ONCOLOGY: Brunner's Ch 58: Assessment and Management of Patients with Breast Disorders Flashcards
A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make?
A) Evaluate the patients milk production.
B) Palpate the area for a breast mass.
C) Assess the patients knowledge of breast cancer.
D) Assure the patient that this likely an age-related change.
B) Palpate the area for a breast mass.
It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau dorange), a classic sign of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The patients knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related change.
The nurse leading an educational session is describing self-examination of the breast. The nurse tells the womens group to raise their arms and inspect their breasts in a mirror. A member of the womens group asks the nurse why raising her arms is necessary. What is the nurses best response?
A) It helps to spread out the fat that makes up your breast.
B) It allows you to simultaneously assess for pain.
C) It will help to observe for dimpling more closely.
D) This is what the American Cancer Society recommends.
C) It will help to observe for dimpling more closely.
The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. Citing American Cancer Society recommendations does not address the womans question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.
A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The woman asks the nurse when her teenage daughters should begin mammography. What is the nurses best advice? A) Age 28 B) Age 35 C) Age 38 D) Age 48
C) Age 38
A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the daughters should begin mammography at age 38 to 43 years.
A woman scheduled for a simple mastectomy in one week is having her preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period?
A) Limit her intake of green leafy vegetables.
B) Increase her water intake to 8 glasses per day.
C) Stop taking aspirin.
D) Have nothing by mouth for 6 hours before surgery.
C) Stop taking aspirin.
The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.
The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurses best response?
A) Yes, its known to have a slight protective effect.
B) Yes, but studies also show an increased risk of osteoporosis.
C) You wont need to worry about getting cancer as long as you take Tamoxifen.
D) Tamoxifen is known to be a highly effective protective measure.
D) Tamoxifen is known to be a highly effective protective measure.
Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.
A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? A) More aggressive chemotherapy B) Left mastectomy C) Radiation therapy D) Bilateral mastectomy
D) Bilateral mastectomy
Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the patients unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.
During a recent visit to the clinic a woman presents with erythema of the nipple and areola on the right breast. She states this started several weeks ago and she was fearful of what would be found. The nurse should promptly refer the patient to her primary care provider because the patients signs and symptoms are suggestive of what health problem? A) Peau dorange B) Nipple inversion C) Pagets disease D) Acute mastitis
C) Pagets disease
Pagets disease presents with erythema of the nipple and areola. Peau dorange, which is associated with breast cancer, is caused by interference with lymphatic drainage, but does not cause these specific signs. Nipple inversion is considered normal if long-standing; if it is associated with fibrosis and is a recent development, malignancy is suspected. Acute mastitis is associated with lactation, but it may occur at any age.
A patient who came to the clinic after finding a mass in her breast is scheduled for a diagnostic breast biopsy. During the nurses admission assessment, the nurse observes that the patient is distracted and tense. What is it important for the nurse to do?
A) Acknowledge the fear the patient is likely experiencing.
B) Describe the support groups that exist in the community.
C) Assess the patients stress management skills.
D) Document a nursing diagnosis of ineffective coping.
A) Acknowledge the fear the patient is likely experiencing.
In the breast cancer diagnostic phase it is appropriate to acknowledge the patients feelings of fear, concern, and apprehension. This must precede interventions such as referrals, if appropriate. Assessment of stress management skills made be necessary, but the nurse should begin by acknowledging the patients feelings. Fear is not necessarily indicative of ineffective coping
A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment? A) Lumpectomy and radiation B) Partial mastectomy and radiation C) Partial mastectomy and chemotherapy D) Total mastectomy and chemotherapy
A) Lumpectomy and radiation
Treatment for breast cancer depends on the disease stage and type, the patients age and menopausal status, and the disfiguring effects of the surgery. For this patient, lumpectomy is the most likely option because the nodule is well-defined. The patient usually undergoes radiation therapy afterward. Because a lumpectomy is possible, mastectomy would not be the treatment of choice.
A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what? A) Supervised breast self-examination B) Mammography C) Fine-needle aspiration D) Chest x-ray
C) Fine-needle aspiration
Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although falsenegative and falsepositive findings are possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays can be used to pinpoint rib metastasis. Neither test is considered diagnostic of breast cancer, however.
A 42 year-old patient tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. She says that she is afraid that she has cancer. Which assessment finding would most strongly suggest that this patients lump is cancerous?
A) Eversion of the right nipple and mobile mass
B) A nonmobile mass with irregular edges
C) A mobile mass that is soft and easily delineated
D) Nonpalpable right axillary lymph nodes
B) A nonmobile mass with irregular edges
Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid-filled benign cyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.
A patient in her 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The patient shares with the nurse that she is somewhat worried about her future, but she appears to be adjusting well to her diagnosis and surgery. What nursing intervention is most appropriate to support this patients coping?
A) Encourage the patients spouse or partner to be supportive while she recovers.
B) Encourage the patient to proceed with the next phase of treatment.
C) Recommend that the patient remain optimistic for the sake of her children.
D) Arrange a referral to a community-based support program
D) Arrange a referral to a community-based support program
The patient is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences. The nurse may educate the patients spouse or partner to listen for concerns, but the nurse should not tell the patients spouse what to do. The patient must consult with her physician and make her own decisions about further treatment. The patient needs to express her sadness, frustration, and fear. She cannot be expected to be optimistic at all times.
The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend?
A) Avoid exercise of the arm for next 2 months.
B) Keep cuticles clipped neatly.
C) Avoid lifting objects heavier than 10 pounds.
D) Use a sling until healing is complete.
C) Avoid lifting objects heavier than 10 pounds.
Following an axillary dissection, the patient should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary.
When planning discharge teaching with a patient who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the patient that she should report what sign or symptom to the physician immediately?
A) Fatigue
B) Temperature greater than 98.5F
C) Sudden cessation of output from the drainage device
D) Gradual decline in output from the drain
C) Sudden cessation of output from the drainage device
The patient should report sudden cessation of output from the drainage device, which could indicate an occlusion. Gradual decline in output is expected. A temperature of 100.4F or greater should also be reported to rule out postoperative infection, but a temperature of 98.5F is not problematic. Fatigue is expected during the recovery period.
The nurse is performing a comprehensive health history of a patient who is in her 50s. The nurse should identify what risk factor that may increase this patients risk for breast cancer?
A) The patient breastfed each of her children.
B) The patient gave birth to her first child at age 38.
C) The patient experienced perimenopausal symptoms starting at age 46.
D) The patient experienced menarche at age 13.
B) The patient gave birth to her first child at age 38.
Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the patients health history is considered to be a risk factor for breast cancer.
A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patients diagnosis?
A) The patient will be scheduled for radiation therapy.
B) The patient might be referred for a biopsy.
C) The patients breast mass is considered an age-related change.
D) The patients diagnosis is likely related to her use of oral contraceptives.
B) The patient might be referred for a biopsy.
Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.
The nurse is reviewing the physicians notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic? A) Nontenderness B) A size of 5 mm C) Softness and a regular shape D) Mobility
A) Nontenderness
Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.
A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram?
A) It does not use radiation.
B) Radiation levels are safe as long as mammograms are performed only once per year.
C) The negative effects of radiation do not accumulate until late in life.
D) Radiation from a mammogram is equivalent to an hour of sunlight.
D) Radiation from a mammogram is equivalent to an hour of sunlight.
The radiation exposure of mammogram is equivalent to about 1 hour of exposure to sunlight. Consequently, the benefits of mammography far outweigh any risks associated with the procedure. Negative consequences are insignificant, and do not accumulate later in life.
For which of the following population groups would an annual clinical breast examination be recommended?
A) Women over age 21
B) Women over age 25
C) Women over age 40
D) All post-pubescent females with a family history of breast cancer
C) Women over age 40
Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently.
A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the patients history that his father was treated for breast cancer. What should the nurse provide to the patient before he leaves the clinic?
A) A referral for a mammogram
B) Instructions about breast self-examination (BSE)
C) A referral to a surgeon
D) A referral to a support group
B) Instructions about breast self-examination (BSE)
Instructions about BSE should be provided to men if they have a family history of breast cancer, because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a patient for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary.
The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE at what time?
A) At the time of menses
B) At any convenient time, regardless of cycles
C) Weekly
D) Between days 5 and 7 after menses
D) Between days 5 and 7 after menses
BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended.
A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor?
A) Womens knowledge of how their breasts normally look and feel
B) The rapport that exists between the woman and her primary care provider
C) Synchronizing womens routines around BSE with the performance of mammograms
D) Womens knowledge of the pathophysiology of breast cancer
A) Womens knowledge of how their breasts normally look and feel
Current practice emphasizes the importance of breast self-awareness, which is a womans attentiveness to the normal appearance and feel of her breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the patient and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The woman does not need to understand the pathophysiology of breast cancer to perform BSE effectively.
A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor? A) Age-related physiologic changes B) Medication adverse effects C) Poor nutrition D) Fluid overload
B) Medication adverse effects
Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.
A woman is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the patient is aware of what potential consequence? A) Chronic breast pain B) Unclear mammography results C) Increased risk of breast cancer D) Decreased nipple sensation
D) Decreased nipple sensation
During the preoperative consultation, the patient should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication.
