Nokea
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.
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A suspicious breast lump is noted on a mammogram. The client asks the nurse which diagnostic test confirms if the lump is cancerous or benign. Which response by the nurse is most correct?
- A. An ultrasound
- B. A biopsy
- C. A magnetic resonance imaging (MRI)
- D. A clinical breast exam
Correct Answer: B
Rationale: To confirm whether a breast lump is cancerous or benign, a tissue sample must be obtained to examine the cells. Although an ultrasound, MRI, and clinical breast exam provide data on the characteristics of the lump, only examining the tissue can specifically identify if and what type of cancer is present.
A nurse is describing to a client the advantages and disadvantages associated with tamoxifen therapy as a means of breast cancer prevention. The nurse would identify that the drug has a beneficial effect on which factor?
- A. Bone mineral density
- B. High density lipoprotein levels
- C. Risk for endometrial cancer
- D. Cataract formation
Correct Answer: A
Rationale: Besides reducing the risk of breast cancer, tamoxifen preserves bone mineral density, thus preventing osteoporosis. It also lowers the low-density lipoprotein cholesterol levels, although it is still unknown if it decreases the incidence of myocardial infarction in women. Tamoxifen can have detrimental effects. It increases the incidences of endometrial cancer, deep vein thrombosis, pulmonary embolism, and cataracts.
The nurse is caring for a client whose physician has ordered a sentinel lymph node mapping. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction?
- A. The procedure allows for an understanding of the spread of cancer cells.
- B. The procedure allows for conservation of breast tissue.
- C. The procedure removes all cancer from the body.
- D. The procedure includes minimal surrounding tissue damage.
Correct Answer: C
Rationale: Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.
The nurse is caring for a client following breast reconstruction surgery using autogenous tissue. When assessing wounds from the surgical procedure, in which area would the nurse assess the wound from which tissue was taken?
- A. The vastus lateralis
- B. The rectus femoris
- C. Gluteus maximus
- D. Rectus abdominis
Correct Answer: D
Rationale: The area in which tissue is taken for breast reconstruction surgery is from the rectus abdominis muscle in a manner similar to a 'tummy tuck.' The nurse must assess this site for healing or complications.
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.