Chapter 70 - Care of Patients with Breast Disorders
A client is struggling with body image after breast cancer surgery. Which behavior indicates to the nurse that the client’s coping is maladaptive?
- Avoiding eye contact with staff Saying,
- “I feel like less of a woman”
- Requesting a temporary prosthesis Saying,
- “This is the ugliest scar ever”
A. Avoiding eye contact with staff Saying,
Which action can the same-day surgery charge nurse delegate to an experienced unlicensed assistive personnel (UAP) who is helping with the care of a client who is having a breast biopsy?
- Assess anxiety level about the surgery.
- Monitor vital signs after surgery.
- Obtain data about breast cancer risk factors.
- Teach about postoperative routine care.
B. Monitor vital signs after surgery.
A client who has undergone breast surgery is struggling with issues concerning her sexuality. What is the best way for the nurse to address the client’s concerns?
- Ask the client if she is using her surgery as an excuse not to have any more sexual relations with her partner.
- Remind the client to avoid sexual intercourse for 2 months after the surgery.
- Ask the client about satisfaction with sexual relations with her partner.
- Teach the client that birth control is a priority.
C. Ask the client about satisfaction with sexual relations with her partner.
A client who has just been notified that the breast biopsy indicates a malignancy tells the nurse, “I just don’t know how this could have happened to me.” Which response by the nurse is best?
- “Please tell me what you mean when you say you don’t know how this could have happened to you.”
- “Do you have a family history that might make you more likely to develop breast cancer?”
- “Would you like me to help you find more information about how breast cancer develops?”
- “Many risk factors for breast cancer have been identified, so it is difficult to determine what might have caused it.”
A. “Please tell me what you mean when you say you don’t know how this could have happened to you.”
The nurse is instructing a client with breast cancer who will be undergoing chemotherapy about the side effects of doxorubicin (Adriamycin). Which side effect does the nurse instruct the client to report to the primary health care provider?
- Hearing loss
The nurse is discussing treatment options with a client newly diagnosed with breast cancer. Which statement by the client indicates a need for further teaching?
- “Hormonal therapy is only used to prevent the growth of cancer. It won’t get rid of it.”
- “I might have chemotherapy before surgery.”
- “If I get radiation, I am not radioactive to others.”
- “Radiation will remove the cancer, so I might not need surgery.”
D. “Radiation will remove the cancer, so I might not need surgery.”
A 48-year-old woman who has been diagnosed with breast cancer with the BRCA genetic mutation requests information about early detection for her daughter because of her daughter's genetic risk. Which information will the nurse convey?
- Breast self-examination (BSE) beginning at 20 years of age is the best way to detect breast cancer
- Hormone replacement therapy (HRT) combining estrogen and progesterone may be recommended by your daughter’s primary health care provider
- MRI for screening typically begins at an age that is 10 years younger than your present age.
- The primary health care provider will most likely discuss prophylactic mastectomy with daughters of women with genetic mutations
C. MRI for screening typically begins at an age that is 10 years younger than your present age.
A client tells the nurse in the gynecology clinic that she doesn’t get a yearly mammogram because she is afraid of what might be found. Which teaching will the nurse provide?
- If your screening for breast cancer is low risk, you can always have a MRI which is cheaper.
- Detection of breast cancer before or after axillary node invasion yields the same outcome.
- Mammography as a baseline screening is recommended by the American Cancer Society at 30 years of age.
- Mammograms help with early detection of localized breast cancer which has a high 5-year survival rate.
D. Mammograms help with early detection of localized breast cancer which has a high 5-year survival rate.
A premenopausal client diagnosed with breast cancer will be receiving therapy with leuprolide. The nurse teaches the client to expect which of the following side effects?
- Heavy menses
- Nausea and vomiting
- Hot flashes
- Weight loss
C. Hot flashes
The nurse is teaching postmastectomy exercises to a client. Which statement made by the client indicates that teaching has been effective?
- “For the pulley exercise, I’ll drape a 6-foot (1.8 meter)-long rope over a shower curtain rod or over the top of a door.”
- “In rope turning, I’ll hold the rope with my arms flexed.”
- “In rope turning, I’ll start by making large circles.”
- “With hand wall climbing, I’ll walk my hands up the wall and back down until they are at waist level.”
A. “For the pulley exercise, I’ll drape a 6-foot (1.8 meter)-long rope over a shower curtain rod or over the top of a door.”
A client is receiving chemotherapy treatment for breast cancer and asks for additional interventions for managing the associated nausea and vomiting. Which complementary and integrative therapy does the nurse suggest?
A client for whom a mastectomy is planned tells the surgical nurse, “I wish there was someone who went through this that I could speak to about how she managed it all.” Which community resource will the nurse recommend?
- National Breast Cancer Coalition
- Reach to Recovery
- Susan G. Komen for the Cure
- Young Survival Coalition
B. Reach to Recovery
The nurse is caring for a client undergoing mastectomy who asks the nurse about breast reconstruction. Which of these will the nurse include in the discussion?
- Many women want breast reconstruction using their own tissue immediately after mastectomy.
- Placement of saline or gel-filled prostheses is not recommended because of the nature of the surgery.
- Reconstruction of the nipple–areola complex is the first stage in the reconstruction of the breast.
- The surgeon would offer the option of breast reconstruction surgery once healing has occurred after a mastectomy.
A. Many women want breast reconstruction using their own tissue immediately after mastectomy.
The nurse at the gynecology clinic is examining a woman’s breasts. Which assessment finding will the nurse report immediately to the primary health care provider?
- A 1-cm freely mobile rubbery mass discovered by the client
- Ill-defined painful rubbery lump in the outer breast quadrant
- Backache and breast fungal infection
- Nipple discharge and dimpling
D. Nipple discharge and dimpling
Which client being cared for on the medical–surgical unit will be best to assign to a nurse who has floated from the intensive care unit (ICU)?
- Recent radical mastectomy client requiring chemotherapy administration
- Modified radical mastectomy client needing discharge teaching
- Stage III breast cancer client requesting information about radiation and chemotherapy
- Client with a Jackson–Pratt drain who just arrived from the postanesthesia care unit after a mastectomy
D. Client with a Jackson–Pratt drain who just arrived from the postanesthesia care unit after a mastectomy
A client who has been diagnosed with breast cancer tells the nurse she wishes to use only natural and complementary interventions. Which of these will the nurse explain to the client?
- If chemotherapy has been recommended, complementary therapies are contraindicated
- This type of therapy would not replace standard treatment
- There are many natural hormonal therapy replacements that can be used
- Complementary therapies can only be used after surgery
B. This type of therapy would not replace standard treatment
The community health nurse is providing education to a group of women about risks for breast cancer. Which of these risk factors will the nurse include in the education session? Select all that apply.
- High breast density
- Male with gynecomastia
- Middle-aged woman
- First child at age 25
A. High breast density
The nurse is teaching a client how to perform breast self-examination (BSE). Which of these techniques does the nurse include in the teaching session? Select all that apply.
- Instruct the client to keep her arm by her side while performing the examination.
- Ensure that the setting in which BSE is demonstrated is private and comfortable.
- Ask the client to remove her shirt. The bra may be left in place.
- Ask the client to demonstrate her own method of BSE.
- Use the fingertips, which are more sensitive than the finger pads, to palpate the breasts.
B. Ensure that the setting in which BSE is demonstrated is private and comfortable.
D. Ask the client to demonstrate her own method of BSE.
The nurse is preparing to discharge a client who has had drains placed after a mastectomy. The nurse recognizes the client understands care of the drains when she states which of these?
- “The surgeon will pull the drains before I leave the hospital.”
- “The drain will help prevent postoperative infection.”
- “I may shower tomorrow morning as long as I don’t face the shower spray.”
- “Drains are generally removed when drainage is less than an ounce (30 ml) for three consecutive days.”
D. “Drains are generally removed when drainage is less than an ounce (30 ml) for three consecutive days.”