Nokea
To determine the risk for breast cancer in a patient who has found a small lump in the left breast, which of the following questions is most pertinent for the nurse to ask?
- A. Do you currently smoke cigarettes?
- B. Have you ever had any breast injuries?
- C. At what age did you start having menstrual periods?
- D. Is there any family history of fibroccystic breast changes?
Correct Answer: C
Rationale: Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibroccystic breast changes are not associated with increased breast cancer risk.
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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.
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.
A patient with stage II breast cancer tells the nurse, 'I need to decide about what type of surgery to have, but I feel so overwhelmed that I cannot make any decisions yet! What23 do you think I should do?' Which of the following responses by the nurse is best?
- A. I would have a lumpectomy, but you need to decide what is best for you.
- B. Tell me what you understand about the surgical options that are available.
- C. It would not be appropriate for me to make the decision about your health.
- D. There is no need to make a decision rapidly, you have time to think about this.
Correct Answer: B
Rationale: This response indicates the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. It is not appropriate to say that it is not the nurse's decision to make as this would close the conversation and indicates that the nurse is not willing to help the patient with the decision about treatment. Because treatment decisions for breast cancer do need to be made relatively quickly, it is not alright to tell the patient that the decision does not need to be made rapidly. Since the nurse's values and situation are not the same as the patient's, imposing the nurse's opinions during this emotionally vulnerable time is not appropriate.
When the nurse is working in the women's health care clinic, which of the following actions is appropriate to take?
- A. Educate a healthy 36-year-old about the need for an annual mammogram
- B. Discuss the need for an annual mammography with a 52-year-old.
- C. Talk about magnetic resonance imaging (MRI) with a 26-year-old with a $BRCA-1$ mutation.
- D. Teach an active 70-year-old that mammography frequency should be individualized based upon her history.
Correct Answer: C
Rationale: MRI (in addition to mammography) is recommended for women who are at high risk for breast cancer. A 52-year-old patient should have a mammography every 2 years. Mammography screening is recommended for women starting at age 40 if they are considered high risk for the development of breast cancer. For healthy older women, an individualized plan of care should be discussed with her health care provider.
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.