Chapter 48 Assessment and Management of Patients with Breast Disorders

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Chapter 48  Assessment and Management of Patients with Breast Disorders

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

Multiple Choice

1. A 45-year-old woman comes into the OB/GYN clinic for her yearly check-up. The woman mentions to the nurse that she has a dimpling of the right breast that has occurred in the last 2 weeks. She has not performed a self-breast examination. What assessment would be appropriate for the nurse to make?

A) Evaluate the patient’s milk production B) Palpate the area for a breast mass
C) Order an immediate mammogram
D) Call the physician to schedule a biopsy

Ans: B
Chapter: 48
Client Needs: B
Cognitive Level: Comprehension Difficulty: Moderate
Integrated Process: Nursing Process Objective: 4
Page and Header: 1473, Assessment

Feedback: It would be most important for the nurse to palpate the breast to determine the presence of a mass. Edema and pitting of the skin may result from a neoplasm blocking

lymphatic drainage, giving the skin an orange-peel appearance (peau d’orange), a classic sign of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. A mammogram is an appropriate diagnostic test, but unless the nurse is a practitioner this would not be within the nurse’s realm of practice. A referral could be made to a physician but the nurse would not proceed to schedule a biopsy.

2. The nurse is giving an educational event for a local women’s group on self-examination of the breast. The nurse tells the women’s group to raise their arms and inspect their breasts in a mirror. A member of the women’s group asks the nurse why she needs to do this. What is the nurse’s best response?

A) “It will give you greater visibility.”
B) “If you feel pain you will need to inspect it.” C) “It will help to observe for dimpling.”
D) “Everyone is different in assessing the breast.”

Ans: C
Chapter: 48
Client Needs: B
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process Objective: 2
Page and Header: 1473, Diagnostic Evaluation

Feedback: The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. This maneuver normally elevates both breasts equally. Pain does not always occur with breast masses. The assessment of the breast should be uniform.

3. A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. The diagnosis is positive for breast cancer. The woman asks you when her teenage daughters should begin mammography. What is your best advice?
A) Age 28 years

B) Age 35years C) Age 38 years D) Age 40 years

Ans: C Chapter: 48 Client Needs: B

Cognitive Level: Comprehension Difficulty: Moderate
Integrated Process: Nursing Process Objective: 1

Page and Header: 1476, Diagnostic Evaluation

Feedback: A general guideline is to begin screening 10 years earlier than the age at which the youngest family member developed breast cancer but not before age 25 years. In families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Since their mother developed breast cancer at age 48 years, the client should begin mammography at age 38 years.

4. A woman, scheduled for a simple mastectomy in one week, is having her preoperative teaching done by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period?
A) Limit her intake of green leafy vegetables
B) Increase her water intake to 8 glasses per day
C) Stop taking vitamin E one week before
D) Have nothing by mouth for 24 hours before surgery

Ans: C
Chapter: 48
Client Needs: B
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process Objective: 6
Page and Header: 1479, Diagnostic Evaluation

Feedback: The nurse should instruct the patient to stop taking vitamin E. Vitamin E has an anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and increase bleeding. Increasing fluid intake or being without fluid 24 hours before surgery will have no effect on bleeding.

5. You are caring for a 52-year-old woman whose sisters and mother died of breast cancer. The patient states, “My doctor wants me to take tamoxifen to help prevent breast cancer. What do you think?” What would be your best response?
A) “We call this drug a chemotherapy agent.”

B) “Tamoxifen prevents osteoporosis.” C) “I would recommend raloxifene.”

D) “Tamoxifen reduces the incidence by 49%.”

Ans: D
Chapter: 48
Client Needs: D-2
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 5
Page and Header: 1484, Malignant Conditions of the Breast

Feedback: Tamoxifen is referred to as a chemopreventive agent, not a chemotherapeutic agent. It does prevent osteoporosis, but this response does not address breast cancer prevention. Raloxifene (Evista) is another drug that shows promise as a chemopreventive agent. Tamoxifen reduces breast cancer incidence by 49%.

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