Nokea
A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate?
- A. Discourage this surgery since the woman is still of childbearing age.
- B. Reassure the client that reconstructive surgery is as easy as breast augmentation.
- C. Inform the client that this surgery removes all mammary tissue and cancer risk.
- D. Include support people, such as the male partner, in the decision making.
Correct Answer: D
Rationale: The cultural aspects of decision making need to be considered. In Nigerian culture, the man often plays a significant role in decision-making processes, so including support people like the male partner is appropriate to ensure culturally sensitive care.
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After a breast examination, the nurse is documenting assessment findings that indicate possible breast cancer. Which abnormal findings need to be included as part of the client's electronic medical record? (Select all that apply.)
- A. Peau d'orange
- B. Dense breast tissue
- C. Nipple retraction
- D. Mobile mass at two o'clock
- E. Non-tender axillary nodes
Correct Answer: A,C,D
Rationale: Peau d'orange (skin dimpling), nipple retraction, and a mobile mass at a specific location (e.g., two o'clock) are abnormal findings suggestive of breast cancer. Dense breast tissue and non-tender axillary nodes are not necessarily indicative of malignancy.
The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the client indicates a lack of understanding?
- A. This condition will become malignant over time.
- B. I should refrain from using hormone replacement therapy.
- C. One cup of coffee in the morning should be enough for time.
- D. This condition makes it more difficult to examine my breasts.
Correct Answer: A
Rationale: Fibrocystic breast condition does not increase a woman's chance of developing breast cancer. Hormone replacement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief to tender breasts. The fibrocystic changes to the breasts make it more difficult to examine the breasts because of fibrotic changes and lumps.
A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best?
- A. You do not need to worry about lymphedema since you did not have radiation therapy.
- B. A risk factor for lymphedema is infection, so wear gloves when gardening outside.
- C. Numbness, tingling, and swelling are common conditions after a mastectomy.
- D. The risk for lymphedema is a real threat and can be very self-limiting.
Correct Answer: B
Rationale: Infection can contribute to lymphedema, so wearing gloves during activities like gardening reduces this risk. Radiation is only one factor; others like obesity and axillary disease also contribute. Lymphedema symptoms are not common post-surgery, and while it is a concern, it is manageable with proper care.
The nurse is formulating a teaching plan according to evidence-based breast cancer screening guidelines for a 50-year-old woman with low risk factors. Which diagnostic methods should be included in the plan? (Select all that apply.)
- A. Magnetic resonance imaging (MRI)
- B. Breast ultrasound
- C. Breast self-awareness
- D. Clinical breast examination
- E. Mammogram
Correct Answer: C,D,E
Rationale: Guidelines recommend annual mammograms for women aged 40 and older, breast self-awareness, and clinical breast examinations for low-risk women. MRI is recommended for high-risk cases, and breast ultrasound is used for follow-up if abnormalities or dense breast tissue are found.
A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is needed?
- A. I can empty the drainage tubes daily and record the output.
- B. I should avoid lifting heavy objects with the affected arm.
- C. I can resume normal activities like swimming immediately.
- D. I will report any signs of infection, such as redness or swelling, to my provider.
Correct Answer: C
Rationale: The client should avoid strenuous activities like swimming until cleared by the provider to prevent complications such as lymphedema or infection. Emptying drainage tubes, avoiding heavy lifting, and reporting signs of infection are appropriate actions, indicating understanding.