Nokea
A patient has a saline breast implant inserted in outpatient surgery. Which of the following instructions should the nurse include in the discharge teaching?
- A. Take Aspirin every 4 hours to reduce inflammation.
- B. Check wound drains for excessive blood or any foul odour.
- C. Wear a loose-fitting bra to decrease irritation of the sutures.
- D. Resume normal activities 2 to 3 days after the mammoplasty.
Correct Answer: B
Rationale: The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.
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The nurse has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen. Which of the following patient statements indicate that the teaching has been effective?
- A. I will expect to have leg cramps with this drug.
- B. I will call the clinic if I develop any hot flashes.
- C. I will be taking the medication for at least a year.
- D. I will call immediately if I experience cloudy and blurred vision.
Correct Answer: D
Rationale: Blurred and cloudy vision should be immediately reported because it is likely that the patient is developing cataracts and the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected adverse effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.
The nurse is assessing a patient at the clinic who has metastatic breast cancer and has a new prescription for trastuzumab. Which of the following findings is a reason for the administration of this medication?
- A. Allergic to iodine
- B. HER-2 positive
- C. Immune to tamoxifen
- D. Severely dehydrated
Correct Answer: B
Rationale: For patients who are HER-2 positive, trastuzumab is a monoclonal antibody to HER-2. After the antibody attaches to the antigen, it is taken into the cancer cells and eventually kills them.
A patient with stage II breast cancer tells the nurse, 'I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What23 do you think I should do?' Which of the following responses by the nurse is best?
- A. I would have a lumpectomy, but you need to decide what is best for you.
- B. Tell me what you understand about the surgical options that are available.
- C. It would not be appropriate for me to make the decision about your health.
- D. There is no need to make a decision rapidly, you have time to think about this.
Correct Answer: B
Rationale: This response indicates the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. It is not appropriate to say that it is not the nurse's decision to make as this would close the conversation and indicates that the nurse is not willing to help the patient with the decision about treatment. Because treatment decisions for breast cancer do need to be made relatively quickly, it is not alright to tell the patient that the decision does not need to be made rapidly. Since the nurse's values and situation are not the same as the patient's, imposing the nurse's opinions during this emotionally vulnerable time is not appropriate.
A patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which of the following findings is most important to report to the health care provider?
- A. There is yellow-green discharge from one of the patient's nipples.
- B. There is an area on the breast that is hot, red, and tender to touch.
- C. The lumps are firm feeling and most are in the upper outer breast quadrants.
- D. The lumps are larger and more painful before the patient's menstrual period.
Correct Answer: B
Rationale: An area that is hot or red suggests an infectious process such as mastitis, which would require further assessment and treatment. The other information will also be reported, but these findings are typical in fibrocystic breasts.
After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about which of the following topics?
- A. Lumpectomy
- B. Lymphatic mapping
- C. Prilocaine
- D. Tamoxifen
Correct Answer: D
Rationale: Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.