Nokea
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.
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The nurse is assessing a patient at the clinic who has metastatic breast cancer and has a new prescription for trastuzumab. Which of the following findings is a reason for the administration of this medication?
- A. Allergic to iodine
- B. HER-2 positive
- C. Immune to tamoxifen
- D. Severely dehydrated
Correct Answer: B
Rationale: For patients who are HER-2 positive, trastuzumab is a monoclonal antibody to HER-2. After the antibody attaches to the antigen, it is taken into the cancer cells and eventually kills them.
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.
The nurse is caring for a patient with left arm lymphedema. Which of the following actions should be included in the plan of care?
- A. Check BP on both right and left arms.
- B. Avoid isometric exercise on the left arm.
- C. Assist with application of compression dressings.
- D. Keep the left arm at or below the level of the heart.
Correct Answer: C
Rationale: Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's right arm. The arm should not be placed in a dependent position.
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.
The nurse is teaching a patient about breast self-examination (BSE) who has had a right-sided mastectomy. Which of the following information should the nurse include in the teaching plan?
- A. Only the remaining breast requires a mammogram screening annually.
- B. BSE should be done daily while taking a bath or shower.
- C. Mammograms should be scheduled every two years.
- D. Performing BSE monthly.
Correct Answer: D
Rationale: It is recommended, postmasectomy, that the patient perform monthly BSE on the remaining breast and the surgical site. The most common site of local recurrence of breast cancer is at the surgical site. The woman should undergo appropriate breast imaging at regular intervals (usually 6 months to 1 year), as determined by her risk of recurrence and breast cancer history.