Breast Cancer

Breast Cancer is
the unregulated growth of abnormal cells in breast tissue

Most common occurring cancer in women and is the ______-leading casue of death in women

Cancer of the breast often begins as a:
Cancer of the breast begins as a single, transformed cell and is often hormone dependent.

Breast cancer is classified as:
noninvasive (in situ), depending on the penetration of the tumor into surrounding tissue

Breast cancer may remain ______________ without metastasis for long periods of time
noninvasive or an invasive disease

Breast cancer may be categorized as:
Carcinoma of the mammary ducts
Carcinoma of mammary lobules
Sarcoma of the breast

Most breast cancers are

Where do most breast cancers arise in:
the terminal section of the breast ductal tissue

Two atypical types of breast cancer:
Inflammatory carcinoma
Paget’s Disease

Most malignant form of cancer
inflammatory Carcinoma

Inflammatory Carcinoma:
A systemic disease
Most malignant form of breast cancer
Edema with dimpling of the skin the result in the skin looking like the peel of an orange is usually present

Paget’s Disease
Involving infiltration of the nipple epithelium

Where can breast cancer metastasis to
auxiliary nodes, lung, bone, liver, and the brain

Possible causes of breast cancer:

2 genes that increase susceptibility

Risk Factors nonmodifiable
age and gender, genetics, family history of breast cancer, personal history of breast cancer, previous breast biopsy, previous chest irradiation, and menstrual history.

Modifiable risk factors include:
use of oral contraceptives, not having children after the age of 30, hormone replacement therapy for more than 5 years, not breast-feeding, drinking alcohol, obesity, high-fat diets, physical inactivity, and environmental pollutions.

lower’s a person’s risk
Breast feeding, moderate or vigorous physical activity, and maintain a healthy body weight

Manifestations of breast cancer may include:
May include:
Non-tender lump
Abnormal nipple discharge
Rash at nipple area
Nipple retraction
Dimpling of skin
Change in nipple position
Usually painless
Most tumors found by women themselves or their partner

Diagnosis begins with detection

most accurate method of detecting non-palpable lesions
Mammography (most accurate method of detecting non-palpable lesions) shows lesions and cancerous changes, such as microcalcification. Ultrasonography may be used to distinguish cysts from solid masses.

Diagnostic tests
Clinical breast examination
Percutaneous needle biopsy
Breast biopsy

Two types of breast biopsy
Aspirated Biopsy-when a needle is used to remove cells or fluid from the breast lesion

Excisional Biopsy- when the tissue from the breast lesion is removed surgically

Importance of mammography
buys a client precious time. tumors may be present as many as 8-10 years before they can be detected by palpation

What confirms diagnosis?
Biopsy or aspiration confirms diagnosis and determines the type of breast cancer.

Pharmacologic Therapy
Chemotherapy is the primary used as adjuvant treatment postoperatively ; usually begins 4 weeks after surgery (very stressful for a patient who just finished major surgery).

Treatments are given every 3 to 4 weeks for 6 to 9 months. Because the drugs differ in their mechanisms of action, various combinations are used to treat cancer.
Principal breast cancer drugs include cyclosphosphamide, methotrexate, fluorouracil, doxorubicin, and paclitaxel.

Additional agents for advanced breast cancer include docetaxel, vinorelbine, mitoxantrone, and fluorouracil.

Herceptin is a monoclonal antibody directed against Her-2/neu oncogene; may be effective for patients who express this gene

Indications for chemotherapy include large tumors, positive lymph nodes, premenopausal women, and poor prognostic factors.

Chemotheraphy is also used as primary treatment in inflammatory breast cancer and as palliative treatment in metastatic disease or recurrence.

Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after surgery.
Hormonal agents may be used in advanced disease to induce remissions that last for months to several years.

Surgery Types
Modified radical
Axillary node dissection

the removal of the entire affected breast, underlying chest muscles, and the lymph

removal of the complete breast only

removal of the tumor and the surrounding margin of breast tissues

removal of the breast tissue and lymph nodes under the arm

what is generally performed during surgery for all invasive breast carcinoma to stage the tumor:
axillary node dissection

excision of the primary tumor and adjacent breast tissues followed by radiation therapy

Radiation therapy
Typically follows breast cancer surgery to destroy any remaining cancer cells
Palliative radiation therapy is also used to treat chest wall recurrences and some bone metastases to help control pain and prevent fractures.

Health hx:
family hx, breast changes, nipple discharge, use of hormone replacement, personal hx of breast cancer, previous diagnostics test and tx of cancer, menstrual hx, pregnancies, alcohol intake, physical activity, dietary hx

Physical assessment:
height and weight, breasts, lymph glands.

Nursing Diagnosis
Decisional Conflict
Risk for Infection
Risk for Injury
Disturbed Body Image

Client will express feelings
Client will not experience infection
Client will make informed treatment decisions
Family and significant others will provide appropriate support for client

Provide opportunities to express thoughts, feelings
Discuss woman’s knowledge of breast cancer
Encourage discussion relating to immediate concerns
Explain surgical procedure
Explain that it is normal to have decreased sensations in surgical area

Decisional Conflict
Provide opportunity for woman to ask questions
Focus on immediate concerns
Listen in nonjudgmental manner
Provide opportunities for her to meet with other women who have had breast cancer
Facilitate team approach

Listen attentively to expressions of grief
Watch for nonverbal clues
Allow time to interact
Explain that it is normal to have periods of depression, anger, denial after surgery
If woman wishes to do so, involve the partner

Risk for infection
Assess surgical dressings
Circle bleeding, drainage on dressing
Observe incision and IV sites for pain, redness, swelling, drainage
Assess drainage system for patency
Note color, amount of drainage
IV catheters on uninvolved side only
Change dressings using aseptic technique
Encourage protein rich diet
Teach woman to care for drainage system
Teach woman to watch for, report manifestations of infection
Explain that she may experience scaling, flaking, dryness, etc., particularly after radiation therapy
Instruct to avoid deodorants, talcum until incision healed

Risk for injury
Use nonsurgical side for BP, IVs
Elevate affected arm higher than shoulder
Encourage ROM in affected arm
Explain lymphedema massage, elastic compression bandage

Disturbed body image
Assess how woman views her body
Discuss image of self before surgery
Explain that redness, swelling in scar will fade with time
Include partner, family in discussing plan of care, ADLs if possible
Offer pamphlets, literature that might increase knowledge
Encourage woman to look at incision when she feels ready
Often reality not as frightening as imagined
If woman interested in breast reconstruction, provide material prior to surgery
Encourage to talk with plastic surgeon

Client experiences no complications resulting from treatment
Side effects from medications are minimized
Pain is managed to allow client to rest, perform essential ADLs

The nurse in the OB/GYN clinic recognizes that which of the following women is most at risk for breast cancer?

Age 23, two children
Age 45, very thin
Age 33, never pregnant
Age 64, positive family history

Age 64, positive family history

Rationale: The risk factors are double for this client due to age and family history. The other clients are not at increased risk for breast cancer.

The nurse caring for a client who is scheduled for a mastectomy finds the client is crying. Which of the following is the most appropriate nursing diagnosis for this client?

Risk for Injury
Disturbed Body Image
Anticipatory Grieving

Anticipatory Grieving

Anticipatory grieving is the most appropriate at this time as the client is crying in anticipation of surgery and losing a part of her body. Disturbed body image would be the priority after surgery when the client sees herself without the breast. Fatigue and risk for injury are possible, but not priorities.

The nurse is planning care for a client who has just undergone a radical mastectomy. Which of the following would the nurse include in that plan?

Start intravenous lines on the affected side in the antecubital area.
Keep the affected arm above the level of the heart.
Wait for the fifth postoperative day to start exercises.
Use warm, moist compresses on the arm to alleviate pain.

Keep the affected arm above the level of the heart.

The arm is kept elevated after a mastectomy to reduce edema. Warm compresses encourage the inflammatory response, causing more edema. IV lines, lab draws, and, blood pressures are performed in the opposite arm because the lymph nodes have been removed. Gentle range of motion may be started immediately after surgery.

The nurse is caring for a client who has had a modified radical mastectomy. Which of the following symptoms, if noted by the nurse, would indicate that the client is experiencing complications from the surgery?

Swelling in the affected arm
Serous drainage
Numbness and tingling in the affected arm

Swelling in the affected arm

Lymphedema or arm edema is a complication of mastectomy that can occur at any time, including years after the surgery. Pain is an expected outcome of surgery as is serous drainage. Numbness and tingling are not associated with mastectomy.

The nurse is conducting a seminar about breast cancer at a community center for women from diverse backgrounds. Which of the following would the nurse include about cultural risks of breast cancer to encourage breast self exam?

Caucasian women are more likely to die from breast cancer because they are often diagnosed in advanced stages.
Asian, Hispanic, and Native American women have a lower incidence of breast cancer.
Breast cancer is more prevalent in Caucasian women under 40.
African American women are more at risk for breast cancer than any other group.

Asian, Hispanic, and Native American women have a lower incidence of breast cancer.

Asian, Hispanic, and Native American women have a lower risk for developing breast cancer. Breast cancer is more prevalent in Caucasian women over 40. Breast cancer is more prevalent in African American women under 40. African American women are more likely to die from breast cancer because diagnosis often occurs at an advanced stage.

A client who has had a mastectomy and her spouse are asking the nurse questions about reconstructive surgery. Which of the following is the best response by the nurse?

Reconstructive surgery may require multiple surgeries.
Reconstructed breasts do not look normal.
Silicone is known to be safe when used as an implant.
Reconstructive surgery must be completed within 3 weeks of the mastectomy.

Reconstructive surgery may require multiple surgeries.

Depending on the type of mastectomy, reconstructive surgery may require multiple surgeries, thereby increasing such risks as reaction to anesthesia and infection. Controversy still exists about the health risks of silicone use. Reconstructed breasts do look normal and the surgery may be performed immediately after mastectomy or later on.

The nurse is administering tamoxifen (Nolvadex) to a client who has had a lumpectomy. Which of the following side effects will the nurse prepare the client to experience?

Pain when walking
Swelling in the breasts
Edema of the ankles
Chilling episodes

Pain when walking

The client taking Tamoxifen is at risk for developing deep vein thrombosis (DVT), and pain while walking is one of the classic symptoms of DVT. Breast swelling, chilling episodes, and edema of the ankles are not side effects associated with the use of this medication.

Nina, an oncology nurse educator is speaking to a women’s group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate?

a. Mammography is the most reliable method for detecting breast cancer.
b. Breast cancer is the leading killer of women of childbearing age.
c. Breast cancer requires a mastectomy.
d. Men can develop breast cancer.

Answer D.

Men can develop breast cancer, although they seldom do. The most reliable method for detecting breast cancer is monthly self-examination, not mammography. Lung cancer causes more deaths than breast cancer in women of all ages. A mastectomy may not be required if the tumor is small, confined, and in an early stage.

Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:

a. at the end of her menstrual cycle.
b. on the same day each month.
c. on the 1st day of the menstrual cycle.
d. immediately after her menstrual period.

Answer D.
Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman’s breasts are still very tender. Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.

A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care?

a. Monitoring temperature
b. Ambulation three times daily
c. Monitoring the platelet count
d. Monitoring for pathological fractures

Answer C.
Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option A elates to monitoring for infection, particularly if leukopenia is present. Options B and D, although important in the plan of care, are not related directly to thrombocytopenia.

Gian, a community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the client to perform the examination:

a. At the onset of menstruation
b. Every month during ovulation
c. Weekly at the same time of day
d. 1 week after menstruation begins

Answer D.
The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.

Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery?

a. Pain at the incisional site
b. Arm edema on the operative side
c. Sanguineous drainage in the Jackson-Pratt drain
d. Complaints of decreased sensation near the operative site

Answer B.
Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication.

A client asks the nurse, “Why do I need to examine my armpits when I do my monthly breast exam?” Which of the following would be an appropriate response for the nurse to make to this client?

a. This is the hardest area to feel for changes.
b. Who told you that you have to do that?
c. I’m not sure why that is important, but it sounds like it is.
d. Breast tissue extends into the axilla.

d. Breast tissue extends into the axilla

During the breast exam, the nurse palpates a series of lymph nodes. Why is this a part of the breast exam?

a. It’s not. It’s done because the chest area is exposed.
b. To review the integrity of the skin.
c. To assess the deep lymph nodes which drain the mammary lobules.
d. To assess shoulder range of motion.

c. To assess the deep lymph nodes which drain the mammary lobules.

The nurse is planning a focused breast/axilla interview and wants to include a general health question. Which of the following questions would fit this criteria?

a. Has your mother or sister had breast cancer?
b. Have you ever had a mammogram?
c. Are you still menstruating?
d. Have you had any breast trauma?

c. Are you still menstruating?

A client comes into the clinic for a routine breast and axilla exam. Which assessment technique does the nurse use first during this examination?

a. Inspection
b. Auscultation
c. Palpation
d. Percussion

A. Inspection

During the breast exam, the nurse asks the client to raise her arms over her head. Why did the nurse change the client’s position?

a. Skin dimpling is accented in this position.
b. The nurse couldn’t palpate the axillae correctly.
c. The client has small breasts.
d. The client has large breasts.

a. Skin dimpling is accented in this position.

The nurse is examining a client’s breasts and follows a specific pattern. Which of the following patterns can be used for a breast exam?

a. Letter H
b. Back and forth technique.
c. Letter S
d. ABC


The client tells the nurse, “At times I have drainage from my right breast.” What should the nurse do with this information?

a. Write it in the medical record and say nothing to the client.
b. Phone for a mammogram for the client immediately.
c. Explain that this could be benign or it could mean something else. It needs to be further investigated.
d. Nothing. It doesn’t mean a thing.

c. Explain that this could be benign or it could mean something else. It needs to be further investigated.

The clinic is sponsoring a client education session for breast cancer awareness month. Which of the following considerations should be included to support cultural differences about breast health?

a. Refer all clients to the American Cancer Society if they have questions.
b. Inform all about the low-cost breast cancer screening program.
c. Encourage all females to increase their intake of vitamins A and E.
d. Encourage all females to complete monthly breast exam

c. Encourage all females to increase their intake of vitamins A and E

a postmenopausal client has difficulty remembering to complete a monthly breast exam. What can be done to help this client?

a. Nothing. This client doesn’t need to do self examinations.
b. Suggest the client plan to conduct the exam the first day of every month.
c. Schedule the client to come into the clinic every month for the exam.
d. Schedule the client to receive a monthly phone call from the clinic as a reminder.

c. Schedule the client to come into the clinic every month for the exam.

When teaching a 22-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that
a. BSE will reduce the risk of dying from breast cancer.
b. performing BSE right after the menstrual period will improve comfort.
c. BSE should be done daily while taking a bath or shower.
d. annual mammograms should be scheduled in addition to BSE.
Rationale: 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 breast cancer mortality. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40.

While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent?
a. “Do you currently smoke cigarettes?”
b. “Have you ever had any breast injuries?”
c. “Is there any family history of fibrocystic breast changes?”
d. “At what age did you start having menstrual periods?
Rationale: 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 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure. She says she does breast self-examination (BSE) monthly and asks whether it is necessary to have an annual mammogram. The nurse’s best response to the patient is,

a. “If your mammogram was painful, it is especially important that you have it done annually.”
b. “An ultrasound examination of the breasts, which is not painful or a source of radiation, can be substituted for a mammogram.”
c. “Because of your age, it is even more important for you to have annual mammograms.”
d. “Unless you find a lump while examining your breasts, a mammogram every 2 years is recommended after age 60.”

Rationale: Annual mammograms are recommended for women over age 40 as long as they are in good health. The incidence of breast cancer increases in women over 60. Pain with a mammogram does not indicate any greater risk for breast cancer. Ultrasound may be used in some situations to differentiate cystic breast problems from cancer but is not a substitute for annual mammograms.

A patient with a small breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that
a. only a small incision is necessary, resulting in minimal breast pain and scarring.
b. if the specimen is positive for malignancy, the patient can be told at the visit.
c. if the specimen is negative for malignancy, the patient’s fears of cancer can be put to rest.
d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
Rationale: An FNA should only be done when an experienced cytologist is available to read the specimen immediately. If the specimen is positive for malignancy, the patient can be given this information immediately. No incision is needed. If the specimen is negative for malignancy, the patient will require biopsy of the lump. FNA is not guided by mammography.

A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse’s response to the patient is based on the knowledge that the most likely cause of the breast lump is
a. fibrocystic complex.
b. fibroadenoma.
c. breast abscess.
d. adenocarcinoma.
Rationale: Fibroadenoma is the most frequent cause of breast lumps in women under 25 years of age. Fibrocystic changes occur most frequently in women ages 35 to 50. Breast abscess is associated with pain and other systemic symptoms. Breast cancer is uncommon in women younger than 25.

During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. The nurse’s first action should be to
a. palpate the breasts for the presence of any discrete lumps.
b. explain that this is a temporary condition caused by hormonal changes.
c. refer the patient for mammography and biopsy of the breast tissue.
d. teach the patient about dietary changes to reduce the breast size.
Rationale: If discrete, circumscribed lumps are present, the patient should be referred for further testing to determine whether breast cancer is present. Gynecomastia is usually a temporary change, but it can be caused by breast cancer. Mammography and biopsy will not be needed unless lumps are present in the breast tissue. Dietary changes will not affect the condition.

At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that
a. her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer.
b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer.
c. because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes.
d. genetic mutations increase cancer risk only in combination with other risk factors such as obesity.
Rationale: Family history is a risk factor for breast cancer, and the nurse should discuss testing for BRCA genes with the patient. Although the BRCA gene is associated with increased risk for breast and ovarian cancer, the patient may be at risk if her mother had either one. About 5% to 10% of patients with breast cancer may have a genetic abnormality that contributes to breast cancer development. Risk factors are cumulative, but a family history alone will increase breast cancer risk.

When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a
a. cousin who was diagnosed with breast cancer at age 38.
b. mother who was diagnosed with breast cancer at age 42.
c. sister who died from ovarian cancer at age 56.
d. grandmother who died from breast cancer at age 72.
Rationale: A significant family history of breast cancer means that the patient has a first-degree relative who developed breast cancer, especially if the relative was premenopausal.

A woman with a positive biopsy for breast cancer is considering whether to have a modified radical mastectomy or breast conservation surgery (lumpectomy) with radiation therapy. Which information should the nurse provide?

a. The postoperative survival rate for each is about the same, but there is a decreased rate of cancer recurrence after mastectomy.
b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity.
c. The hair loss associated with post-lumpectomy chemotherapy is not acceptable to some patients.
d. The treatment period for the mastectomy is shorter, and breast reconstruction can provide a normal-appearing breast.

Rationale: The impact on breast function and appearance is less with lumpectomy and radiation, but there is some effect on breast sensitivity. The rate of cancer recurrence is the same for the two procedures. Chemotherapy may be used after either lumpectomy or mastectomy, but it is not always needed. The treatment period is shorter after mastectomy, but breast reconstruction does not provide a normal-appearing breast.

Following a modified radical mastectomy, the health care provider recommends chemotherapy even though the lymph nodes were negative for cancer cells. The patient tells the nurse that she does not know what to do about chemotherapy because she has heard that she may not even need chemotherapy and that the side effects are uncomfortable. The nursing diagnosis that best reflects the patient’s problem is

a. anxiety related to prospect of additional cancer therapy.
b. fear related to uncomfortable side effects of chemotherapy.
c. decisional conflict related to lack of knowledge about prognosis and treatment options.
d. risk for ineffective health maintenance related to reluctance to consider additional treatment.

Rationale: The patient’s statements indicate that she is having difficulty making a decision about treatment because of a lack of understanding about prognosis and treatment. Although she may have some anxiety and fear, these are not the priorities at this time. The patient expresses concerns about chemotherapy rather than reluctance to consider additional treatment.

A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to
a. teach the patient about the need to monitor serum electrolyte levels.
b. ask the patient to call the health care provider before using any over-the-counter (OTC) pain relievers.
c. instruct the patient to call if she notices ankle swelling.
d. have the patient schedule frequent eye examinations.
Rationale: Herceptin 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. OTC pain relievers do not interact with Herceptin. Changes in visual acuity may occur with tamoxifen, but not with Herceptin.

A 34-year-old woman has undergone a modified radical mastectomy for a breast tumor. The pathology report identified the tumor as a stage I, estrogen-receptor-positive adenocarcinoma. The nurse will plan on teaching the patient about
a. raloxifene (Evista).
b. estradiol (Estrace).
c. trastuzumab (Herceptin).
d. tamoxifen (Nolvadex).
Rationale: Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used post-mastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2/neu antigen.

A patient returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate intervention for the nurse to include in implementing postoperative care for the patient includes

a. teaching the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes for the best pain relief.
b. insisting that the patient examine the surgical incision when the dressings are removed.
c. posting a sign at the bedside warning against blood pressures or venipunctures in the right arm.
d. encouraging the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.

Rationale: The patient is at risk for lymphedema and infection if blood pressures or venipuncture are done on the right 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 patient who has had a left modified radical mastectomy and axillary lymph node dissection. The nurse determines that teaching has been successful when the patient says,

a. “I should keep my left arm supported in a sling when I am up until my incision is healed.”
b. “I may expose my left arm to the sun for several hours each day to increase circulation and promote healing.”
c. “I can do whatever exercises and activities I want as long as I do not elevate my left hand above my head.”
d. “I will continue to exercise my left arm with finger-walking up the wall or combing my hair.”

Rationale: The patient should continue with arm exercises to regain strength and range of motion. The left arm should be elevated to the level of the heart when the patient is up. Sun exposure is avoided because of the risk of sunburn. The left hand should be elevated at or above heart level to reduce swelling and lymphedema.

A 38-year-old woman is scheduled for a breast-conservation therapy with a lumpectomy. As the nurse prepares her for surgery, she begins to cry and says, “I just do not know how to handle all of this.” An appropriate response to the patient by the nurse is,

a. “Would you like to talk about how you are feeling right now?”
b. “I can see you are really upset. Would you like to be alone for a while?”
c. “The important thing is that the tumor was found and is going to be removed.”
d. “With this surgery you will have very little change in the appearance of your breast.”

Rationale: The nurse encourages the patient to express feelings about the diagnosis and surgery. The response beginning, “I can see you are really upset” may indicate that the nurse is uncomfortable being with the patient while she is upset. The response beginning, “The important thing is that the tumor was found” places the nurse’s value system above the patient’s current concerns. And the response, “With this surgery you will have very little change in the appearance of your breast” does not address all the patient’s possible concerns and is not true.

After the nurse completes discharge teaching for a patient who has had a left modified radical mastectomy and lymph node dissection, which statement by the patient indicates that no further teaching is needed?

a. “I will avoid reaching over the stove with my left hand.”
b. “I will need to do breast self-examination on my right breast monthly.”
c. “I will keep my left arm elevated until I go to bed.”
d. “I will remember to use my right arm and to rest the left one.”

Rationale: The patient should avoid any activity that might injure the left arm, such as reaching over a burner. Breast self-examination should be done to the right breast and the left mastectomy site. The left arm should be elevated when the patient is lying down also. The left arm should be used to improve range of motion and function.

Which statement by a 32-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that the goals of therapy are being met?
a. “I am not sure how my husband will react when I tell him about this cancer.”
b. “I am ready to die if that is God’s plan for me.”
c. “I need to know all the options before making a decision about treatment.”
d. “I will do whatever the doctor thinks is best.”
Rationale: One goal for the patient with breast cancer is active participation in the decision-making process. The response beginning, “I am not sure how my husband will react” indicates that the goal of satisfaction with the support provided by significant others is still unmet. The response, “I am ready to die if that is God’s plan for me” suggests that the patient may not be willing to have treatment. The response, “I will do whatever the doctor thinks is best” indicates that the patient is not participating actively in treatment decisions.

Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and an axillary lymph node dissection is appropriate to assign to an LPN/LVN?
a. Administering an analgesic 30 minutes before the scheduled arm exercises
b. Teaching the patient how to avoid injury to the right arm
c. Assessment of the patient’s range of motion for the right arm
d. Evaluation of the patient’s understanding of discharge instructions about drain care
Rationale: LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient’s understanding of instructions are more complex tasks that are more appropriate to RN-level education and scope of practice.

A nurse is teaching a group of women about the appropriate method for performing a breast self-exam (BSE). Which of the following statements regarding breast self-exam demonstrates correct comprehension of the material?

“Breast exams should begin around age 30.”
“Breast exams should be done one week prior to the menstrual cycle.”
“Breast exams should incorporate both feeling and looking at the breasts.”
“Breast exams should be done during the middle of the menstrual cycle.”

Breast exams should incorporate both feeling and looking at the breasts.”
Breast exams should incorporate both feeling and looking at the breasts. Premenstrual swelling and tenderness of the breasts may be present one week prior. Breast self-examination should begin as early as possible, preferably when the individual is an adolescent.

A client describes breast swelling and tenderness. What piece of data would be most important for the nurse to gather?

Timing of the symptoms
Birth control method
Method of breast self-examination
Diet history

Timing of the symptoms
The breast undergoes regular cyclical changes in response to hormonal stimulation. The nurse will want to determine when the swelling and tenderness occurs within the menstrual cycle. Birth control method, method of BSE, and diet history may contribute to the database, but do not have priority.

Which nursing intervention has priority for the client scheduled for a mammogram?

Instruct the client to take Tylenol prior to the mammogram.
Instruct the client to schedule the mammogram for two weeks after menses.
Instruct the client to refrain from using deodorant.
Instruct the client to avoid caffeine for 5-7 days prior.

Instruct the client to refrain from using deodorant.
In order to obtain an accurate interpretation, the client must avoid lotions, powders, deodorants, or other cosmetics on the day of the exam. The other responses may assist the woman in preventing discomfort.

The nurse obtains a health history from the following clients. To which one should she give priority in teaching about breast cancer prevention?

Age 57, has taken estrogen replacement therapy for 10 years, 5 feet, 2 inches tall, 210 pounds
Gravida 4, Para 4, regular menstrual cycle, uses Depo- Provera for birth control
Menarche at age 13, drinks a glass of wine three times per week, sister with uterine cancer
Age 45, African-American, lives in federally funded housing

Age 57, has taken estrogen replacement therapy for 10 years, 5 feet, 2 inches tall, 210 pounds
Women over 50 who have taken estrogen replacement therapy for more than five years and are obese after menopause are at greater risk for breast cancer. The other women do not exhibit risk factors.

Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
a. breast self-examination.
b. mammography.
c. fine needle aspiration.
d. chest X-ray.
C. Fine needle aspiration

Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
a. Vision changes
b. Hearing loss
c. Headache
d. Anorexia
Answer A. The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn’t associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don’t warrant a change in therapy.

Which of these findings in the breast of a patient who is suspected of having breast cancer would support the diagnosis?

a) complaints of dull, achy, pain
b) palpation of a mobile mass
c) presence of an inverted nipple
d) area of discoloration skin

– inversion of nipple is one of the manifestations of breast cancer. A cancerous lesion is non-mobile.

How often should a female who is above 40 years old, go for cancer detection examination?

a) daily
b) weekly
c) monthly
d) yearly

D. Yearly

A client receiving chemotherapy has an infiltrated intravenous line and extravasation at the site. The nurse avoids doing which of the following in the management of this situation?

a) applying direct manual pressure to the site
b) stopping the administration of the medication
c) administering an available antidote as prescribed
d) leaving the needle in place and aspirating any residual medication

– General recommendations for managing extravasation of a chemotherapeutic agent include stopping the infusion, leaving the needle in place and attempting to aspirate any residual medication from the site, administering an antidote if available, and assessing the site for complications. Direct pressure is not applied to the site because it could further injure tissues exposed to the chemotherapeutic agent.

A client with breast cancer is returned to the room following a right total mastectomy. The nurse should:

Elevate the client’s right arm on pillows

Place the client’s right arm in a dependent sling

Keep the client’s right arm on the bed beside her

Place the client’s right arm across her body

Elevate right arm

the client who had right modified radical mastectomy 4 years before is being admitted for a cardiac workup for chest pain. which intervention is most important for the nurse to implement
1. determine when the client had chemo last
2. ask the client is she received Adriamycin
3. post a message at the head of the bed to not use the right arm
4. examine the chest wall for cancer sites
3. post a message at the head of the bed to not use the right arm