Nokea
The nurse is caring for four clients in an oncology unit. Following report, which client would the nurse identify as having the most life-threatening diagnosis?
- A. A client with stage IV cancer receiving palliative care
- B. A client diagnosed with a stage one tumor with no lymph node involvement
- C. A client receiving chemotherapy and radiation with a low blood count
- D. A client with an estrogen receptor-positive tumor receiving oral chemotherapy
Correct Answer: A
Rationale: The client with stage IV cancer, indicating metastasis, and receiving palliative care, which includes comfort measures, is in highest life-threatening condition. A client with a stage I tumor and no lymph node involvement has a good prognosis as the cancer has been caught at an early stage. A low blood count is common when the client is receiving chemotherapy. It is common to have chemotherapy and radiation as a treatment regimen. Clients have experienced good prognosis with estrogen receptor positive tumor treatment of oral chemotherapy.
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A client complains of having tender and painful breasts, often feeling multiple jumps within the breast tissue. The nurse would need to gather additional information about which of the following?
- A. Alcohol and caffeine consumption
- B. Client's workplace in relation to the surroundings
- C. Timing of symptoms in relation to the menstrual cycle
- D. Bathing frequency and living surroundings
Correct Answer: C
Rationale: Considering that the client has tender and painful breasts and often feels lumps within her breast tissue, it is most likely that she suffers from fibrocystic breast disease. To confirm these findings, the nurse should ask relevant questions about the characteristics and timing of symptoms in relation to the menstrual cycle. Symptoms of fibrocystic breast disease are noticeable before menstruation and usually state during menstruation. The size of one cyst becomes larger before menstruation and often changes with the menstrual cycle. The nurse should further ask the client about her habits of smoking and consuming coffee, chocolate, and caffeinated soft drinks, not alcohol, because they aggravate the condition. Workplace surroundings or cleanliness habits do not matter because fibrocystic breast disease is not infectious.
The nurse is caring for a breastfeeding client who has developed a breast abscess. When instructing on the cause of abscess formation, which organism is the most common cause?
- A. Staphylococcus aureus
- B. Escherichia coli
- C. Pseudomonas aeruginosa
- D. Enterococcus faecalis
Correct Answer: A
Rationale: An abscess in the breast is most frequently a complication of mastitis. The most common cause is Staphylococcus aureus (S. aureus).
The nurse is caring for a client who has been diagnosed with a breast lump. The physician states that studies indicate a cancerous tumor in situ. The client is anxious and wants to know what may come next. The nurse is most correct to support physician instruction of which of the following?
- A. Since your tumor appears localized, removal of the tumor is indicated.
- B. A mastectomy is recommended for all clients in this situation.
- C. The next step is just as the physician described. We can have the physician talk to you again.
- D. Chemotherapy and radiation are typical treatments prescribed by the oncologist.
Correct Answer: A
Rationale: The nurse is correct to restate the information that the physician has just discussed. Many times, anxious clients have a difficult time understanding information. The nurse realizes that a tumor that is in situ has developed in a localized area without invading the surrounding tissue. This criterion would allow the removal of tissue from only that area, not an entire mastectomy. When the client asks for the next step, chemotherapy and radiation, as indicated, would be initiated after removal of the tumor.
While the nurse is providing education for a client with a family history of breast cancer, the client asks, 'What is the most common type of breast cancer?' What is the correct response from the nurse?
- A. Inflammatory breast cancer
- B. Ductal carcinoma
- C. Lobular carcinoma
- D. Medullary carcinoma
Correct Answer: B
Rationale: Ductal carcinoma makes up 70% to 80% of cases of breast malignancy. Inflammatory breast cancer is 1% to 5%, lobular carcinoma is 5% to 10%, and medullary carcinoma is the rarest among those listed.
A client with a painless, firm, notender lump in the breast is being scheduled for diagnostic testing. Which test would the nurse expect the physician to order?
- A. Standard mammogram
- B. Ultrasound
- C. Excisional biopsy
- D. Culture of discharge
Correct Answer: B
Rationale: Ultrasound can reveal physical characteristics unique to a fibroadenom a versus malignant mass with a higher degree of accuracy than standard mammography. In the case of very young women - an atypical age for breast cancer - an excisional biopsy is performed only if the mass changes or becomes larger. If the mass is detected in a woman with a higher risk for developing breast cancer, such as one with a family history or of an older age, a biopsy is performed to confirm that the tissue is indeed benign. There is no discharge to culture.