Nokea
The nurse is assessing a patient at the clinic who has metastatic breast cancer and has a new prescription for trastuzumab. Which of the following findings is a reason for the administration of this medication?
- A. Allergic to iodine
- B. HER-2 positive
- C. Immune to tamoxifen
- D. Severely dehydrated
Correct Answer: B
Rationale: For patients who are HER-2 positive, trastuzumab is a monoclonal antibody to HER-2. After the antibody attaches to the antigen, it is taken into the cancer cells and eventually kills them.
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The nurse is assessing a patient with Paget's disease. Which of the following findings should the nurse anticipate that the patient may experience? (Select all that apply.)
- A. Greenish coloured nipple discharge
- B. Itchiness of the breast
- C. Increased temperature
- D. Nipple ulceration
- E. A burning sensation in the breast
Correct Answer: B,D,E
Rationale: A patient with Paget's disease may experience itching, burning sensation, bloody nipple discharge with superficial erosion, and ulceration may be present. A patient with Paget's disease generally does not have a temperature. The discharge is bloody from the nipple, not a greenish colour.
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 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.
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 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.