Nokea
The nurse is assessing a male patient and notes bilateral enlargement of the breasts. Which of the following actions should the nurse take first?
- A. Question the patient about any medications being currently used.
- B. Teach the patient about how to palpate the breast tissue for lumps.
- C. Refer the patient for mammography and biopsy of the breast tissue.
- D. Explain that this is a temporary condition due to hormonal changes.
Correct Answer: A
Rationale: The first action should be further assessment. Since gynecomastia is a possible adverse effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.
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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 at menopausal symptoms and considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. Which of the following information should the nurse include when discussing HRT with the patient?
- A. HRT does not appear to increase the risk for breast cancer unless there are other risk factors.
- B. HRT is a safe therapy for menopausal symptoms if there is no family history of $BRCA$ genes.
- C. She and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer.
- D. Alternative therapies with herbs and natural drugs are as effective as estrogen in relieving menopausal symptoms.
Correct Answer: C
Rationale: Because Happened to have been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.
The nurse is preparing a patient with a small immobile breast lump for a fine-needle aspiration (FNA) biopsy. Which of the following information about the procedure should the nurse explain to the patient?
- A. FNA is done in the outpatient clinic, and results are available in 1 to 2 days.
- B. Only a small incision is needed, resulting in minimal breast pain and scarring.
- C. If the biopsy results are negative, no further diagnostic testing will be needed.
- D. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
Correct Answer: A
Rationale: FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is needed. FNA may be guided by ultrasound, but not by mammogram. Since the immobility of the breast lump suggests cancer, further testing will be done if the FNA is negative.
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.
Which of the following statements by a patient newly diagnosed with stage I breast cancer indicates to the nurse that patient teaching may be needed?
- A. There are several options available for treating the cancer.
- B. I will probably need radiation to the breast after having the surgery.
- C. I can probably have reconstructive surgery at the same time as a mastectomy.
- D. Mastectomy will be the best choice to decrease the chance of cancer recurrence.
Correct Answer: D
Rationale: The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.