Nokea
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.
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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.
The nurse is conducting a breast assessment on a female patient. Which of the following findings is most indicative of a need for further evaluation?
- A. Bilateral nodules that are tender with palpation
- B. A nodule that is $1 \mathrm{cm}$ in size, painlessOf course! Here is a basic salad recipe with some ingredients and steps: painless
- C. and firm"
- D. A lump that increases in size before the menstrual period
- E. A lump that is small, mobile, and has a rubbery consistency
Correct Answer: B
Rationale: Painless and fixed lumps suggest breast cancer, a nodule that is $1 \mathrm{cm}$ in size, firm, and painless suggests breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma.
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.
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 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.