherapy for breast cancer. Which therapies
wound the nurse suggest? (Select all that apply.

Answer 24

Acupuncture
Aromatherapy
Shiatsu

Alternative and complementary measures are chosen by many women. For nausea and vomiting, the best choices would be acupuncture, aromatherapy, and shiatsu