Nokea
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.
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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 patient at high risk for breast cancer is scheduled for an incision biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the patient asks why an incision is being done instead of just removing the mass. What would be the nurses best response?
- A. An incision is performed because its known to be less painful and more accurate than other forms of testing.
- B. An incision is performed to confirm a diagnosis and so that special studies can be done that will help determine the treatment.
- C. An incision is performed to assess the potential for recovery from a mastectomy.
- D. An incision is performed on patients who are younger than the age of 40 and who are otherwise healthy.
Correct Answer: B
Rationale: Incisional biopsy removes a portion of the mass to confirm breast cancer and allows for specialized studies to guide treatment. It is not chosen for pain, age, or mastectomy recovery assessment, and complete mass removal may not be feasible or necessary initially.
A patient is being discharged from the ambulatory surgery center after an incision of a mass in her left breast. What are the criteria for discharging this patient? Select all that apply.
- A. Patient must understand when she can begin ambulating
- B. Patient must have someone to accompany her home
- C. Patients must understand limitations
- D. Patient must understand care of limitations
- E. Patients must understand when she can safely remove her catheter
Correct Answer: B,C,D
Rationale: Discharge criteria include having an escort home, understanding activity restrictions, and knowing biopsy site care. Ambulation is expected before discharge, and urinary catheters are not typically used in this procedure.
A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements?
- A. Modified tendons and ligaments
- B. Connective tissue and smooth muscle
- C. Lobules and ducts
- D. Endocrine glands and sebaceous glands
Correct Answer: C
Rationale: Each breast lobe consists of lobules (milk-producing glands) and ducts (milk transport), which are the functional units of the breast. Tendons, ligaments, smooth muscle, or endocrine/sebaceous glands are not primary components.
A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment?
- A. Lumpectomy and radiation
- B. Partial mastectomy and radiation
- C. Partial mastectomy and chemotherapy
- D. Total mastectomy and chemotherapy
Correct Answer: A
Rationale: A small, well-defined nodule suggests early-stage breast cancer, for which lumpectomy followed by radiation is a common treatment to preserve the breast while effectively treating the cancer. Mastectomy or chemotherapy may be considered for more advanced or aggressive disease, which is not indicated here.