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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.
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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.
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 is assessing a patient with Paget's disease. Which of the following findings should the nurse anticipate that the patient may experience? (Select all that apply.)
- A. Greenish coloured nipple discharge
- B. Itchiness of the breast
- C. Increased temperature
- D. Nipple ulceration
- E. A burning sensation in the breast
Correct Answer: B,D,E
Rationale: A patient with Paget's disease may experience itching, burning sensation, bloody nipple discharge with superficial erosion, and ulceration may be present. A patient with Paget's disease generally does not have a temperature. The discharge is bloody from the nipple, not a greenish colour.
A patient has a saline breast implant inserted in outpatient surgery. Which of the following instructions should the nurse include in the discharge teaching?
- A. Take Aspirin every 4 hours to reduce inflammation.
- B. Check wound drains for excessive blood or any foul odour.
- C. Wear a loose-fitting bra to decrease irritation of the sutures.
- D. Resume normal activities 2 to 3 days after the mammoplasty.
Correct Answer: B
Rationale: The patient should be taught drain care because the drains will be in place for 2 or 3 days after surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.
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.