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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.
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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 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 has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen. Which of the following patient statements indicate that the teaching has been effective?
- A. I will expect to have leg cramps with this drug.
- B. I will call the clinic if I develop any hot flashes.
- C. I will be taking the medication for at least a year.
- D. I will call immediately if I experience cloudy and blurred vision.
Correct Answer: D
Rationale: Blurred and cloudy vision should be immediately reported because it is likely that the patient is developing cataracts and the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected adverse effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.
A patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic with these symptoms. Which of the following findings is most important to report to the health care provider?
- A. There is yellow-green discharge from one of the patient's nipples.
- B. There is an area on the breast that is hot, red, and tender to touch.
- C. The lumps are firm feeling and most are in the upper outer breast quadrants.
- D. The lumps are larger and more painful before the patient's menstrual period.
Correct Answer: B
Rationale: An area that is hot or red suggests an infectious process such as mastitis, which would require further assessment and treatment. The other information will also be reported, but these findings are typical in fibrocystic breasts.
Which of the following information should the nurse include when teaching a patient about the transverse rectus abdominis musculocutaneous (TRAM) procedure?
- A. Saline-filled implants are placed under the pectoral muscles.
- B. Recovery from the TRAM surgery takes at least 6 to 8 weeks.
- C. Muscle tissue is removed from the back and used to form a breast.
- D. TRAM flap procedures may be done in outpatient surgery centres.
Correct Answer: B
Rationale: Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and requires postoperative hospitalization. Saline implants are used in mammoplasty.