NCLEX Breast Cancer

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C. Assess blood pressure only on unaffected arm.
The nurse is caring for a patient diagnosed with breast cancer
who just underwent an axillary lymph node dissection. What in- Blood pressure readings, venipunctures, and injections should not
tervention should the nurse use to decrease the lymphedema? be done on the affected arm. Elastic bandages should not be used
A. Keep affected arm flat at the patient's side. in the early postoperative period because they inhibit collateral
B. Apply an elastic bandage on the affected arm. lymph drainage. The affected arm should be elevated above the
C. Assess blood pressure only on unaffected arm. heart, and isometric exercises are recommended and gradually
D. Restrict exercise of the affected arm for 1 week. increased starting in the recovery room to reduce fluid volume in
the arm.
A. Nulliparity
C. Early menarche
The nurse is volunteering at a community center to teach women
D. Late menopause
about breast cancer. What should the nurse include when dis-
E. Personal history of colon cancer
cussing risk factors (select all that apply)?
A. Nulliparity
Women are at an increased risk for development of breast cancer
B. Age 30 or over
if they are over the age of 50; have a family history of breast
C. Early menarche
cancer; have a personal history of breast, colon, endometrial,
D. Late menopause
or ovarian cancer; have a long menstrual history as seen with
E. Personal history of colon cancer
early menarche or late menopause; and have had a first full-term
pregnancy after the age of 30 or are nulliparous.
The nurse has been asked to participate in a healthy living work-
shop. While teaching about women's health, which guidelines B. "It's recommended that you get a mammogram each year after
should the nurse provide to the audience? you turn 40."
A. "Mammograms are necessary if you have a family history of
breast cancer." Annual mammograms are recommended after age 40. They are
B. "It's recommended that you get a mammogram each year after recommended for all women, not solely those with a family history
you turn 40." of breast cancer. BSE is not a replacement for mammography, and
C. "If you are not able to perform breast self-examination (BSE), clinical breast examinations are not necessary at each office visit,
you should go for regular mammograms." but recommended at least every 3 years for women in their 20s
D. "You should ensure that your primary care provider performs a and 30s, and then every year beginning at age 40.
breast exam each time you visit."
A 51-year-old woman has recently had a unilateral, right total
mastectomy and axillary node dissection for the treatment of D. Promote gradually increasing mobility as soon as possible
breast cancer. What nursing intervention should the nurse include following surgery.
in the patient's care?
A. Immobilize the patient's right arm until postoperative day 3. Mobility should be encouraged beginning in the postanesthesia
B. Maintain the patient's right arm in a dependent position when care unit (PACU) and increased gradually throughout the patient's
at rest. recovery. Immobilization is counterproductive to recovery, and the
C. Administer diuretics prophylactically for the prevention of lym- limb should not be in a dependent position. Diuretics are not used
phedema. to prevent lymphedema but may be used in active treatment of the
D. Promote gradually increasing mobility as soon as possible problem.
following surgery.
Which task could the registered nurse delegate to unlicensed as-
sistive personnel (UAP) during the care of a patient who has had B. Mobilize the patient in a slightly hunched position.
recent transverse rectus abdominis musculocutaneous (TRAM)
flap surgery? Mobilization of a postsurgical patient may be delegated, and
A. Document the condition of the patient's incisions. the patient who has had a TRAM flap should not stand or walk
B. Mobilize the patient in a slightly hunched position. fully erect, in order to minimize strain on the incisions. Changing
C. Change the patient's abdominal and chest dressings. dressings, assessing wounds, and reprogramming a PCA pump
D. Change the parameters of the patient-controlled analgesic are not appropriate tasks to delegate to UAP.
(PCA) pump.
A 50-year-old patient is preparing to begin breast cancer treat-
B. "It's important that you let your care provider know about any
ment with tamoxifen (Nolvadex). What point should the nurse em-
changes in your vision."
phasize when teaching the patient about her new drug regimen?
A. "You may find that your medication causes some breast sen-
Tamoxifen has the potential to cause cataracts and retinopa-
sitivity."
thy. The drug is likely to exacerbate rather than alleviate peri-
B. "It's important that you let your care provider know about any
menopausal symptoms. Breast tenderness is not associated with
changes in your vision."
tamoxifen, and it is not necessary for the patient to abstain from
C. "You'll find that this drug often alleviates some of the symptoms
alcohol.
that accompany menopause."

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 NCLEX Breast Cancer
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D. "It's imperative that you abstain from drinking alcohol after you
begin taking tamoxifen."
When doing breast self-examination, the female patient should C. Left nipple deviation
report which findings to her physician?
A. Palpable rib margins Unilateral deviation of a nipple may be a clinical indicator of breast
B. Denser breast tissue cancer or other problem and should be reported to the health care
C. Left nipple deviation provider. Dense breast tissue, palpable rib margins, and different
D. Different sized breasts sized breasts are all normal findings.
D. Assess the patient's response to the diagnosis of breast cancer.
The patient with breast cancer has a left mastectomy with axillary
node dissection. Ten lymph nodes are resected with three positive
Assessment is the first step in planning patient care. Because the
for malignant cells. The patient has stage IIB breast cancer. What
nurse is the patient's advocate and this is an extremely stressful
is the best nursing intervention to use in planning care?
time for the patient and family, the nurse should focus on the pa-
A. Evaluate left arm lymphatic accumulation. Incorrect
tient's response to the diagnosis of breast cancer when planning
B. Maintain joint flexibility and left arm function.
care for this patient. The approach for the care of the left arm and
C. Teach her about chemotherapy and radiation therapy.
teaching the patient about further therapy will be based on this
D. Assess the patient's response to the diagnosis of breast cancer.
assessment.
A. Improve the woman's self-image
A 72-year-old patient who had a mastectomy for breast cancer
6 months ago wants to have breast reconstructive surgery. The
The most likely motivation for this patient to seek breast recon-
nurse knows that what is the most likely motivation for this patient
structive surgery is to improve her self-esteem. With this surgery,
seeking this surgery?
she will not be able to experience sexual arousal or restore the
A. Improve the woman's self-image
pre-mastectomy appearance of the breast. The abdominoplasty
B. Be able to experience sexual arousal
(tummy tuck) effect will only be a possibility with the transverse
C. To get a tummy tuck as well as the breast mound
rectus abdominis musculocutaneous (TRAM) flap, not with a
D. Restore the pre-mastectomy appearance of the breast
breast implant or tissue expansion.
D. "Self-breast examination is a reliable way to detect breast
The nurse teaches a 53-year-old patient about screening for
cancer early."
early detection of breast cancer. Which statement by the patient
requires an intervention by the nurse?
Screening for the early detection of breast cancer includes yearly
A. "I should plan to have a mammogram every year."
mammograms starting at age 40 and clinical breast examina-
B. "I will see a health care provider every year for a breast
tion every year at age 40. An alternative suggestion is to begin
examination."
screening mammograms at age 50. Breast self-examination has
C. "A breast examination should be done right after my menstrual
benefits and limitations and may not be a reliable method for early
period."
detection of breast cancer. BSE is optional but should be done in
D. "Self-breast examination is a reliable way to detect breast
premenopausal women right after the menstrual period when the
cancer early."
breasts are less lumpy and tender.
C. A 72-year-old female with a family history of breast cancer
The nurse caring for patients in a primary care clinic identifies
which patient as being the most at risk for the development of The risk factors most associated with breast cancer are female
breast cancer? gender, advancing age, and family history. The incidence of breast
A. A 25-year-old female with fibrocystic breast disease cancer increases dramatically after age 60. Mutations in BRCA
B. A 59-year-old male who has inherited the APC gene genes may cause 5% to 10% of breast cancers; APC gene is
C. A 72-year-old female with a family history of breast cancer associated with colon cancer. Obesity and physical inactivity in-
D. A 43-year-old male who is obese and leads a sedentary lifestyle crease the risk for breast cancer. Fibrocystic breast disease is not
associated with the development of breast cancer.
C. Irregular, nontender lump with induration

Clinical manifestations of breast cancer may include a palpable

The nurse performs a breast examination on a 68-year-old female
lump that is hard, irregular, poorly delineated, nonmobile, and
patient. Which clinical manifestation, if assessed by the nurse,
nontender. Nipple retraction, peau d'orange, induration, and dim-
indicates that further evaluation for breast cancer is needed?
pling of the overlying skin may also be noted. Mastitis presents
A. Bilateral pendulous breasts
with breasts that are warm to touch, indurated, and painful. Atro-
B. Right breast is warm, painful to touch
phy of the mammary glands associated with aging may result in
C. Irregular, nontender lump with induration
pendulous breasts. Manifestations of fibrocystic breast changes
D. Palpable lump that is tender and movable
include palpable lumps that are round, well delineated, and freely
movable. The lump is usually tender and increases in size and
tenderness before menstruation.
C. Monitor cardiac rhythm.

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The nurse is caring for a 52-year-old woman with breast cancer
who is receiving high-dose doxorubicin (Adriamycin). Which as-
sessment is most important for the nurse to make?
A. Observe for alopecia.
B. Determine visual acuity.
C. Monitor cardiac rhythm.
E. Assess mouth and throat.
The nurse is caring for an obese 67-year-old woman after a right
mastectomy with axillary lymph node dissection. Which should the
nurse include in the discharge instructions?
A. "Arm exercises should not be started for 4 to 6 weeks."
B. "Discontinue arm exercises if you have discomfort or pain."
C. "Special massage therapy can decrease swelling in your arm."
D. "Keep your right arm in a sling to decrease pain and swelling."
The 60-year-old woman comes to the clinic 3 years after her
last regular appointment. She reports occasional diffuse breast
tenderness, aching, and soreness. What do you anticipate will
happen first?
A. Magnetic resonance imaging (MRI)
B. Mammography
C. Teaching the patient to take vitamin E
D. Teaching continual wearing of a support bra
What are the current guidelines for breast cancer screening?
A. Yearly mammograms starting at age 40
B. Breast self-examination (BSE) monthly for women starting at
age 20
C. Breast ultrasound every 5 years after age 50
D. Clinical breast examination (CBE) yearly starting at age 20
A young woman was just told by her physician that she has breast
cancer. What is your most appropriate action?
A. Offer to answer questions.
B. Call the chaplain.
C. Leave her alone to give her privacy.
D. Encourage her to talk about her feelings.
You are a community health nurse planning a program on breast
cancer screening guidelines for women in the neighborhood.
What would you include to best promote learning and adherence
of the participants (select all that apply)?
A. Short audiotape on the BSE procedure
B. Packet of articles from the medical literature
C. Written guidelines for mammography and CBE
D. Discussion of the value of early breast cancer detection
E. Need to get mammogram starting at age 35
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Doxorubicin (especially at high doses) may cause cardiotoxicity
and heart failure. The nurse should monitor for cardiac dysrhyth-
mias, electrocardiogram changes, and clinical manifestations of
heart failure. Other adverse effects of doxorubicin include stom-
atitis and alopecia, but these effects are not as serious as cardiac
problems. Tamoxifen may cause visual changes.
C. "Special massage therapy can decrease swelling in your arm."
Decongestive therapy may be used for acute lymphedema and
includes a massage-like technique to mobilize the subcutaneous
accumulation of fluid. Arm exercises should be performed to
prevent contractures and muscle shortening, maintain muscle
tone, and improve lymph and blood circulation. The arm exer-
cises should be initiated after surgery and increased gradually.
Pain medications should be administered 30 minutes before arm
exercises. The operative arm should be kept at the level of the
heart but not in a sling; a sling discourages use of the arm.
B. Mammography
Although these symptoms can indicate benign mastalgia, mam-
mography is anticipated to exclude cancer and provide informa-
tion on the cause of mastalgia. Usually, mastalgia improves after
menopause, and the current recommendation for mammograms
is yearly after age 40. MRI is used for screening in high-risk
women, including those whose mammography or ultrasound re-
sult is suspicious for malignancy and women who previously had
an occult breast cancer detected by mammography. Self-help
measures to treat mastalgia are considered after cancer has been
excluded.
A. Yearly mammograms starting at age 40
Yearly mammograms should start at age 40 and continue for as
long as a woman is in good health. BSE is considered optional,
but if done, it should start at age 20. Breast ultrasound is used with
mammography to differentiate a solid mass from a cystic mass, to
evaluate a mass in a pregnant or lactating woman, or to locate and
biopsy a suspicious lesion seen on magnetic resonance imaging
(MRI). It is not used in screening. CBE preferably is done at least
every 3 years for women between the ages of 20 and 30 years
and every year for women beginning at age 40.
Reference: 1306-1307
D. Encourage her to talk about her feelings.
In a crisis, talking about feelings and letting the patient take the
lead is the best approach.
Reference: 1323
C. Written guidelines for mammography and CBE
D. Discussion of the value of early breast cancer detection
When teaching women about breast cancer screening guide-
lines, include information about potential benefits, limitations, and
harm (chance of a false-positive result). Allow time for questions
about the procedure and a return demonstration. At every periodic
health examination, ask the woman who is performing BSE to
demonstrate her technique. Demonstration of BSE and provision
of written guidelines are appropriate teaching methods.
Reference: 1307
 NCLEX Breast Cancer
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In teaching a patient who wants to perform BSE, you inform her
that the technique involves palpation of the breast tissue and
A. palpation of cervical lymph nodes.
B. hard squeezing of the breast tissue.
C. a mammogram to evaluate breast tissue.
D. inspection of the breasts for any changes.
When discussing risk factors for breast cancer with a group of
women, you emphasize that the greatest known risk factor for
breast cancer is
A. being a woman older than 60 years.
B. experiencing menstruation for 40 years or longer.
C. using hormone replacement therapy during menopause.
D. having a paternal grandmother with postmenopausal breast
cancer.
A patient with breast cancer has a lumpectomy with sentinel
lymph node biopsy that is positive for cancer. For the other tests
done to determine the risk for cancer recurrence or spread, what
results support a more favorable prognosis (select all that apply)?
A. Well-differentiated tumor
B. Estrogen receptor-positive tumor
C. Involvement of two to four axillary nodes
D. Overexpression of the HER2 protein
E. High DNA proliferative index
A modified radical mastectomy with an axillary lymph node dis-
section has been scheduled for your patient with breast cancer.
What will you do postoperatively to restore arm function on the
affected side?
A. Apply heating pads or blankets to increase circulation.
B. Place daily ice packs to minimize the risk of lymphedema.
C. Teach passive exercises with the affected arm in a dependent
position.
D. Emphasize regular exercise for the affected shoulder to in-
crease range of motion.
Preoperatively, to meet the psychologic needs of a woman sched-
uled for a modified radical mastectomy, you would
A. discuss the limitations of breast reconstruction.
B. include her significant other in all conversations.
C. promote an environment for expression of feelings.
D. explain the importance of regular follow-up screening.
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D. inspection of the breasts for any changes.
BSE is performed by palpation of breast tissue with three levels
of pressure. Breasts also should be inspected for size, shape,
redness, scaliness, or dimpling of the breast skin or nipple.
Reference: 1307
A. being a woman older than 60 years.
The identifiable risk factors most associated with breast cancer
include female gender and advancing age. The incidence of breast
cancer in women under 25 years of age is very low and increases
gradually until age 60. After age 60 the incidence increases dra-
matically.
Reference: 1311
A. Well-differentiated tumor
B. Estrogen receptor-positive tumor
In general, the more well differentiated the tumor, the less ag-
gressive it is. Poorly differentiated tumors appear morphologically
disorganized and are more aggressive. Other information useful
for treatment decisions and determining the prognosis is the pa-
tient's estrogen and progesterone receptor status. Receptor-pos-
itive tumors (1) commonly show histologic evidence of being well
differentiated, (2) frequently have a diploid (more normal) DNA
content and low proliferative indices, (3) have a lower chance
for recurrence, and (4) are frequently hormone dependent and
responsive to hormonal therapy.
Reference: 1314
D. Emphasize regular exercise for the affected shoulder to in-
crease range of motion.
Restoring arm function on the affected side after mastectomy and
axillary lymph node dissection is a key nursing goal. Place the
woman in a semi-Fowler's position, with the arm on the affected
side elevated on a pillow. Flexing and extending the fingers should
begin in the recovery room, with progressive increases in activity
encouraged. Postoperative arm and shoulder exercises are in-
stituted gradually under a surgeon's direction. These exercises
are designed to prevent contractures and muscle shortening,
maintain muscle tone, and improve lymph and blood circulation.
The goal of all exercise is a gradual return to full range of motion
within 4 to 6 weeks.
Reference: 1320, 1323
C. promote an environment for expression of feelings.
Throughout interactions with a woman with breast cancer, you
should be aware of the extensive psychologic impact of the dis-
ease. Effective care includes sensitivity to the woman's efforts to
cope with a life-threatening disease. You should provide a safe
environment for the expression of the full range of feelings.
Reference: 1323