ONCOLOGY: Ignatavicius Ch 70: Care of Patients with Breast Disorders Flashcards
The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the client indicates a lack of understanding?
a. This condition will become malignant over time.
b. I should refrain from using hormone replacement therapy.
c. One cup of coffee in the morning should be enough for me.
d. This condition makes it more difficult to examine my breasts.
a. 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.
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?
a. When was your last mammogram at the clinic?
b. How many cans of caffeinated soda do you drink in a day?
c. Do the small lumps seem to change with your menstrual period?
d. Do you have a first-degree relative who has breast cancer?
c. 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. Reduction of caffeine in the diet has been shown to give relief in fibrocystic breast conditions, but research has not found that it has a significant impact. Questions related to the clients last mammogram or breast cancer history are not related to the nurses assessment.
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)?
a. Aid in the draining of the cysts by needle aspiration.
b. Teach the client to wear a supportive bra to bed.
c. Administer diuretics to decrease breast swelling.
d. Obtain a cold pack to temporarily relieve the pain.
d. Obtain a cold pack to temporarily relieve the pain.
All of the options would be comfort measures for a client with a fibrocystic breast condition. The UAP can obtain the cold or heat therapy. Only the nurse should aid the health care provider with a needle aspiration, teach, and administer medications.
Which finding in a female client by the nurse would receive the highest priority of further diagnostics?
a. Tender moveable masses throughout the breast tissue
b. A 3-cm firm, defined mobile mass in the lower quadrant of the breast
c. Nontender immobile mass in the upper outer quadrant of the breast
d. Small, painful mass under warm reddened skin
c. Nontender immobile 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. The other lesions are benign breast disorders. The tender moveable masses throughout the breast tissue could be a fibrocystic breast condition. A firm, defined mobile mass in the lower quadrant of the breast is a fibroadenoma, and a painful mass under warm reddened skin could be a local abscess or ductal ectasia.
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?
a. Take the clients vital signs and record them in the chart.
b. Notify the surgeon about the aspirin ingestion by the client.
c. Warn the client that health insurance may not pay for the procedure.
d. Teach the client about avoiding twisting above the waist after the operation.
b. 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. Vital signs should be recorded and postoperative teaching should be completed in the preoperative time frame, but these are not the priority since the procedure may be rescheduled. The warning about the clients health insurance is not appropriate at this time.
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?
a. I am fortunate that I breast-fed each of my three children for 12 months.
b. It looks as though I need to start working out at the gym more often.
c. I am glad that we can still have wine with every evening meal.
d. When I have menopausal symptoms, I must avoid hormone replacement therapy.
c. 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. Breast-feeding, regular exercise, and avoiding hormone replacement are also strategies for breast cancer prevention.
A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate?
a. Discourage this surgery since the woman is still of childbearing age.
b. Reassure the client that reconstructive surgery is as easy as breast augmentation.
c. Inform the client that this surgery removes all mammary tissue and cancer risk.
d. Include support people, such as the male partner, in the decision making.
d. 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.
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?
a. Encourage the client to search the Internet for information tonight.
b. Ask the client if sexuality has been a problem with her partner.
c. Explore the idea of a referral to a breast cancer support group.
d. Assess whether there has been any mental illness in her past.
c. 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. The nurse could assess the frequency and satisfaction of sexual relations but should not assume that there is a problem in that area. Assessment of mental illness is not an appropriate action.
A client has just returned from a right radical mastectomy. Which action by the unlicensed assistive personnel (UAP) would the nurse consider unsafe?
a. Checking the amount of urine in the urine catheter collection bag
b. Elevating the right arm on a pillow
c. Taking the blood pressure on the right arm
d. Encouraging the client to squeeze a rolled washcloth
c. 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. Infection could occur with injections and blood draws. Checking urine output, elevation of the affected arm on a pillow, and encouraging beginning exercises are all safe postoperative interventions.
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?
a. I am glad that these tubes will fall out at home when I finally shower.
b. I should measure the drainage each day to make sure it is less than an ounce.
c. I should be careful how I lie in bed so that I will not kink the tubing.
d. If there is a foul odor from the drainage, I should contact my doctor.
a. 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.
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?
a. Placing the head of bed at 30 degrees
b. Elevating the left arm on a pillow
c. Administering morphine for pain at a 4 on a 0-to-10 scale
d. Supporting the left arm while initially ambulating the client
c. 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.
During dressing changes, the nurse assesses a client who has had breast reconstruction. Which finding would cause the nurse to take immediate action?
a. Slightly reddened incisional area
b. Blood pressure of 128/75 mm Hg
c. Temperature of 99 F (37.2 C)
d. Dusky color of the flap
d. 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. The blood pressure is within normal limits and the temperature is slightly elevated but should be monitored.
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?
a. It blocks the release of luteinizing hormone.
b. It interferes with cancer cell division.
c. It selectively blocks estrogen in the breast.
d. It inhibits DNA synthesis in rapidly dividing cells.
c. 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.
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?
a. Shortness of breath
b. Nausea and vomiting
c. Hair loss
d. Mucositis
a. 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. Nausea, vomiting, hair loss, and mucositis are common problems associated with chemotherapy regimens.
A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best?
a. You do not need to worry about lymphedema since you did not have radiation therapy.
b. A risk factor for lymphedema is infection, so wear gloves when gardening outside.
c. Numbness, tingling, and swelling are common sensations after a mastectomy.
d. The risk for lymphedema is a real threat and can be very self-limiting.
b. 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. Radiation therapy is just one of the factors that could cause lymphedema. Other risk factors include obesity and the presence of axillary disease. The symptoms of lymphedema are heaviness, aching, fatigue, numbness, tingling, and swelling, and are not common after the surgery. Women with lymphedema live fulfilling lives.
