Nokea
A client is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug?
- A. It blocks the release of luteinizing hormone.
- B. It interferes with cancer cell division.
- C. It blocks estrogen in the breast.
- D. It inhibits DNA synthesis in rapidly dividing cells.
Correct Answer: C
Rationale: Tamoxifen (Nolvadex) reduces the estrogen available to breast tumors to stop or prevent growth. It does not block luteinizing hormone (leuprolide does this), interfere with cell division (chemotherapy agents like cyclophosphamide do this), or inhibit DNA synthesis (doxorubicin does this).
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A woman diagnosed with breast cancer had these laboratory tests performed at an office visit. Which test results indicate to the nurse that some further diagnoses are needed?
- A. The elevated alkaline phosphatase and calcium suggest bone involvement.
- B. Only alkaline phosphatase is decreased, suggesting liver metastasis.
- C. Hematocrit and hemoglobin are decreased, indicating anemia.
- D. The elevated hematocrit and hemoglobin indicate dehydration.
Correct Answer: A
Rationale: The alkaline phosphatase (normal 30 to 120 U/L) and total calcium (normal 9 to 10.5 mg/dL) levels are elevated (125 U/L and 12 mg/dL, respectively), suggesting bone metastasis. Hematocrit (19%) and hemoglobin (14 g/dL) are within normal limits for females, ruling out anemia or dehydration.
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.
A woman has been using acupuncture to treat the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which conditions would cause the nurse to recommend against further use of acupuncture? (Select all that apply.)
- A. Lymphedema
- B. Bleeding tendencies
- C. Low white blood cell count
- D. Elevated serum calcium
- E. High platelet count
Correct Answer: A,B,C
Rationale: Acupuncture is contraindicated in lymphedema due to poor drainage in the affected extremity, bleeding tendencies due to increased bleeding risk, and low white blood cell count due to infection risk. Elevated serum calcium and high platelet count do not contraindicate acupuncture.
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.