Nokea
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.
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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 caring for a patient following breast augmentation surgery. Which of the following information should the nurse include in patient teaching?
- A. A drain will be in place for 24 hours after the surgery and then removed.
- B. Temperature will be monitored every 4 hours postoperatively.
- C. A compression dressing will be in place for 5-7 days.
- D. Most women can resume normal activities 1 week postoperative.
Correct Answer: B
Rationale: The patient's temperature should be monitored. Breast augmentation patients have drains in place in the surgical site to prevent hematoma formation and then removed 2 to 3 days after surgery, or when drainage is less than 20 to 30 mL per day. The drainage must be examined for colour and odour to detect postoperative infection or hemorrhage. A compression dressing is not kept in place for 5-7 days, dressings should be changed as necessary with sterile technique and prescribed. Depending on the extent of the operation, most women can resume normal activities within 2 to 3 weeks. Strenuous exercise may not be appropriate until several weeks later.
The nurse is caring for a patient who has had a right mastectomy and the patient asks the nurse how long the biannual mammography will have to continue. Which of the following time frames should the nurse inform the patient is recommended for mammography postmastectomy?
- A. Every 6 months for a year
- B. Every 6 months for 2 years
- C. Every 6 months for 3 years
- D. Every 6 months for life
Correct Answer: B
Rationale: The patient should undergo appropriate breast imaging at regular intervals (usually 6 months to 1 year) for two consecutive years.
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.
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.