Nokea
A 35-year-old mother of three young children has been diagnosed with stage II breast cancer. After discussing treatment options with her physician, the woman goes home to talk to her husband, later calling the nurse for clarification of some points. The patient tells the nurse that the physician has recommended breast conservation surgery followed by radiation. The patients husband has done some online research and is asking why his wife does not have a modified radical mastectomy to be sure all the cancer is gone. What would be the nurses best response?
- A. Modified radical mastectomies are very hard on a patient, both physically and emotionally and they really arent necessary anymore.
- B. According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial.
- C. Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence.
- D. According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy.
Correct Answer: D
Rationale: For stage II breast cancer, breast conservation surgery with radiation offers survival rates equivalent to modified radical mastectomy, per current guidelines. Mastectomies remain necessary in some cases, are not inherently riskier for recurrence, and their physical/emotional impact is not the primary reason for choosing conservation.
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A patient has been discharged home after a total mastectomy without reconstruction. The patient lives alone and has a home health referral. When the home care nurse performs the first scheduled visit to this patient, what should the nurse assess? Select all that apply.
- A. Adherence to the exercise plan
- B. Overall psychological functioning
- C. Integrity of surgical drains
- D. Understanding of cancer
- E. Use of the breast prosthesis
Correct Answer: A,B,C
Rationale: The home care nurse assesses incision and drain integrity, adherence to exercises to prevent lymphedema, and psychological functioning to ensure recovery. Cancer understanding is less critical at this stage, and prosthesis use is typically addressed later.
A patient who has had a lumpectomy calls the clinic to talk to the nurse. The patient tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone drew a line with a red marker. What would the nurse suspect is the womans problem?
- A. Mondor disease
- B. Deep vein thrombosis (DVT) of the breast
- C. Recurrent malignancy
- D. An area of fat necrosis
Correct Answer: A
Rationale: Mondor disease, a superficial thrombophlebitis of the breast, presents as a tender, red, linear area, often post-surgery like lumpectomy. DVT of the breast is not a recognized condition, recurrent malignancy is unlikely to present this way, and fat necrosis typically involves a firm, nontender mass.
A 23-year-old woman comes to the free clinic stating I think I have a lump in my breast. Do I have cancer? The nurse instructs the patient that a diagnosis of breast cancer is confirmed by what?
- A. Supervised breast self-examination
- B. Mammography
- C. Fine-needle aspiration
- D. Chest x-ray
Correct Answer: C
Rationale: Fine-needle aspiration or biopsy provides histologic confirmation of breast cancer, making it the definitive diagnostic method. Breast self-examination and mammography are screening tools, not diagnostic, and chest x-rays are used for metastasis evaluation, not primary diagnosis.
A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the patients that effective BSE is dependent on what factor?
- A. Womens knowledge of how their breasts normally look and feel
- B. The rapport that exists between the woman and her primary care provider
- C. Synchronizing womens routines around BSE with the performance of mammograms
- D. Womens knowledge of the pathophysiology of breast cancer
Correct Answer: A
Rationale: Effective BSE relies on the patient's familiarity with her breasts' normal appearance and feel, enabling detection of changes. Rapport with providers, mammogram synchronization, or pathophysiology knowledge are not essential for BSE efficacy.
A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the patients history that his father was treated for breast cancer. What should the nurse provide to the patient before he leaves the clinic?
- A. A referral for a mammogram
- B. Instructions about breast self-examination (BSE)
- C. A referral to a surgeon
- D. A referral to a support group
Correct Answer: B
Rationale: Men with a family history of breast cancer, like a father, have an increased risk and should be taught breast self-examination to monitor for changes. Referrals for mammograms, surgery, or support groups are not indicated without symptoms or a diagnosis.