Nokea
The nurse is caring for a client diagnosed with ductal carcinoma and lymph node involvement. Which diagnostic test, ordered by the physician, does the nurse identify as assessing possible metastasis?
- A. A complete blood count
- B. A chest x-ray
- C. A multiple gated acquisition (MUGA) scan
- D. A bone density test
Correct Answer: B
Rationale: A chest x-ray can identify any tumors present in the lung fields. Lymph nodes containing cancer cells are commonly involved in metastasis, which most frequently spreads to the skeletal and pulmonary systems (in that order). In addition, metastases may be found in the brain, adrenals, and liver. A blood count will not detect metastasis. A bone density study or MUGA scan will not detect metastasis.
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The nurse is obtaining a history from a client who states recurrent breast tenderness. The client inquiries if there is something wrong with her breasts. Which question by the nurse is a priority?
- A. Do you have a history of breast disorders and cancer in the family?
- B. Does the tenderness occur around the same time each month?
- C. Have you pulled a muscle or had any injury to the breast?
- D. When did you first recognize the symptoms?
Correct Answer: B
Rationale: The breasts are part of the female reproductive system, and they respond to the hormonal cycle associated with ovulation, menstruation, and pregnancy. Because the hormonal cycle is monthly, it is best to ask the client if the tenderness occurs at the same time each month. The other options are also important questions to ask.
The nurse is providing shift report related to a client newly received back to the unit from the post anesthesia care unit (PACU). The nurse is stating that the client had breast tissue removed with 7 of 14 lymph nodes, the lining of the chest muscles and pectoralis major and minor muscles removed. The oncoming nurse documents which procedure completed?
- A. A segmental mastectomy
- B. A total mastectomy
- C. A modified radical mastectomy
- D. A radical mastectomy
Correct Answer: D
Rationale: A modified radical mastectomy is a procedure in which the breast, some lymph nodes, the lining over the chest muscles, and the pectoralis minor muscle are removed. A segmental mastectomy is where the tumor and some breast tissue and lymph nodes are removed. A total mastectomy includes only breast tissue. A radical mastectomy removes the breast, axillary lymph nodes, and pectoralis major and minor muscles. Sternal lymph nodes may also be removed with this procedure.
A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which rationale does the nurse give for the use of this group of drugs?
- A. They prevent prehormones from becoming estrogen, blocking the tumor's ability to use it.
- B. They block progesterone-dependent tumors from growing.
- C. They attack to endogenous protein receptors to slow the growth of cancerous cells.
- D. They stimulate the immune system to attack a protein common in many tumors.
Correct Answer: A
Rationale: Aromatase inhibitors prevent prehormones from becoming estrogen thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth. Antiprogogestin drug, such as antipeptide, blocks progesterone-dependent breast cancers. A monoclonal antibody, resuzumab attacks to protein receptors to slow the growth of cancer cells. A breast cancer vaccine is under investigation in Italy. This vaccine stimulates the immune system to attack a protein called mammaglobin-A, which is found in 80% of breast cancer tumors.
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.
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.