Question 1

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

Accepted Answer

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.

Question 2

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

Accepted Answer

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.

Question 3

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

Accepted Answer

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.

Question 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

Accepted Answer

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.

Question 5

The nursing intervention that would best meet a client's mobility needs for the first 24 hours after modified radical mastectomy is

Accepted Answer

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.

Question 6

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

Accepted Answer

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

Question 7

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

Accepted Answer

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.

Question 8

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

Accepted Answer

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

Question 9

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

Accepted Answer

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.

Question 10

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

Accepted Answer

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

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

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 2½ 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.

Question 13

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

Accepted Answer

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.

Question 14

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

Accepted Answer

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.

Question 15

The nurse explains that the most frequent breast mass is

Accepted Answer

Fibrocystic masses are the most frequently occurring breast pathology.

Question 16

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

Accepted Answer

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.

Question 17

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

Accepted Answer

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

Question 18

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

Accepted Answer

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.

Question 19

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

Accepted Answer

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.

Question 20

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 physician's explanation, the nurse would clarify that this type of tumor is

Accepted Answer

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.

Quiz 40: Management of Clients with Breast Disorders