Nokea
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.
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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 pathology report for a patient who has had a modified radical mastectomy identifies the tumour as an estrogen-receptor positive adenocarcinoma. Which of the following medications should the nurse include when teaching the patient?
- A. Estradiol
- B. Raloxifene
- C. Tamoxifen
- D. Trastuzumab
Correct Answer: C
Rationale: Tamoxifen is used for estrogen-dependent breast tumours in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumours. Trastuzumab is used to treat tumours that have the HER-2 receptor.
The nurse is teaching a patient about breast self-examination (BSE) who has had a right-sided mastectomy. Which of the following information should the nurse include in the teaching plan?
- A. Only the remaining breast requires a mammogram screening annually.
- B. BSE should be done daily while taking a bath or shower.
- C. Mammograms should be scheduled every two years.
- D. Performing BSE monthly.
Correct Answer: D
Rationale: It is recommended, postmasectomy, that the patient perform monthly BSE on the remaining breast and the surgical site. The most common site of local recurrence of breast cancer is at the surgical site. The woman should undergo appropriate breast imaging at regular intervals (usually 6 months to 1 year), as determined by her risk of recurrence and breast cancer history.
The nurse is caring for a patient with breast cancer who is receiving chemotherapy and tamoxifen. Which of the following findings is most important to communicate to the health care provider?
- A. The patient has symptoms of numbness and tingling in the right arm and leg.
- B. The patient has complaints of fatigue.
- C. The patient eats only $5$ of food on meal tray.
- D. The patient's white blood cell (WBC) count is $5 \times 10^9/L$.
Correct Answer: A
Rationale: One-sided tingling and numbness may indicate a stroke and should be reported to the health care provider. Tamoxifen increases the risk of blood clots, cataracts, stroke, and endometrial cancer in postmenopausal women. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.
The nurse is caring for a patient who is scheduled for stereotactic core biopsy of the breast. Which of the following information should the nurse include in patient education?
- A. A local anaesthetic will be given before the biopsy specimen is obtained.
- B. You will need to lie flat on your back and lie very still during the biopsy.
- C. A thin needle will be inserted into the lump and aspirated to remove tissue.
- D. You should not have anything to eat or drink for 6 hours before the procedure.
Correct Answer: A
Rationale: A local anaesthetic is given before stereotactic biopsy. NPO status is not needed because no sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to obtain the specimens.