Chapter 40: Management of Clients with Breast Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 40: Management of Clients with Breast Disorders

MULTIPLE CHOICE

1. The nurse explains that the most frequent breast mass is

a.

carcinoma.

b.

fibroadenoma.

c.

fibrocystic disease.

d.

mastitis.

ANS: C

Fibrocystic masses are the most frequently occurring breast pathology.

DIF: Comprehension/Understanding REF: p. 968 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. A nurse is teaching women about health promotion measures related to breast cancer. The woman the nurse would advise is at higher risk and should be sure to engage in breast cancer screening activities is the woman who

a.

began menstruation at an early age.

b.

experienced menopause at an early age.

c.

had five children.

d.

needed surgical removal of her ovaries at age 32.

ANS: A

Oophorectomy before menopause reduces the risk of breast cancer. Hormonal and other factors associated with increased risk include (a) early menarche, (b) late menopause, (c) nulliparity, (d) exogenous estrogen given for menopausal manifestations, and (e) history of cancer of the uterus, ovary, or colon.

DIF: Application/Applying REF: p. 941 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Health Screening Physiological Integrity Physiological Adaptation-Pathophysiology

3. The client discovered a stone-hard lump during breast self-examination (BSE) that has been determined to be confined to the lobular unit without permeating the basement membrane. Reinforcing the physicians explanation, the nurse would clarify that this type of tumor is

a.

intraductal carcinoma.

b.

infiltrating ductal carcinoma.

c.

lobular carcinoma in situ.

d.

tubular carcinoma.

ANS: C

Malignant-appearing cells confined to the ductal or lobular units without permeating the basement membrane are considered to represent carcinoma in situ. Lobular carcinoma in situ is a solid proliferation of atypical cells expanding lobular units. Lobular carcinoma is a type of ductal carcinoma as is tubular.

DIF: Application/Applying REF: pp. 947-948 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. When a 25-year-old client asks the nurse how she can lower her risk of breast cancer, the nurse would suggest that the client

a.

have a mammogram every 2 years.

b.

increase her intake of leafy green vegetables.

c.

increase her intake of vitamin C.

d.

minimize intake of alcohol.

ANS: D

Alcohol intake is the best-established dietary risk factor for breast cancer in epidemiologic studies. A positive correlation between the two has been established, and a moderate intake (two drinks per day) increases the risk of breast cancer by altering estrogen metabolism. Mammograms are a screening activity and do not reduce the risk of developing breast cancer. There are no studies that show a correlation between eating fruits and vegetables or intake of vitamin C and lowered risk.

DIF: Application/Applying

REF: p. 944, Complementary and Alternative Therapy: Multivitamins, Alcohol, and Breast Cancer, Evolve site OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

5. When a client with stage I breast cancer asks the nurse about the usual treatment for her problem, the nurse would base an answer on the fact that

a.

breast-conserving surgery is appropriate at this stage.

b.

mastectomy is done as soon as possible.

c.

radiation and chemotherapy are used instead of surgery.

d.

radiation therapy is given before surgery.

ANS: A

Breast-conserving procedures are selected for stage I and II breast cancers. Radiation therapy is begun once healing is confirmed, the timing depending on whether chemotherapy is used and what agents are involved.

DIF: Comprehension/Understanding REF: p. 951 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

6. A client diagnosed with early-stage breast cancer is to undergo radiation therapy along with a lumpectomy rather than mastectomy. In helping the client make her decision, the nurse would explain to the client that

a.

distant recurrence is seen more often with lumpectomy.

b.

effects are comparable between the two remedies.

c.

radiation therapy is not needed with mastectomy.

d.

radiation may cause a significant incidence of secondary malignancies.

ANS: B

The goal today is to preserve the breast, because there is no evidence that a mastectomy is more beneficial than lumpectomy plus radiation therapy.

DIF: Application/Applying REF: p. 951 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

7. Teaching a client who will soon begin radiation therapy for treatment of breast cancer, the nurse would tell the client that she should expect

a.

a low-residue diet to decrease diarrhea.

b.

dry, itchy skin changes to develop.

c.

pain in the long bones, especially the legs.

d.

permanent pigment changes to the breast.

ANS: B

Side effects from radiation to the breast include temporary skin changes (e.g., itchy, dry, tender, red, swollen, or dry desquamation), moist desquamation (especially in skinfolds), fatigue, and dry throat.

DIF: Application/Applying REF: pp. 961-962 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Radiation Therapy

8. The nursing care plan for a client receiving tamoxifen for the treatment of breast cancer would include

a.

assisting the client in coping with hot flashes.

b.

decreasing sodium intake.

c.

encouraging milk products to increase calcium intake.

d.

increasing fluid intake.

ANS: A

Tamoxifen causes hot flashes and is considered to be teratogenic. However, it is usually well-tolerated.

DIF: Application/Applying REF: p. 946 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

9. To help a client cope with the body image change caused by chemotherapy with doxorubicin, the nurse suggests that the client

a.

begin an exercise routine.

b.

get fitted for a good prosthesis.

c.

obtain a wig before hair is lost.

d.

purchase some new clothes.

ANS: C

Women receiving methotrexate and 5-fluorouracil (5-FU) will not experience hair loss, whereas women receiving doxorubicin and cyclophosphamide will have complete hair loss at weeks after their first injection. Buying the wig before the hair is lost gives the woman more control because she is prepared and does not have to go out in public without hair.

DIF: Application/Applying REF: pp. 955, 964 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

10. In a client receiving chemotherapy for breast cancer, the nurse would assess for

a.

back pain.

b.

confusion.

c.

infection.

d.

weight gain.

ANS: C

Common side effects of most antineoplastic chemotherapy combinations include depression of red blood cells, white blood cells (WBCs), and platelets. Reduction of WBCs put the client at risk for infection.

DIF: Application/Applying REF: pp. 963-964 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

11. After a modified radical mastectomy, the action by the client that would indicate to the nurse that the client is developing a positive body image is

a.

asking about a prosthesis.

b.

looking at the incision.

c.

talking about her feelings.

d.

wearing make-up and her own nightgown.

ANS: D

The post-mastectomy client will begin to exhibit her presurgical or baseline positive body image, as evidenced by wearing usual make-up and using her own nightgown or other feminine attire after surgery.

DIF: Analysis/Analyzing REF: p. 954 OBJ: Evaluation

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

12. The nurse explains that a breast tumor that is estrogen receptor positive (ER+) is associated with

a.

faster tumor growth rates.

b.

longer survival.

c.

more aggressive behavior.

d.

poor response to hormonal manipulation.

ANS: B

Cancers that lack either progesterone or estrogen receptors are more likely to recur than those that are ER+ and progesterone receptor positive.

DIF: Analysis REF: pp. 951-952 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

13. When the client scheduled for a modified radical mastectomy asks the nurse what tissue the surgeon will remove, the nurse would answer

a.

breast, skin, and axillary nodes.

b.

breast, skin, and muscle.

c.

breast, skin, muscle, and axillary nodes.

d.

breast, skin, muscle, axillary nodes, and internal mammary nodes.

ANS: A

Modified radical mastectomy involves the en bloc removal of the breast, axillary lymph nodes, and overlying skin, with the muscles left intact.

DIF: Comprehension/Understanding REF: p. 952 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

14. The nursing intervention that would best meet a clients mobility needs for the first 24 hours after modified radical mastectomy is

a.

encourage the client to touch the fingers to shoulders, extending arm fully.

b.

encourage the client to use the operative arm to brush her hair.

c.

maintain complete immobility of the operative arm for the first 24 hours.

d.

perform passive range-of-motion exercises with the operative arm.

ANS: A

In the immediate postoperative period for the mastectomy client, the nurse should encourage the client to perform arm exercises and elevate the arm to promote lymphatic drainage and prevent infection.

DIF: Application/Applying REF: p. 957 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Mobility/Immobility

15. The nurse explains to a client following mastectomy with lymph node dissection that care of the operative arm should include

a.

avoiding heavy lifting and trauma to the arm.

b.

having blood pressure taken on the operative arm.

c.

limiting all movement until the incision is healed.

d.

wearing an Ace bandage wrap for 2 years.

ANS: A

The client is vulnerable to secondary edema in the arm on the operated side for life. Heavy lifting could lead to edema in the arm, and trauma in the arm may lead to edema and infection. Blood pressures are taken on the opposite arm. Gentle range of motion is started on postoperative day 1. Ace bandages are not routinely worn; however, pressure garments are available if lymphedema does occur.

DIF: Application/Applying REF: p. 956 OBJ: Intervention

MSC: Physiological Integrity

16. When the client asks the nurse when she can purchase a permanent breast prosthesis, the nurse explains that a prosthesis can be obtained when

a.

a year has passed.

b.

all the sutures and drains are removed.

c.

the client is discharged.

d.

the wound has healed completely.

ANS: D

A permanent prosthesis should not be purchased until the wound has healed completely, because the contours of the incision site may change.

DIF: Application/Applying REF: p. 958 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

17. For a client receiving cyclophosphamide (Cytoxan) as part of chemotherapy for her breast cancer, the nurse would include the instruction to

a.

drink eight glasses of water daily.

b.

eat iron-rich foods.

c.

practice good skin care.

d.

take high-fiber laxatives.

ANS: A

The nurse should advise women taking cyclophosphamide by mouth for the 14-day regimen to drink eight glasses of water a day to prevent hemorrhagic cystitis.

DIF: Application/Applying REF: p. 964 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

18. A client is receiving chemotherapy with paclitaxel for breast cancer. A priority nursing intervention is to

a.

encourage the client to get adequate rest.

b.

monitor the clients safety.

c.

teach the client about the drug regimen.

d.

watch for drug side effects.

ANS: B

All interventions are appropriate; however, paclitaxel can cause neurotoxicity, leading to gait instability and the risk of falls. Safety is the priority in this case.

DIF: Analysis/Analyzing REF: p. 964 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

19. The nursing intervention that would receive the highest priority before discharge of a client following mastectomy is

a.

arrange for Reach for Recovery volunteer to visit.

b.

describe the plan for follow-up treatment and surveillance.

c.

discuss methods of improving self-image.

d.

share information about mastectomy support groups.

ANS: B

The highest risk factor for breast cancer is a history of breast cancer. Half of the women who receive treatment for local disease will develop metastatic disease. Therefore the nurse should instruct clients that they require follow-up cancer surveillance for the rest of their lives. All the other options are valid discharge interventions, but do not have the same priority.

DIF: Application/Applying REF: pp. 964-965 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

20. The statement made by a client with fibrocystic disease that would indicate to the nurse a correct understanding of the disease is

a.

If I give up coffee, it may get better.

b.

It may get worse after menopause.

c.

Pregnancy usually worsens the symptoms.

d.

This can be treated with daily diuretics.

ANS: A

The exact cause is unknown, although some evidence indicates hormonal imbalance and even an association with high caffeine consumption. Fibrocystic disease typically improves during pregnancy and lactation. It occurs during the reproductive years and disappears with menopause.

DIF: Comprehension/Understanding REF: p. 968 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

21. A young client has a breast lump that presents as a fluid-filled cyst and increases slightly in size premenstrually. The nurse would suspect the breast disorder of

a.

a cyst.

b.

a papilloma.

c.

carcinoma.

d.

ductal hyperplasia.

ANS: A

Fibrocystic breasts are the most frequently occurring condition of the female breast. Typical fibrocystic lesions are fluid-filled cysts that are round, well circumscribed, and movable. Depending on the amount of fluid in the cyst, it may feel soft or hard. Assessment findings may include nodularity and tenderness.

DIF: Comprehension/Understanding REF: p. 968 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

22. A client complains of premenstrual mastalgia. Self-care measures the nurse could suggest to help decrease the clients manifestations might include having the client

a.

apply ice to her breasts.

b.

decrease caffeine intake.

c.

perform breast massage.

d.

use warm, moist soaks.

ANS: B

Wearing a well-fitting bra for support, particularly during jogging and other bouncing exercises, and decreasing caffeine intake may help relieve pain in the breasts.

DIF: Application/Applying REF: p. 968 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Self Care

23. In caring for a client with post-mastectomy breast reconstruction using a subpectoral implant, the nurse would stress that the client can prevent capsule formation by

a.

using daily heat applications.

b.

keeping the implant very soft.

c.

not wearing a bra until the implant drops.

d.

wearing a bra at all times.

ANS: C

Initially, the implant sits higher on the chest than a normal breast and is hard. Over time the muscle stretches and the implant drops and softens. These women do not wear bras because the implant needs to migrate into the pocket created for it on the chest.

DIF: Application/Applying REF: p. 960

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

24. In the discharge teaching plan for a client with breast augmentation, the nurse would explain that the client should

a.

avoid touching the breasts.

b.

perform full range-of-motion arm exercises a week after surgery.

c.

sleep on her back in a head-elevated position for a week.

d.

take aspirin for pain relief and to decrease inflammation.

ANS: C

To reduce edema, the client should maintain a head-elevated position for a week when in bed.

DIF: Application/Applying REF: pp. 968-969 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

25. A male client has been diagnosed with metastatic breast cancer. The nurse would understand that this client most likely may have feelings of sexual inadequacy because

a.

breast cancer is a female disease.

b.

decreased libido is common in male breast cancer clients.

c.

radiation therapy produces unwanted skin side effects.

d.

treatment includes medical orchiectomy.

ANS: D

While all answers may be pertinent, a male client with metastatic breast cancer is treated with an LHRH agonist (goserelin), which induces a medical orchiectomy state.

DIF: Analysis/Analyzing REF: p. 967 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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