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Which of the following actions should the nurse take first when caring for a patient who has been admitted for lumpectomy and axillary lymph node dissection?
- A. Teach the patient how to deep breathe and cough.
- B. Discuss options for postoperative pain management.
- C. Explain the post discharge care of the axillary drains.
- D. Ask the patient to describe what she knows about the surgery.
Correct Answer: D
Rationale: Before teaching, the nurse should assess the patient's current knowledge level. The other teaching may also be appropriate, depending on the assessment findings.
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The nurse is caring for a patient who has had a right mastectomy and the patient asks the nurse how long the biannual mammography will have to continue. Which of the following time frames should the nurse inform the patient is recommended for mammography postmastectomy?
- A. Every 6 months for a year
- B. Every 6 months for 2 years
- C. Every 6 months for 3 years
- D. Every 6 months for life
Correct Answer: B
Rationale: The patient should undergo appropriate breast imaging at regular intervals (usually 6 months to 1 year) for two consecutive years.
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.
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.
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.