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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.
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After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about which of the following topics?
- A. Lumpectomy
- B. Lymphatic mapping
- C. Prilocaine
- D. Tamoxifen
Correct Answer: D
Rationale: Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.
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.
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.
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 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.