Nokea
During a follow-up visit, a female client who underwent a mastectomy presents with an infection that requires an antibiotic. The client reports having been doing some gardening. What further instruction and reinforcement of teaching should the nurse provide?
- A. Avoid working in the garden or yard altogether.
- B. Wear gloves and protective clothing to avoid any injuries.
- C. Increase the frequency of follow-up visits if she does work.
- D. Avoid household chores for at least 6 to 9 months.
Correct Answer: B
Rationale: The nurse should recommend that the client wear gloves when doing backyard work or housework to prevent injuries that may heal slowly or become infected. Working, whether it is in the backyard or doing some household chores, can be helpful in promoting feelings of usefulness, thereby increasing the client reporting abilities and self-state. The client should be advised to follow up more frequently, however, this would not help prevent any untoward injury.
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A client with a painless, firm, notender lump in the breast is being scheduled for diagnostic testing. Which test would the nurse expect the physician to order?
- A. Standard mammogram
- B. Ultrasound
- C. Excisional biopsy
- D. Culture of discharge
Correct Answer: B
Rationale: Ultrasound can reveal physical characteristics unique to a fibroadenom a versus malignant mass with a higher degree of accuracy than standard mammography. In the case of very young women - an atypical age for breast cancer - an excisional biopsy is performed only if the mass changes or becomes larger. If the mass is detected in a woman with a higher risk for developing breast cancer, such as one with a family history or of an older age, a biopsy is performed to confirm that the tissue is indeed benign. There is no discharge to culture.
The nurse is caring for a client following breast reconstruction surgery using autogenous tissue. When assessing wounds from the surgical procedure, in which area would the nurse assess the wound from which tissue was taken?
- A. The vastus lateralis
- B. The rectus femoris
- C. Gluteus maximus
- D. Rectus abdominis
Correct Answer: D
Rationale: The area in which tissue is taken for breast reconstruction surgery is from the rectus abdominis muscle in a manner similar to a 'tummy tuck.' The nurse must assess this site for healing or complications.
The nurse is working at an oncologist's office specializing in breast cancer. The nurse cares for individuals of varied ages, backgrounds, and stages of breast cancer. Which criteria are considered a priority when determining adjunct treatment in addition to surgery? Select all that apply.
- A. Stage of tumor
- B. Cosmetic consequence
- C. Presence of metastasis
- D. Age
- E. Gender
- F. Sensitivity to estrogen
Correct Answer: A,C,D,F
Rationale: When working in an oncologist's office, the nurse is correct to identify that the stage of tumor and presence of metastasis help to guide treatment. Other factors include age of client and sensitivity to estrogen. Cosmetic consequence is not considered a priority when considering lifesaving treatment options. Many times, reconstruction is a possibility. Gender is not a consideration because treatment options are very similar.
The nurse is caring for a client who will be having artificial implants for breast reconstruction. The client is arriving at the physician's office for which procedure to be completed before the surgery can be done?
- A. Incisional alignment
- B. Tissue expansion
- C. Fluid drainage
- D. Pain control
Correct Answer: B
Rationale: Before an implant for breast reconstruction can produce an optimum cosmetic appearance, the skin and tissue on the chest wall are expanded to provide a large enough space to fill and approximate the size of the remaining breast. The other options are not correct.
The lactation nurse is caring for a mother who is 2 weeks postpartum and has mastitis. Which statement, made by the client, requires instruction and is the probable cause of the mastitis?
- A. I feed the baby every 2 hours.
- B. I break the baby's such before pulling the baby off of the breast.
- C. I nurse the baby on one breast each feeding.
- D. I use a lanolin ointment on my dry nipples.
Correct Answer: C
Rationale: Because the client has mastitis, emptying each breast with alternate feedings is important. The baby's such is strongest at the beginning of the feeding, thus, the mother should alternate the breast that the baby starts nursing from. If not, one breast would not be drained of the milk.