Nokea
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.
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When the nurse is working in the women's health care clinic, which of the following actions is appropriate to take?
- A. Educate a healthy 36-year-old about the need for an annual mammogram
- B. Discuss the need for an annual mammography with a 52-year-old.
- C. Talk about magnetic resonance imaging (MRI) with a 26-year-old with a $BRCA-1$ mutation.
- D. Teach an active 70-year-old that mammography frequency should be individualized based upon her history.
Correct Answer: C
Rationale: MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A 52-year-old patient should have a mammography every 2 years. Mammography screening is recommended for women starting at age 40 if they are considered high risk for the development of breast cancer. For healthy older women, an individualized plan of care should be discussed with her health care provider.
Which of the following actions should the nurse take first when caring for a patient who has been admitted for lumpectomy and axillary lymph node dissection?
- A. Teach the patient how to deep breathe and cough.
- B. Discuss options for postoperative pain management.
- C. Explain the post discharge care of the axillary drains.
- D. Ask the patient to describe what she knows about the surgery.
Correct Answer: D
Rationale: Before teaching, the nurse should assess the patient's current knowledge level. The other teaching may also be appropriate, depending on the assessment findings.
The nurse is caring for a patient with left arm lymphedema. Which of the following actions should be included in the plan of care?
- A. Check BP on both right and left arms.
- B. Avoid isometric exercise on the left arm.
- C. Assist with application of compression dressings.
- D. Keep the left arm at or below the level of the heart.
Correct Answer: C
Rationale: Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's right arm. The arm should not be placed in a dependent position.
The nurse is caring for a patient who returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. Which of the following nursing actions should be included in the plan of care?
- A. Insist that the patient examine the surgical incision when the dressings are removed.
- B. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes.
- C. Post a sign at the bedside warning against blood pressures or venipunctures in the right arm.
- D. Obtain a permanent breast prosthesis for the patient before she is discharged from the hospital.
Correct Answer: C
Rationale: The patient is at risk for lymphedema and infection if blood pressures or venipunctures are done on the right arm. The patient is taught to use the PCA as needed for pain control rather than at a set time. The nurse allows the patient to examine the incision and participate in care when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks after surgery.
A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast cancer. Which of the following topics indicate that the student needs more education about breast cancer diagnostic testing?
- A. A firm, moveable mass is most often breast cancer
- B. HER-2 receptor testing
- C. Estrogen receptor testing
- D. Oncotype DX assay testing
Correct Answer: A
Rationale: A firm, moveable mass is characteristic of fibroadenoma, not breast cancer. The other tests are likely to be used for additional diagnostic testing in a patient with breast cancer.