Nokea
A nurse is describing to a client the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which factor?
- A. Bone mineral density
- B. High density lipoprotein levels
- C. Risk for endometrial cancer
- D. Cataract formation
Correct Answer: A
Rationale: Besides reducing the risk of breast cancer, tamoxifen preserves bone mineral density, thus preventing osteoporosis. It also lowers the low-density lipoprotein cholesterol levels, although it is still unknown if it decreases the incidence of myocardial infarction in women. Tamoxifen can have detrimental effects. It increases the incidences of endometrial cancer, deep vein thrombosis, pulmonary embolism, and cataracts.
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The nurse is providing shift report related to a client newly received back to the unit from the post anesthesia care unit (PACU). The nurse is stating that the client had breast tissue removed with 7 of 14 lymph nodes, the lining of the chest muscles and pectoralis major and minor muscles removed. The oncoming nurse documents which procedure completed?
- A. A segmental mastectomy
- B. A total mastectomy
- C. A modified radical mastectomy
- D. A radical mastectomy
Correct Answer: D
Rationale: A modified radical mastectomy is a procedure in which the breast, some lymph nodes, the lining over the chest muscles, and the pectoralis minor muscle are removed. A segmental mastectomy is where the tumor and some breast tissue and lymph nodes are removed. A total mastectomy includes only breast tissue. A radical mastectomy removes the breast, axillary lymph nodes, and pectoralis major and minor muscles. Sternal lymph nodes may also be removed with this procedure.
The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When the nurse assesses the client's breast, which assessment finding is characteristic of fibrocystic disease?
- A. One breast is larger than the other.
- B. The lump is firm and immovable.
- C. The lump is round and movable.
- D. Nipple retractions are noted.
Correct Answer: C
Rationale: The lump being round and movable is characteristic of fibrocystic breast disease, which often presents with multiple, mobile, and tender lumps that may change with the menstrual cycle. One breast being larger than the other is not specific to fibrocystic disease. A firm and immovable lump is more suggestive of malignancy. Nipple retractions are associated with breast cancer, not fibrocystic disease.
The nurse is caring for a client diagnosed with ductal carcinoma and lymph node involvement. Which diagnostic test, ordered by the physician, does the nurse identify as assessing possible metastasis?
- A. A complete blood count
- B. A chest x-ray
- C. A multiple gated acquisition (MUGA) scan
- D. A bone density test
Correct Answer: B
Rationale: A chest x-ray can identify any tumors present in the lung fields. Lymph nodes containing cancer cells are commonly involved in metastasis, which most frequently spreads to the skeletal and pulmonary systems (in that order). In addition, metastases may be found in the brain, adrenals, and liver. A blood count will not detect metastasis. A bone density study or MUGA scan will not detect metastasis.
A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which rationale does the nurse give for the use of this group of drugs?
- A. They prevent prehormones from becoming estrogen, blocking the tumor's ability to use it.
- B. They block progesterone-dependent tumors from growing.
- C. They attack to endogenous protein receptors to slow the growth of cancerous cells.
- D. They stimulate the immune system to attack a protein common in many tumors.
Correct Answer: A
Rationale: Aromatase inhibitors prevent prehormones from becoming estrogen thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogogestin drug, such as antipeptide, blocks progesterone-dependent breast cancers. A monoclonal antibody, resuzumab attacks to protein receptors to slow the growth of cancer cells. A breast cancer vaccine is under investigation in Italy. This vaccine stimulates the immune system to attack a protein called mammaglobin-A, which is found in 80% of breast cancer tumors.
The nurse is caring for a client whose physician has ordered a sentinel lymph node mapping. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction?
- A. The procedure allows for an understanding of the spread of cancer cells.
- B. The procedure allows for conservation of breast tissue.
- C. The procedure removes all cancer from the body.
- D. The procedure includes minimal surrounding tissue damage.
Correct Answer: C
Rationale: Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.