ONCOLOGY: Lewis Ch 51: Breast Disorders Flashcards
What information should the nurse include when teaching a young women’s community service group about breast self-examination (BSE)?
a. BSE will reduce the risk of dying from breast cancer.
b. BSE should be done daily while taking a bath or shower.
c. Annual mammograms should be scheduled in addition to BSE.
d. Performing BSE after the menstrual period is more comfortable.
d. Performing BSE after the menstrual period is more comfortable.
Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.
Which question is most pertinent for the nurse to ask a 43-yr-old patient about her risk for breast cancer?
a. “Do you currently smoke tobacco?”
b. “Have you ever had a breast injury?”
c. “At what age did you start having menstrual periods?”
d. “Is there a family history of fibrocystic breast changes?”
c. “At what age did you start having menstrual periods?”
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.
A 51-yr-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FNA) biopsy. What should the nurse explain as an advantage to this procedure?
a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days.
b. Only a small incision is needed, resulting in minimal breast pain and scarring.
c. If the biopsy results are negative, no further diagnostic testing will be needed.
d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
a. FNA is done in the outpatient clinic, and results are available in 1 to 2 days.
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. Because the immobility of the breast lump suggests cancer, further testing will be done if the FNA results are negative.
Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation?
a. Bilateral breast nodules that are tender with palpation.
b. A breast nodule that is 1 cm in size, nontender, and fixed.
c. A breast lump that increases in size before the menstrual period.
d. A breast lump that is small and mobile, with a rubbery consistency.
b. A breast nodule that is 1 cm in size, nontender, and fixed.
Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.
A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide?
a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes.
b. HT does not appear to increase the risk for breast cancer unless there are other risk factors.
c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer.
d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.
c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer.
Because HT is linked to an increased risk for breast cancer, the patient and health care provider must determine whether to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT 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.
A 58-yr-old woman tells the nurse, “I understand that I have stage 2 breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?” Which response by the nurse is best?
a. “I would have a lumpectomy, but you need to decide what is best for you.”
b. “It would not be appropriate for me to make a decision about your health.”
c. “Tell me what you understand about the surgical options that are available.”
d. “There is no need to make a decision rapidly; you have time to think about this.”
c. “Tell me what you understand about the surgical options that are available.”
Inquiring about the patient’s understanding shows the nurse’s willingness to assist the patient with the decision-making process without imposing the nurse’s values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse’s opinions or showing an unwillingness to discuss the topic could cut off communication.
What will the nurse teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin)?
a. Hot flashes may occur with the medication.
b. Serum electrolyte levels will be drawn monthly.
c. The patient will need frequent eye examinations.
d. The patient should call if she notices ankle swelling.
d. The patient should call if she notices ankle swelling.
Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.
After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. What topic should the nurse plan to teach the patient?
a. Estradiol
b. Tamoxifen
c. Raloxifene
d. Trastuzumab
b. Tamoxifen
Tamoxifen is used for estrogen-dependent breast tumors 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 tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.
Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes?
a. Teach the patient to use the ordered patient-controlled analgesia every 10 minutes.
b. Obtain a permanent breast prosthesis before the patient is discharged from the hospital.
c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm.
d. Insist that the patient examine the surgical incision when the initial dressings are removed.
c. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm.
The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the left arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.
The nurse provides discharge teaching for a 61-yr-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful?
a. “I will need to use my right arm and to rest the left one.”
b. “I will avoid reaching over the stove with my left hand.”
c. “I will keep my left arm in a sling until the incision is healed.”
d. “I will stop the left arm exercises if moving the arm is painful.”
b. “I will avoid reaching over the stove with my left hand.”
The patient should avoid any activity that might injure the left arm, such as reaching over a burner. If the left arm exercises are painful, analgesics should be used, and the exercises continued in order to restore strength and range of motion. The left arm should be elevated at or above heart level and should be used to improve range of motion and function.
A 33-yr-old patient has a saline breast implant inserted in the outpatient surgery area. Which instruction will the nurse include in the discharge teaching?
a. Take aspirin every 4 hours to reduce inflammation.
b. Check wound drains for excessive blood or a foul odor.
c. Wear a loose-fitting bra to decrease irritation of the sutures.
d. Resume normal activities 2 to 3 days after the mammoplasty.
b. Check wound drains for excessive blood or a foul odor.
The patient 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.
The nurse is providing preoperative teaching about the transverse rectus abdominis musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include?
a. Saline-filled implants are placed under the pectoral muscles.
b. Recovery from the TRAM surgery takes at least 6 to 8 weeks.
c. Muscle tissue removed from the back is used to form a breast.
d. TRAM flap procedures may be done in outpatient surgery centers.
b. Recovery from the TRAM surgery takes at least 6 to 8 weeks.
Patients 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.
A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed?
a. “There are several options that I can consider for treating the cancer.”
b. “I will probably need radiation to the breast after having the surgery.”
c. “Mastectomy is the best choice to decrease the chance of cancer recurrence.”
d. “I can probably have reconstructive surgery at the same time as a mastectomy.”
c. “Mastectomy is the best choice to decrease the chance of cancer recurrence.”
The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.
Which information will the nurse include when teaching a patient who is scheduled for stereotactic core biopsy of the breast?
a. A local anesthetic will be given before the biopsy specimen is obtained.
b. You will need to lie flat on your back and lie very still during the biopsy.
c. A thin needle will be inserted into the lump and aspirated to remove tissue.
d. You should not have anything to eat or drink for 6 hours before the procedure.
a. A local anesthetic will be given before the biopsy specimen is obtained.
A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to obtain the specimens.
A patient diagnosed with breast cancer asks the nurse what “triple negative” means. What should an accurate response from the nurse about triple-negative breast cancer include?
a. The tumor is not likely to be responsive to hormone therapy.
b. Treatment with chemotherapy is not likely to be recommended.
c. HER-2 receptor testing was repeated for a total of three samples.
d. Estrogen receptor testing identified three hormones causing the cancer.
a. The tumor is not likely to be responsive to hormone therapy.
A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.
The nurse is teaching a patient about breast self-examination. Which area on the accompanying illustration should the nurse identify as the area that most breast cancers are located?
a. 1
b. 2
c. 3
d. 4
e. 5
a. 1
