Chapter 70: Care of Patients with Breast Disorders Nursing School Test Banks

Chapter 70: Care of Patients with Breast Disorders
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

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?
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.
ANS: A
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.

DIF: Applying/Application REF: 1462
KEY: Reproductive problems| physiology| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

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?
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?
ANS: C
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.

DIF: Applying/Application REF: 1462
KEY: Reproductive problems| nursing assessment| physiology
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

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)?
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.
ANS: D
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.

DIF: Applying/Application REF: 1462
KEY: Reproductive problems| delegation| unlicensed assistive personnel (UAP)| comfort measures MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

4. 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
ANS: C
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.

DIF: Applying/Application REF: 1469
KEY: Reproductive problems| cancer| assessment
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

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?
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.
ANS: B
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.

DIF: Applying/Application REF: 1463
KEY: Reproductive problems| surgical care| patient safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

6. A 68-year-old male client is embarrassed about having bilateral breast enlargement. Which statement by the nurse is the most appropriate?
a. Breast cancer in men is quite rare.
b. It is good that you came to be carefully evaluated.
c. Gynecomastia usually comes from overeating.
d. When you get older, the male breast always enlarges.
ANS: B
The most appropriate statement is the one that is supportive of the client. A breast mass should be carefully evaluated for breast cancer, even if it is not common. Gynecomastia as a symptom can be related to antiandrogen agents, aging, obesity, estrogen excess, or lack of androgens.

DIF: Applying/Application REF: 1463
KEY: Reproductive problems| caring| patient-centered care
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Psychosocial Integrity

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?
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.
ANS: C
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.

DIF: Applying/Application REF: 1465
KEY: Reproductive problems| cancer| health promotion
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

8. 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.
ANS: D
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.

DIF: Applying/Application REF: 1468
KEY: Reproductive problems| cancer| caring| culture
MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity

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?
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.
ANS: C
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.

DIF: Applying/Application REF: 1469
KEY: Reproductive problems| cancer| caring
MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity

10. 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
ANS: C
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.

DIF: Applying/Application REF: 1473
KEY: Reproductive problems| cancer| postoperative nursing| patient safety| unlicensed assistive personnel (UAP)
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

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?
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.
ANS: A
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.

DIF: Applying/Application REF: 1474
KEY: Reproductive problems| cancer| postoperative nursing
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

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?
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
ANS: C
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.

DIF: Applying/Application REF: 1474
KEY: Reproductive problems| delegation| comfort measures| cancer| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

13. 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
ANS: D
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.

DIF: Applying/Application REF: 1476
KEY: Reproductive problems| cancer| postoperative care| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

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?
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.
ANS: C
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.

DIF: Remembering/Knowledge REF: 1477
KEY: Reproductive problems| cancer| hormone therapy
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
a. Shortness of breath
b. Nausea and vomiting
c. Hair loss
d. Mucositis
ANS: A
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.

DIF: Applying/Application REF: 1477
KEY: Reproductive problems| cancer| chemotherapy
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

16. 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.
ANS: B
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.

DIF: Applying/Application REF: 1478
KEY: Reproductive problems| cancer| postoperative nursing
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Health Promotion and Maintenance

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?
a. Elevated alkaline phosphatase and calcium suggests bone involvement.
b. Only alkaline phosphatase is decreased, suggesting liver metastasis.
c. Hematocrit and hemoglobin are decreased, indicating anemia.
d. The elevated hematocrit and hemoglobin indicate dehydration.
ANS: A
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. Both the hematocrit and hemoglobin are within normal limits for females.

DIF: Applying/Application REF: 1470
KEY: Reproductive problems| cancer| laboratory values
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

1. 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.)
a. Age greater than 65 years
b. Increased breast density
c. Osteoporosis
d. Multiparity
e. Genetic factors
ANS: A, B, E
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. Osteoporosis and multiparity are not risk factors for breast cancer. A high postmenopausal bone density and nulliparity are moderate and low increased risk factors, respectively.

DIF: Remembering/Knowledge REF: 1466
KEY: Reproductive problems| cancer| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. 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.)
a. Annual mammogram
b. Magnetic resonance imaging (MRI)
c. Breast ultrasound
d. Breast self-awareness
e. Clinical breast examination
ANS: A, D, E
Guidelines recommend a screening annual mammogram for women ages 40 years and older, breast self-awareness, and a clinical breast examination. An MRI is recommended if there are known high risk factors. A breast ultrasound is used if there are problems discovered with the initial screening or dense breast tissue.

DIF: Applying/Application REF: 1467
KEY: Reproductive problems| cancer| clinical practice guidelines| health promotion
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. 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.)
a. Peau dorange
b. Dense breast tissue
c. Nipple retraction
d. Mobile mass at two oclock
e. Nontender axillary nodes
ANS: A, C, D
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. Dense breast tissue and nontender axillary nodes are not abnormal assessment findings that may indicate breast cancer.

DIF: Remembering/Knowledge REF: 1469
KEY: Reproductive problems| cancer| nursing assessment
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

4. 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.)
a. Lymphedema
b. Bleeding tendencies
c. Low white blood cell count
d. Elevated serum calcium
e. High platelet count
ANS: A, B, C
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. An elevated serum calcium and high platelet count would not have any contraindication for acupuncture.

DIF: Remembering/Knowledge REF: 1472
KEY: Reproductive problems| cancer| safety
MSC: Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

SHORT ANSWER

1. A client states that she rates her pain as a 5 on a 0-to-10 scale post-mastectomy. The provider has ordered morphine 4 mg for moderate pain every 4 hours. The morphine is supplied in a solution of 8 mg/mL. How many mL will the nurse administer? ____ mL

ANS:
0.5 mL

8x = 4
x = 0.5 mL

DIF: Applying/Application REF: 1481
KEY: Postoperative| pain| opioid analgesics| drug calculation
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

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