Chapter 73: Care of Patients with Breast Disorders Nursing School Test Banks

Chapter 73: Care of Patients with Breast Disorders

Test Bank

MULTIPLE CHOICE

1. A client recently had a mammogram. Which statement by the client indicates a need for clarification regarding the importance or purpose of this procedure?

a.

Now that I have had a mammogram, my risk for getting breast cancer is reduced.

b.

I will still do a breast self-examination monthly even after the mammogram.

c.

Yearly mammograms can reduce my risk of dying from breast cancer.

d.

The amount of radiation exposure from a mammogram is very low.

ANS: A

Regular or yearly mammography does not decrease the incidence of breast cancer. It only assists in early detection and diagnosis and decreases the mortality rate from breast cancer. The client should be instructed that the mammogram uses a very small amount of radiation in the test, and that consistent scheduling of a mammogram, along with a breast self-examination performed at least monthly, can reduce the clients risk of dying from breast cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Nursing Process (Evaluation)

2. When performing a clinical breast examination on a client, the nurse palpates a thickened area where the skin folds under the breast. Which is the nurses best action?

a.

Proceed with the examination.

b.

Determine whether the thickness is bilateral.

c.

Ask how long the thickness has been present.

d.

Change the clients position and re-assess.

ANS: A

A thickened area where the skin folds under the breast is the inframammary ridge, a normal anatomic finding. Clients should be taught to identify this ridge and not confuse it with the presence of a lump or abnormal tissue thickening. Because this is a normal finding, no concern is necessary about whether it is present bilaterally or occurs in a different position, or how long the finding has been notable.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

3. A client who has discovered a lump in her breast becomes tearful when scheduling a mammogram. Which is the nurses best response?

a.

All lumps are considered cancerous until proven otherwise.

b.

Unless you have a relative with breast cancer, this lump is probably benign.

c.

Diagnosing cancer at this early stage is most likely to result in a cure.

d.

Many women have breast lumps, and most of the lumps are benign.

ANS: D

The finding of a breast lump or mass is a frightening experience. Clients should be reassured, until they can be seen or testing is done, that 90% of all breast lumps or masses are benign. It is inaccurate for the nurse to state that all lumps are considered cancerous until proven benign, or that the lump is probably benign unless the client has a relative with breast cancer. Diagnosing cancer at an early stage results in cure more often than when the cancer is in later stages, but such a comment before diagnosis will only scare the client more.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1588

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Nursing Process (Implementation)

4. A client has just been diagnosed with fibrocystic breast disease. She asks what this means in terms of her health. Which is the nurses best response?

a.

This increases your risk for breast cancer, so schedule yearly mammograms.

b.

This will increase as you age, especially if you have never been pregnant.

c.

This will diminish with menopause if you dont take replacement hormones.

d.

This is genetic and you should teach your daughters about it.

ANS: C

Although the cause of fibrocystic breast changes is unknown, the condition seems to be related to normal fluctuations in estrogen levels during the menstrual cycle. Symptoms usually resolve after menopause in the absence of estrogen supplementation. The presence of fibrocystic breast changes does not necessarily increase the clients risk for breast cancer, will not necessarily increase with age, and does not routinely have a genetic component.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning

5. Which client does the nurse encourage to seek genetic counseling regarding her risk for BRCA1 or BCRA2 gene mutationrelated breast cancer?

a.

Woman whose father had lung cancer and mother had leukemia

b.

Woman whose sister has breast cancer and mother has ovarian cancer

c.

Woman whose fraternal twin sister has breast cancer

d.

Older woman who has bilateral benign breast disease

ANS: B

The best-defined increased genetic risk for breast cancer is related to mutations in the BRCA1 or BRCA2 gene. Families in which either of these genes is mutated have higher rates of breast and ovarian cancer in first-degree relatives. Being older is the primary risk factor for developing breast cancer but is not related to the genetic component; neither is benign breast disease. Lung cancer and leukemia are not genetically related to breast cancer. Having a twin with breast cancer does increase the genetic risk, but not as much as having two first-degree relatives with related cancers.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)

MSC: Integrated Process: Nursing Process (Assessment)

6. Which statement made by a client about breast cancer indicates correct understanding of the disease?

a.

Breast cancer is the leading cause of cancer deaths among women in the United States.

b.

Breast cancer is the leading type of cancer among women in North America.

c.

Late onset of menses and early menopause increase the risk for breast cancer.

d.

Breast cancer decreases with age, and very old women have virtually no risk.

ANS: B

Breast cancer is the second most common form of cancer diagnosed in women (after skin cancer) and is the second leading cause of cancer deaths in women in the United States (after lung cancer). The incidence of breast cancer increases with age. Early onset of menses and late menopause increase the risk for breast cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)

MSC: Integrated Process: Nursing Process (Evaluation)

7. Which comment made by a client with breast cancer indicates correct understanding regarding cancer causes and prevention?

a.

I will prevent recurrence of my cancer by eating a low-fat diet from now on.

b.

If I had breast-fed my children, this would not have happened to me.

c.

I hope this doesnt increase my risk for bone cancer or lung cancer.

d.

I will have regular mammograms on my other breast to detect cancer early.

ANS: D

Regular mammography can help detect breast cancer at an early stage. Women who have had breast cancer have a greater risk of developing cancer in the other breast. The other statements are inaccurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

8. A client has advanced breast cancer and bone metastasis. Which problem does the nurse consider the priority?

a.

Pain

b.

Mobility problems

c.

Risk for infection

d.

Malnutrition

ANS: A

Bone metastasis can cause intense continuous pain that disrupts the clients activities and sleep and reduces the clients quality of life. This problem should be managed ahead of all other problems. Although the client may also be experiencing impaired mobility and risks for infection and malnutrition, none of these problems will be as disruptive as acute pain. The pain must become manageable before the other problems can be addressed.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

9. A client had a mastectomy nearly a year ago and is distressed over continued tingling and burning in the ipsilateral arm. What orders does the nurse prepare to implement?

a.

Teach the client about gabapentin (Neurontin).

b.

Demonstrate the use of heat therapy to the axilla.

c.

Discuss ways to prevent constipation with pain meds.

d.

Reassure the client that this will disappear shortly.

ANS: A

Injury to nerves causes paresthesias such as burning, tingling, pins and needles, and numbness after a mastectomy. These sensations are usually gone by the end of a year. Because this clients symptoms are distressing and have lasted so long, the nurse should anticipate an order for Neurontin. Narcotic pain medications will not be helpful or needed. Heat therapy may or may not be helpful, and reassuring the client at this point will sound unbelievable.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

10. A client had a mastectomy and axillary node dissection. The nurse empties sanguineous drainage from the clients incisional Jackson-Pratt drain on the first postoperative day. Which other action regarding the drain is of high priority for the nurse?

a.

Flushing the tubing with urokinase to ensure patency

b.

Compressing and closing the drain to ensure suction

c.

Advancing the tubing inch from the insertion site

d.

Clamping the drain for 2 hours and releasing it for 2 hours

ANS: B

The Jackson-Pratt drain removes fluid from the wound through closed suction. The drain must be compressed and closed to create suction as it slowly re-expands. The drain should never be flushed with urokinase, tubing should not be advanced, and the drain should not be clamped and released for 2 hours.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

11. A client is postoperative from a left-sided mastectomy. She says that the incision and the inner side of her arm from the armpit to the elbow are numb. Which is the nurses best action?

a.

Teach the client to avoid lifting heavy objects.

b.

Measure the circumference of the clients left arm.

c.

Reassure the client that this is an expected finding.

d.

Notify the surgeon as soon as possible.

ANS: C

The nerves supplying the skin in the area were injured during surgery, decreasing sensation to the area. These problems frequently resolve over time. Teaching the client to avoid lifting heavy objects or measuring the circumference of the arm will not improve sensation to the clients arm. The surgeon does not need to be notified about normal findings.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Implementation)

12. A client receiving tamoxifen (Tamofen) asks how this therapy helps fight breast cancer. Which is the nurses best response?

a.

This agent decreases estrogen levels. so the cancer stops growing.

b.

The drug causes you to secrete testosterone, which limits cancer growth.

c.

Tamoxifen kills estrogen-secreting cells and growth of blood vessels to cancer cells.

d.

It blocks estrogen receptors, and this limits cancer cell growth.

ANS: D

Tamoxifen is an estrogen antagonist-agonist. Its use in breast cancer is limited to cancers that express the estrogen receptor. Tamoxifen binds to estrogen receptors, inhibiting the binding of estrogen to receptors, thereby starving the cancer cells of an essential growth factor. The drug does not decrease circulating levels of estrogen, does not cause testosterone to be secreted instead of estrogen, and does not kill off estrogen-secreting cells.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Teaching/Learning

13. A client asks how soon after a mastectomy she can engage in sexual activity. Which is the nurses best response?

a.

When do you want to resume sexual activity?

b.

Most surgeons say to wait several weeks after the operation.

c.

As soon as the incision has healed completely.

d.

You shouldnt worry about sexuality right now.

ANS: B

Most surgeons prefer that the client wait 4 to 6 weeks postoperatively before resuming sexual activity, although this very personal advice should be individualized. Asking the client when she wants to resume sexual activity places the burden on her to make a tentative decision. Until the incision is healed, clients should be taught how to protect the incision and avoid contact with the surgical site during intercourse. Telling the client not to worry about sexuality is dismissing and disrespectful.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Nursing Process (Implementation)

14. Which exercise plan or activity does the nurse teach the client for the first postoperative day after a modified radical mastectomy?

a.

Perform no movement or exercise today. Keep the arm supported and the elbow flexed, and as close to your body as possible.

b.

Without moving your shoulder, straighten your elbow three times hourly and squeeze a rubber ball with your fingers.

c.

Face the wall and extend your arm straight out to the wall. Walk your fingers as far above your head as your arm will reach, and then walk them back down.

d.

Hold your operative arm straight out from the shoulder to the side. Use your nonoperative arm to pull the operative arm completely straight above your head.

ANS: B

Mild exercise begins on the first postoperative day. Exercises should not put stress on the incision and do not involve the shoulder at this point. Full extension of the elbow, with support, is important, as is using grip maneuvers for the hand on the affected side. Total immobility is not recommended. The other two exercises can be performed a few days after the operation.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

15. A client is experiencing lymphedema in the arm on the operative side after a modified radical mastectomy. Which statement indicates correct understanding of managing this problem?

a.

I will reduce my intake of salt and water.

b.

I will elevate my arm on a pillow at night.

c.

I will try to drink at least 3 liters of water each day.

d.

I will wear long sleeves to prevent sun exposure.

ANS: B

The formation of edema is aggravated by having the arm in a position dependent to the heart. Elevating the arm as much as possible assists gravity to promote better venous and lymph return. This will be a more effective intervention than salt reduction or drinking large amounts of water. Preventing sun exposure will have no effect on the lymphedema.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Evaluation)

16. A woman is asking about monthly breast self-examination (BSE). What information does the nurse provide to the client?

a.

It is a valuable tool for finding breast lumps early.

b.

After menopause, it is no longer useful.

c.

BSE should be combined with other assessments.

d.

Women in their 30s should begin monthly BSE.

ANS: C

BSE can be presented as an option for breast self-awareness. However, BSE is no better than awareness of normal breast findings. It is best when combined with clinical breast examinations and mammography. Women of all ages can practice BSE.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1594

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

17. A client with a family history of breast cancer tells the nurse that she has made several recent lifestyle changes. Which question by the nurse about these practices is most important?

a.

Are you a vegetarian?

b.

Do you drink green tea?

c.

What supplements do you use?

d.

Do you smoke cigarettes?

ANS: C

Soy supplements in high amounts should be avoided by women who have breast cancer or who are at high risk for breast cancer. Dietary soy, eaten in normal amounts, does not appear to present the same risk. The other activities do not have the same risk as taking large quantities of soy supplements.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

18. A client has large breasts. Which health problem is she most likely to develop?

a.

Breast tenderness

b.

Breast cancer

c.

Chest pain

d.

Back pain

ANS: D

The added weight of large breasts and the altered center of gravity increase spinal pull and contribute to back pain. She is not at risk for developing increased breast tenderness, cancer, or chest pain.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1590

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

19. A client is undergoing treatment for breast cancer and asks the nurse about natural treatments for her chemotherapy-induced nausea. Which is the most appropriate response by the nurse?

a.

Anything you can take will interfere with your chemotherapy.

b.

I dont know of any recommended complementary treatments for nausea.

c.

Black cohosh and flaxseed are good for combating nausea.

d.

Ginger has been used for nausea; would you consider taking it?

ANS: D

Up to 80% of women with breast cancer have used complementary therapies. Ginger, along with acupuncture, aromatherapy, hypnosis, progressive muscle relaxation, and shiatsu, has been used for nausea. Black cohosh and flaxseed are used for hot flashes. The client should check with her provider and other credible sources regarding any desired therapies to ensure that they wont interfere with the chemotherapy. Even if the nurse doesnt know of specific therapies, it is never appropriate to just say, I dont know. The nurse should investigate for the client.

DIF: Cognitive Level: Comprehension/Understanding REF: Table 73-3, p. 1600

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Implementation)

20. A client had a mastectomy with reconstruction, and several axillary nodes were dissected. Which statement by the client indicates good understanding of discharge instructions?

a.

I must be careful not to injure the arm or hand on the side of my surgery.

b.

Im glad that lymphedema is no longer a problem, as it was in my mothers day.

c.

I will have a hard time waiting for a whole year to see how my breast will look.

d.

I need to pull my drains out by inch each day until they are totally out.

ANS: A

Lymphedema is a complication following mastectomy, especially if lymph nodes have been removed. The client must use measures to prevent this from occurring for the rest of her life. Preventing injury is one way of preventing lymphedema. Breast reconstruction should look optimal in 3 to 6 months. The health care provider will remove drains at a postoperative appointment.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

21. A client is being treated with anastrozole (Arimidex) for breast cancer. The nurse is developing a plan of care for the client. Which intervention is the highest priority?

a.

Teach the client to weigh herself each day at the same time.

b.

Instruct the client to keep a symptom journal for menopausal symptoms.

c.

Monitor the client closely for evidence of osteoporosis.

d.

Review the clients dietary habits to prevent weight gain.

ANS: C

Arimidex is an aromatase inhibitor. A major side effect of the aromatase inhibitors is loss of bone density. Fluid retention, menopausal symptoms, and weight gain are not primary side effects of Arimidex or other aromatase inhibitors.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Planning)

22. A client with a history of breast cancer is admitted through the emergency department with shortness of breath, weakness, fatigue, and new lower extremity edema. The clients oxygen saturation is 88%. After stabilizing the client, which action by the nurse is most important?

a.

Obtain a list of the clients medications.

b.

Orient her to her room and surroundings.

c.

Place the client on intake and output.

d.

Assess the clients family cardiac history.

ANS: A

Some chemotherapeutic drugs, such as doxorubicin (Adriamycin) and trastuzumab (Herceptin), are known to be cardiotoxic. Although all other actions are appropriate, the nurse (and the provider) must know the medications the client is on, with specific emphasis on assessing for causative agents.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Assessment)

23. The clinic nurse is preparing a client for a physical and breast examination. The nurse notes the clients breast appears as shown in the photograph below. Which action by the nurse takes priority?

a.

Continue preparations and note the finding in the clients chart.

b.

Ask the client how long this problem has been present.

c.

Alert the health care provider and prepare to order a mammogram.

d.

Question the client about routine drug and alcohol intake.

ANS: C

This finding (dimpling of the skin) is suspicious for infiltrating ductal carcinoma. The nurse should alert the provider and prepare to order a mammogram for the client. In addition, the nurse should be prepared to refer the client to a breast specialist. The nurse does need to continue preparing the client and document the finding, but this is not as important as the mammogram and referral. Assessment can continue before, during, or after the examination, but is also not as vital as facilitating further diagnostic testing.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation-Pathophysiology)

MSC: Integrated Process: Nursing Process (Implementation)

MULTIPLE RESPONSE

1. The nurse is assessing a client with a history of ductal ectasia. Which signs and symptoms supporting this diagnosis does the nurse correlate with this condition? (Select all that apply.)

a.

A soft mass on palpation

b.

Greenish-brown nipple discharge

c.

Enlarged axillary nodes

d.

A mass with regular borders

e.

Redness and edema over the site of the mass

f.

Mass tenderness on palpation

ANS: B, C, E, F

The benign condition, ductal ectasia, is caused by dilation and thickening of collecting ducts in the subareolar area. It results in activation of the inflammatory response when the ducts fill with cellular debris. Clinical manifestations of this condition include development of a hard mass with irregular borders that is tender on palpation. A greenish-brown nipple discharge, enlarged axillary nodes, and redness and edema over the site of the mass are also noted. Palpation of a soft mass or a mass with regular borders is not applicable to ductal ectasia.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. Which factors are considered to be indicative of a moderately increased risk of a clients developing breast cancer? (Select all that apply.)

a.

High postmenopausal bone density

b.

Ionizing radiation

c.

Family history of one first-degree relative

d.

Genetic factors

e.

First child born after age 30

f.

Biopsy-confirmed atypical hyperplasia

ANS: A, B, C, F

Factors considered to be indicative of a moderately increased risk of a clients developing breast cancer include high postmenopausal bone density, ionizing radiation, family history of one first-degree relative, and biopsy-confirmed atypical hyperplasia. Female gender and genetic factors are indicative of high increased risk. The first child born after age 30 is indicative of low increased risk of developing breast cancer.

DIF: Cognitive Level: Knowledge/Remembering REF: Table 73-2, p. 1593

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

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