Breast Cancer Questions

1. A client is beginning external beam radiation therapy to the right axilla after a
lumpectomy for breast cancer. Which information should the nurse include in client
teaching?

A. Use a heating pad under the right arm.

B. Immobilize the right arm
C. Place ice on the area after each treatment
D. Apply deodorant only under the left arm

The nurse should instruct the client to avoid applying chemicals or heat or cold to the
are being treated.

2. A 36-year-old female client is currently receiving radiation therapy to the chest

wall for recurrent breast cancer. She has pain while swallowing and burning and
tightness in her chest. The nurse should further assess the client for indications of:
A. Hiatal hernia
B. Stomatitis
C. Radiation enteritis
D. Esophagitis

Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis,
which is a common complication of radiation therapy of the chest wall.

3. A daughter is concerned that her mother is in denial because when they discuss the
diagnosis of breast cancer, the mother says that breast cancer is not that serious and
then changes the subject. The nurse can tell the daughter that denial can be a healthy
defense mechanism if it is used:

A. To permit her mother to seek unconventional treatments

B. When making decisions about her own care
C. Alone and not in combination with other defense mechanisms
D. To allow her mother to continue in her role as a mother

Denial is a defense mechanism used to shut out a situation that is too frightening or
threatening to tolerate. In this case, denial allows the client to vacillate between
acceptance of the illness and its treatment and denial of the actual or potential
seriousness of the disease.
4. A 45-year-old single mother of three teenaged boys has metastatic breast cancer.
Her parents live 750 miles away and have only been able to visit twice since her
initial diagnosis 14 months ago. The progression of her disease has forced the client to
consider high-dose chemotherapy. She is concerned about her children's welfare
during the treatment. When assessing the client's present support systems, the nurse
will be most concerned about the potential problems with:

A. Denial as a primary coping mechanism

B. Support systems and coping strategies
C. Decision-making abilities
D. Transportation and money for the boys

The client's resources for coping with the emotional and practical needs of herself and
her family need to be assessed because usual coping strategies and support systems
are often inadequate in especially stressful situations.

5. A 42-year-old client with breast cancer is concerned that her husband is depressed
by her diagnosis. Which change in her husband's behavior may confirm her fears?

A. Increased decisiveness
B. Problem-focused coping style
C. Increase in social interactions
D. Disturbance in his sleep patterns

Depression can be a mixture of affective responses, behavioral responses, and

cognitive responses.

6. A 42-year-old husband and father of 7-year-old girl and a 10-year-old boy is

concerned about what he should tell his children regarding his wife's impending death
from aggressive breast cancer. The nurse should first:

A. Refer the family to pastoral care services

B. Encourage the husband to come to terms with his own grief
C. Suggest that the healthcare provider tell the children about the seriousness of their
mother's illness
D. Begin education about strategies for communication with his children

Without clear, consistent communication, the parent-child relationship may become

strained during the illness and subsequent death of a parent. A great number of
parents do not know how to communicate with their children, especially about
difficult emotional topics at a time when they are also under great emotional stress.
The nurse should begin by providing information and developmentally appropriate
books about the grieving process for children.

7. While talking to her husband, who is caring for their children, a middle-aged
woman who has stage 4 breast cancer slams the phone down. She begins to cry and
states that she is feeling guilty for being hospitalized. Which nursing action will best
support the client emotionally?
A. Ask the client if she would like to speak with a grief counselor
B. Call the healthcare provider and request an antidepressant
C. Sit with the client, and help her acknowledge and discuss her feelings
D. Suggest the client call her husband when she is calmer

Acknowledgment and discussion of the client's feelings begin the establishment of a

therapeutic relationship between nurse and client.

8. A client being treated for advanced breast cancer with chemotherapy reports that
she must be allergic to one of her drugs because her entire face is swollen. What
assessment does the nurse perform?

A. Asks whether the client has other known allergies

B. Checks the capillary refill on fingernails bilaterally
C. Examines the client's neck and chest for edema and engorged veins
D. Compares blood pressure measured in the right arm with that in the left arm

The client's swollen face indicates possible superior vena cava syndrome, which is an
oncologic emergency. Manifestations result from the blockage of venous return from
the head, neck, and upper trunk. Early manifestations occur when the client arises
after a night's sleep and include edema of the face, especially around the eyes, and
tightness of the shirt or blouse collar. As the compression worsens, the client develops
engorged blood vessels and erythema of the upper body, edema in the arms and
hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be
successful. Late manifestations include hemorrhage, cyanosis, mental status changes,
decreased cardiac output, and hypotension. Death results if compression is not
relieved.

9. The nurse is teaching the 47-year-old female client about recommended screening
practices for breast cancer. Which statement by the client indicates understanding of
the nurse's instructions?

A. "My mother and grandmother had breast cancer, so I am at risk."

B. "I get a mammography every 2 years since I turned 30."
C. "A clinical breast examination is performed every month since I turned 40."
D. "A CT scan will be done every year after I turn 50."

A strong family history of breast cancer indicates a risk for breast cancer. Annual
screening may be indicated for a strong family history. The client may perform a self-
breast examination monthly; a clinical examination by a health care provider is
indicated annually. An annual mammography is performed after age 40 or in younger
clients with a strong family history.

10. The nurse suspects metastasis from left breast cancer to the thoracic spine when
the client has which symptom?

A. Vomiting
B. Back pain
C. Frequent urination
D. Cyanosis of the toes

Typical sites of breast cancer metastasis include bone, manifested by back pain, lung,
liver, and brain. Signs of metastasis to the spine may include numbness, pain,
paresthesia and tingling, and loss of bowel and bladder control.

11. A 52-year-old client relates to the nurse that she has never had a mammogram
because she is terrified that she will have cancer. Which response by the nurse is
therapeutic?

A. "Don't worry, most lumps are discovered by women during breast self-
examination."
B. "Does anyone in your family have breast cancer?"
C. "Finding a cancer in the early stages increases the chance for cure."
D. "Have you noticed a lump or thickening in your breast?"

Providing truthful information addresses the client's concern.

12. A client who is undergoing chemotherapy for breast cancer reports problems with
concentration and memory. Which intervention is indicated at this time?

A. Explain that this occurs in some clients and is usually permanent.

B. Encourage the client that a small glass of wine may help her relax.
C. Protect the client from infection.
D. Allow the client an opportunity to express her feelings.

Although no specific intervention for the side effect is known, therapeutic

communication and listening may be helpful to the client.

13. The nurse is teaching a client who is receiving an anti-estrogen drug about the side
effects she may encounter. Which of these should the nurse include in the discussion?
Select all that apply.

A. Heavy menses
B. Smooth facial skin
C. Hyperkalemia
D. Breast tenderness
E. Weight loss
F. Deep vein thrombosis (DVT)

Breast tenderness and shrinking breast tissue, Venous thromboembolism, Irregular

menses or no menstrual period, Acne may develop, Hypercalcemia, not hyperkalemia,
is typical and Fluid retention with weight gain may occur.

14. The nurse is assigned to care for a client immediately after breast-conserving
surgery for cancer. What is the priority for care of the client at this time?

A. Teach the client to sleep in the prone position each night.

B. Empty wound drains and record the output amount.
C. Remind the client how to perform breast self-examination.
D. Monitor the incision and flap for adequate tissue perfusion.

Assess the incision and flap for duskiness and decreased capillary refill during
dressing changes, which are signs of poor tissue perfusion. The client should avoid
sleeping in the prone position. Emptying drains, documenting output, and
encouraging BSE are important but are not the priority in the immediate postoperative
phase.

15. The client who has recently had breast cancer surgery requests a volunteer to visit
her home to help with recovery. Which community resource will the nurse
recommend?

A. National Breast Cancer Coalition

B. Reach for Recovery
C. Susan G. Komen for the Cure
D. Young Survival Coalition

The American Cancer Society's program "Reach for Recovery" provides volunteers
who visit clients in the hospital or at home. They bring personal messages of hope,
informational materials on breast cancer recovery, and a soft, temporary breast form.

16. The client has been diagnosed with breast cancer. Which treatment option chosen
by the client requires the nurse to discuss with the client the necessity of considering
additional therapy?

A. Chemotherapy
B. Complementary and alternative therapy (CAM)
C. Hormonal therapy
D. Neoadjuvant therapy

No proven benefit has been found with using complementary and alternative therapy
alone as a cure for breast cancer. The nurse must ensure that the client's choices can
be safely integrated with conventional treatment for breast cancer.

17. A client asks the nurse about early detection of breast masses. Which statement by
the nurse about early detection of breast masses is correct?

A. "A yearly breast examination by a health care provider can substitute for breast
self-examination (BSE)."
B. "Detection of breast cancer before axillary node invasion yields the same survival
rate."
C. "Mammography as a baseline screening is recommended by the American Cancer
Society at 30 years of age."
D. "The goal of screening for breast cancer is early detection because BSE does not
prevent breast cancer."

The purpose of screening is early detection. BSE does not prevent breast cancer.
18. The nurse is instructing a client on how to perform breast self-examination (BSE).
Which techniques will the nurse include in teaching the client about BSE? Select all
that apply.

A. Instruct the client to keep her arm by her side while performing the examination.
B. Ensure that the setting in which BSE is demonstrated is private and comfortable.
C. Ask the client to remove her shirt. The bra may be left in place.
D. Ask the client to demonstrate her own method of BSE.
E. Use the fingertips, which are more sensitive than the finger pads, to palpate the
breasts.

The setting should be private and comfortable to promote an environment conducive

to learning and to prevent potential client embarrassment. Before teaching breast
palpation, ask the client to demonstrate her own method, so that the nurse can assess
the client's understanding of BSE. For better visualization, the arm should be placed
over the head. The client should undress from the waist up. The finger pads, which are
more sensitive than the fingertips, are used when palpating the breasts.

19. A client with a high genetic risk for breast cancer asks the nurse about options for
prevention and early detection. Which option for prevention and early detection is the
option of choice?

A. Breast self-examination (BSE) beginning at 20 years of age

B. Hormone replacement therapy combining estrogen and progesterone
C. Magnetic resonance imaging (MRI) and mammography every year beginning at
age 30
D. Prophylactic mastectomy

The American Cancer Society recommends that high-risk women (greater than 20%
lifetime risk) have an MRI and mammography every year beginning at age 30.

20. The nurse suspects that which client has the highest risk for breast cancer?

A. Older adult woman with high breast density

B. Nullipara older adult woman
C. Obese older adult male with gynecomastia
D. Middle-aged woman with high breast density

People at high increased risk for breast cancer include women aged 65 years and older
with high breast density.

21. The nurse is instructing a client with breast cancer who will be undergoing
chemotherapy about side effects of doxorubicin (Adriamycin). Which side effect will
the nurse instruct the client to report to the physician?

A. Diaphoresis
B. Dysphagia
C. Edema
D. Hearing loss
Doxorubicin (Adriamycin) is an anthracycline, and clients must be instructed to be
aware of and to report cardiotoxic effects, including edema, shortness of breath,
chronic cough, and excessive fatigue.

22. The client who has undergone breast surgery is struggling with issues concerning
her sexuality. What is the best way for the nurse to address the client's concerns?

A. Allow the client to bring up the topic first.

B. Remind the client to avoid sexual intercourse for 2 months after the surgery.
C. Suggest that the client wear a bra during intercourse.
D. Teach the client that birth control is a priority.

Clients may prefer to lay a pillow over the surgical site or wear a bra or camisole to
prevent contact with the surgical site during intercourse.

23. The client is struggling with body image after breast cancer surgery. Which
behavior indicates to the nurse that the client is maladaptive?

A. Avoiding eye contact with staff

B. Saying, "I feel like less of a woman"
C. Requesting a temporary prosthesis immediately
D. Saying, "This is the ugliest scar ever"

Avoiding eye contact may be an indication of decreased self-image.

24. Which assessment finding indicates to the nurse that the client is at high risk for a
malignant breast lesion?

A. 1-cm freely mobile rubbery mass discovered by the client

B. Ill-defined painful rubbery lump in the outer breast quadrant
C. Backache and breast fungal infection
D. Nipple discharge and dimpling

Nipple discharge and dimpling are high-risk assessment findings for a malignant
breast lesion.

25. The large-breasted client reports discomfort, backaches, and fungal infections
because of her excessive breast size. The nurse plans to provide information to the
client about which breast treatment option?

A. Augmentation
B. Compression
C. Reconstruction
D. Reduction mammoplasty

Breast reduction mammoplasty surgery removes excess breast tissue and repositions
the nipple and remaining skin flaps to produce the best cosmetic effect.
26. The nurse is discussing treatment options with the client newly diagnosed with
breast cancer. Which statement by the client indicates a need for further teaching?

A. "Hormonal therapy is only used to prevent the growth of cancer. It won't get rid of
it."
B. "I might have chemotherapy before surgery."
C. "If I get radiation, I am not radioactive to others."
D. "Radiation will remove the cancer, so I might not need surgery."

Typically, radiation therapy follows surgery to kill residual tumor cells. Radiation
therapy plays a critical role in the therapeutic regimen and is effective treatment for
almost all sites where breast cancer can metastasize. The purpose of radiation therapy
is to reduce the risk for local recurrence of breast cancer.

27. The client is receiving chemotherapy treatment for breast cancer and asks for
additional support for managing the associated nausea and vomiting. Which
complementary therapy will the nurse suggest?

A. Ginger
B. Journaling
C. Meditation
D. Yoga

It has long been believed that ginger helps alleviate nausea and vomiting. Current
studies are being done on the effect of ginger on chemotherapy-induced nausea.

28. The client who has had a mastectomy asks the nurse about breast reconstructive
surgery. Which statement by the nurse about breast reconstruction is true?

A. "Many women want breast reconstruction using their own tissue immediately after
mastectomy."
B. "Placement of saline- or gel-filled prostheses is not recommended because of the
nature of the surgery."
C. "Reconstruction of the nipple-areola complex is the first stage in the reconstruction
of the breast."
D. "The surgeon should offer the option of breast reconstruction surgery once healing
has occurred after the mastectomy."

Many women want autogenous reconstruction after mastectomy.

29. Which action can the same-day surgery charge nurse delegate to an experienced
unlicensed assistive personnel (UAP) who is helping with the care of a client who is
having a breast biopsy?

A. Assess anxiety level about the surgery.

B. Monitor the vital signs after surgery.
C. Obtain data about breast cancer risk factors.
D. Teach about postoperative routine care.
Vital sign assessment is included in nursing assistant education and usually is part of
the job description for UAP working in a hospital setting.

30. A client who has just been notified that the breast biopsy indicates a malignancy
tells the nurse, "I just don't know how this could have happened to me." Which of
these responses by the nurse will be most appropriate?

A. "Tell me what you mean when you say you don't know how this could have
happened to you."
B. "Do you have a family history that might make you more likely to develop breast
cancer?"
C. "Would you like me to help you find more information about how breast cancer
develops?"
D. "Many risk factors for breast cancer have been identified, so it is difficult to
determine what might have caused it."

The client's statement may indicate shock and denial or a request for more
information. To provide appropriate care, further assessment is needed about the
client's psychosocial status. The first action by the nurse in this situation is to obtain
more data by asking open-ended questions.

31. A premenopausal client diagnosed with breast cancer will be receiving hormonal
therapy. The nurse anticipates that the physician will request which medication for
this client?

A. Anastrazole (Arimdex)
B. Fulvestrant (Faslodex)
C. Leuprolide (Lupron)
D. C. Trastuzumab (Herceptin)

Leuprolide (Lupron) is used in premenopausal women whose main estrogen source is

the ovaries and who may benefit from luteinizing hormone-releasing hormone (LH-
RH) agonists that inhibit estrogen synthesis.

32. Nurse April is teaching a client who suspects that she has a lump in her breast.
The nurse instructs the client that a diagnosis of breast cancer is confirmed by:

A. breast self-examination.
B. mammography.
C. fine needle aspiration.
D. chest X-ray.

Fine needle aspiration and biopsy provide cells for histologic examination to confirm
a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable
method for detecting breast lumps early. Mammography is used to detect tumors that
are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.

33. When teaching women about the risk of breast cancer, which risk factor does the
nurse know is the most common for the development of the disease?
A. Having an aunt with breast cancer
B. Being an older adult
C. Being a Euro-American
D. Consuming a low-fat diet

There is no single-known cause for breast cancer. Being an older woman or man is the
primary risk factor, although some people are at higher risk than others. Having a
first-degree relative (mother, sister, or daughter) with breast cancer can increase the
risk; an aunt is not considered a first-degree relative. Although Euro-American
women older than 40 years are at a more increased risk than other racial/ethnic
groups, the greater risk is being an older adult. Consuming a high-fat diet is
considered a risk factor.

34. The nurse is teaching postmastectomy exercises to the client. Which statement
made by the client indicates that teaching has been effective?

A. "For the pulley exercise, I'll drape a 6-foot-long rope over a shower curtain rod or
over the top of a door."
B. "In rope turning, I'll hold the rope with my arms flexed."
C. "In rope turning, I'll start by making large circles."
D. "With hand wall climbing, I'll walk my hands up the wall and back down until they
are at waist level."

This is a correct description of how to perform the pulley exercise properly.

35. A client who has just been discharged from the hospital after a modified radical
mastectomy is referred to a home health agency. Which nursing action will be most
appropriate to delegate to an experienced home health aide?

A. Assessing the safety of the home environment

B. Developing a plan to decrease lymphedema risk
C. Monitoring pain level and analgesic effectiveness
D. Reinforcing the guidelines for hand and arm care

Reinforcement of previously taught information about hand and arm care should be
done by all caregivers.

36. The client frequently finds lumps in her breasts, esp. around her period. Which
info should the nurse teach the client re: breast self-care?

A. This is a benign process that does not need follow up.

B. Eliminate chocolate and caffeine from diet.
C. Practice breast self-exam monthly.
D. This is how breast cancer starts and she needs surgery.

The American Cancer Soc. doesn't recommend monthly self-exams for everyone, but
knowing baseline is helpful.
37. The client diagnosed with breast cancer is considering whether to have a
lumpectomy or a more invasive procedure, a modified radical mastectomy. Which
info should the nurse discuss?

A. Ask if she is afraid of general anesthesia.

B. Ask how she feels about radiation and chemotherapy.
C. Tell her that she will need reconstruction with either procedure.
D. Find out if she has BC in her family.

She should understand the Tx regimen for F/U care. Rad. and chemo are reqd for
lumpectomy; Regimen results are equal to MRM.

38. The client has undergone a wedge resection for cancer on the left breast. Which
discharge instruction should the nurse teach?

A. Don't life more than 5 lbs. with left hand until released by HCP
B. The cancer has been totally removed and no F/U therapy is required.
C. Client should empty Hemovac every 12 hours.
D. Client should arrange for an appt. with a plastic surgeon for reconstruction.

Pressure on incision should be limited.

39. Which recommendation is the American Cancer Society guideline for early
detection of BC?

A. Beginning at 18 y.o. have a biannual clinical breast exam with HCP.

B. Beginning at 30 y.o. perform monthly breast self-exams.
C. Beginning at 40 y.o., receive a yearly mammogram.
D. Beginning at 50 y.o. have a breast sonogram every 5 yrs.

40. The client has a mastectomy and asks nurse about a Tram Flap procedure. Which
info should nurse provide?

A. The surgeon will insert a saline filled sac under the skin to simulate a breast.
B. The surgeon will pull the client's own tissue under the skin to create a breast.
C. The surgeon will use tissue from inside the mouth to make a nipple.
D. The surgeon can make the breast any size the client wants.

41. The nurse is teaching a class on breast health to a group of ladies at the senior
center. Which is the most important risk factor to emphasize to this group?

A. Find out about family Hx of BC

B. Men at this age can get breast cancer and should also be screened.
C. Monthly self-exam is the key to early detection.
D. The older a woman gets, the greater the chance of developing BC.

Female gender and increasing age are risk factors.

42. The client who is scheduled for breast biopsy with sentinel node dissection sates,
"I don't understand. What does a sentinel node biopsy do?"

A. A dye is injected into the tumor and traced to determine spread of cells.
B. The surgeon removes the nodes that drain the diseased portion of the breast.
C. The nodes that can be felt manually will be removed and sent to pathology.
D. A visual inspection of the lymph nodes will e made while the client is sleeping.

Radioactive dye is injected into tumor and traced to identify which lymph nodes the
tumor has shed into.

43. The client is 4 months pregnant and finds a lump in her breast and the biopsy is
positive for stage II BC. Which Tx should the nurse anticipate?

A. A lumpectomy to be performed after the baby is born.

B. A modified radical mastectomy.
C. Radiation therapy to chest wall only.
D. Chemo only until baby is born.

Can't do rad/chemo which would also be required for lumpectomy. Tumor should be
removed ASAP.

44. The client who had a right modified radical mastectomy 4 years before is being
admitted for a cardiac workup for chest pain. Which intervention is most important?

A. Determine when client had chemo last.

B. Ask client if she received Adriamycin, an antineoplastic agent.
C. Post a message at the head of the bed to not use the right arm.
D. Examine the chest wall for cancer sites.

Risk for lymphedema.

45. The client is being discharged after a left modified radical mastectomy. Which
discharge instructions should the nurse include? Select all that apply:

A. Notify HCP of temperature of 100 F

B. Carry large purses and bundles with the right hand.
C. Do not go to church or anywhere with crowds.
D. Try to keep the arm as still as possible until seen by HCP.
E. Have a mammogram of the right and left breast yearly.

A is correct. Possible infection. B is Correct. Risk of lymphedema. Protect arm from

injury. D is wrong. Should be taught arm climbing exercises before DC. E is Correct.
Risk for more cancer is high in both breasts.
46. The client who has had a mastectomy tells the nurse, "My husband will leave me
now that I am not a whole woman anymore." Which response is therapeutic?

A. Are you afraid that your husband will not find you sexually appealing?
B. Your husband should be grateful that you will be able to live and be with him.
C. Maybe your husband would like to attend a support group for spouses.
D. You don't know that's true. Give him a chance.

This is restating her feelings and is therapeutic.

47. The client has been diagnosed with BC. What is the most appropriate referral for
the nurse to make?

A. Hospital social worker

B. Can Surmount
C. Reach to Recovery
D. I Can Cope

Reach to Recovery is specific to breast cancer.

48. A client asks the nurse, "Why do I need to examine my armpits when I do my
monthly breast exam?" Which of the following would be an appropriate response for
the nurse to make to this client?

A. This is the hardest area to feel for changes.

B. Who told you that you have to do that?
C. I'm not sure why that is important, but it sounds like it is.
D. Breast tissue extends into the axilla.

49. During the breast exam, the nurse palpates a series of lymph nodes. Why is this a
part of the breast exam?

A. It's not. It's done because the chest area is exposed.

B. To review the integrity of the skin.
C. To assess the deep lymph nodes which drain the mammary lobules.
D. To assess shoulder range of motion.

50. A 14-year-old female client is upset because her breast development is not equal.
What can the nurse say to this client?

A. Don't worry about that!

B. They look equal to me.
C. Maybe you should talk with your mother about breast surgery?
D. Breast tissue growth is uneven but will even out as you get older.

51. An elderly female client wants to know when she can stop doing breast exams.
What can the nurse say to this client?

A. It's not really necessary at your age.

B. Breast cancer can still develop when you get older.
C. Probably in a month or two.
D. You can stop five years after menopause.

52. A female client tells the nurse, "I know I should examine my breasts but I just
don't." What should the nurse do with this information?

A. Nothing.
B. Talk with the client about possible fears associated with the breast exam.
C. Instruct the client on how to perform the breast exam again.
D. Instruct the client on getting an annual mammogram instead.

Many females do not perform the breast exam even after receiving instruction. This
type of behavior may be related to anxiety and fear of cancer or surgery. During the
assessment, the nurse needs to encourage the client to share her fears and concerns.

53. The nurse is planning a focused breast/axilla interview and wants to include a
general health question. Which of the following questions would fit these criteria?

A. Has your mother or sister had breast cancer?

B. Have you ever had a mammogram?
C. Are you still menstruating?
D. Have you had any breast trauma?

General health questions for the breast/axilla focused interview include a description
of the breasts, changes in the breasts with menstruation, and date of the last menstrual
period.

54. A 58-year-old client says to the nurse, "My saggy breasts embarrass me!" What
can the nurse say to this client in response?

A. Maybe you can have breast augmentation surgery?

B. Wearing a good bra will help.
C. Don't be silly.
D. Breasts sag because of declining estrogen levels.

55. A pregnant client is upset and thinks she has breast disease because she has a thick
white discharge coming from her left breast. What can the nurse say or do for this
client?

A. Nothing. This client needs a mammogram as soon as possible.

B. A thick yellow discharge from the breasts during pregnancy is normal.
C. Call the physician. This information is not normal.
D. Help the client understand that she might not be able to breastfeed her infant.

56. A client comes into the clinic for a routine breast and axilla exam. Which
assessment technique does the nurse use first during this examination?

A. Inspection
B. Auscultation
C. Palpation
D. Percussion

57. During the breast exam, the nurse asks the client to raise her arms over her head.
Why did the nurse change the client's position?

A. Skin dimpling is accented in this position.

B. The nurse couldn't palpate the axillae correctly.
C. The client has small breasts.
D. The client has large breasts.

58. The nurse is examining a client's breasts and follows a specific pattern. Which of
the following patterns can be used for a breast exam?

A. Letter H
B. Back and forth technique.
C. Letter S
D. ABC

59. The client tells the nurse, "At times I have drainage from my right breast." What
should the nurse do with this information?

A. Write it in the medical record and say nothing to the client.

B. Phone for a mammogram for the client immediately.
C. Explain that this could be benign or it could mean something else. It needs to be
further investigated.
D. Nothing. It doesn't mean a thing.

60. A client with fibrocystic breast disease says she has increased breast pain and
tenderness with menses. Which of the following can help this client?

A. Nothing can be done to help this client.

B. Discuss how this can be a precursor to breast cancer.
C. Review how reducing caffeine and salt and wearing a support bra might help.
D. Explain how a breast biopsy is indicated.

61. The clinic is sponsoring a client education session for breast cancer awareness
month. Which of the following considerations should be included to support cultural
differences about breast health?

A. Refer all clients to the American Cancer Society if they have questions.
B. Inform all about the low-cost breast cancer screening program.
C. Encourage all females to increase their intake of vitamins A and E.
D. Encourage all females to complete monthly breast exams.

62. A postmenopausal client has difficulty remembering to complete a monthly breast

exam. What can be done to help this client?

A. Nothing. This client doesn't need to do self examinations.

B. Suggest the client plan to conduct the exam the first day of every month.
C. Schedule the client to come into the clinic every month for the exam.
D. Schedule the client to receive a monthly phone call from the clinic as a reminder.

Remind the client to use a calendar to keep a record of when she performs the breast
examination. Teach clients to perform the exam at the same time each month.

63. The nurse is caring for a patient diagnosed with breast cancer who just underwent
an axillary lymph node dissection. What intervention should the nurse use to decrease
the lymphedema?

A. Keep affected arm flat at the patient's side.

B. Apply an elastic bandage on the affected arm.
C. Assess blood pressure only on unaffected arm.
D. Restrict exercise of the affected arm for 1 week.

Blood pressure readings, venipunctures, and injections should not be done on the
affected arm. Elastic bandages should not be used in the early postoperative period
because they inhibit collateral lymph drainage. The affected arm should be elevated
above the heart, and isometric exercises are recommended and gradually increased
starting in the recovery room to reduce fluid volume in the arm.

64. The nurse is volunteering at a community center to teach women about breast
cancer. What should the nurse include when discussing risk factors (select all that
apply)?

A. Nulliparity
B. Age 30 or over
C. Early menarche
D. Late menopause
E. Personal history of colon cancer

Women are at an increased risk for development of breast cancer if they are over the
age of 50; have a family history of breast cancer; have a personal history of breast,
colon, endometrial, or ovarian cancer; have a long menstrual history as seen with
early menarche or late menopause; and have had a first full-term pregnancy after the
age of 30 or are nulliparous.

65. The nurse has been asked to participate in a healthy living workshop. While
teaching about women's health, which guidelines should the nurse provide to the
audience?

A. "Mammograms are necessary if you have a family history of breast cancer."

B. "It's recommended that you get a mammogram each year after you turn 40."
C. "If you are not able to perform breast self-examination (BSE), you should go for
regular mammograms."
D. "You should ensure that your primary care provider performs a breast exam each
time you visit."

Annual mammograms are recommended after age 40. They are recommended for all
women, not solely those with a family history of breast cancer. BSE is not a
replacement for mammography, and clinical breast examinations are not necessary at
each office visit, but recommended at least every 3 years for women in their 20s and
30s, and then every year beginning at age 40.

66. A 51-year-old woman has recently had a unilateral, right total mastectomy and
axillary node dissection for the treatment of breast cancer. What nursing intervention
should the nurse include in the patient's care?

A. Immobilize the patient's right arm until postoperative day 3.

B. Maintain the patient's right arm in a dependent position when at rest.
C. Administer diuretics prophylactically for the prevention of lymphedema.
D. Promote gradually increasing mobility as soon as possible following surgery.

Mobility should be encouraged beginning in the post anesthesia care unit (PACU) and
increased gradually throughout the patient's recovery. Immobilization is
counterproductive to recovery, and the limb should not be in a dependent position.
Diuretics are not used to prevent lymphedema but may be used in active treatment of
the problem.

67. Which task could the registered nurse delegate to unlicensed assistive personnel
(UAP) during the care of a patient who has had recent transverse rectus abdominis
musculocutaneous (TRAM) flap surgery?

A. Document the condition of the patient's incisions.

B. Mobilize the patient in a slightly hunched position.
C. Change the patient's abdominal and chest dressings.
D. Change the parameters of the patient-controlled analgesic (PCA) pump.

Mobilization of a postsurgical patient may be delegated, and the patient who has had a
TRAM flap should not stand or walk fully erect, in order to minimize strain on the
incisions. Changing dressings, assessing wounds, and reprogramming a PCA pump
are not appropriate tasks to delegate to UAP.

68. A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen
(Nolvadex). What point should the nurse emphasize when teaching the patient about
her new drug regimen?

A. "You may find that your medication causes some breast sensitivity."
B. "It's important that you let your care provider know about any changes in your
vision."
C. "You'll find that this drug often alleviates some of the symptoms that accompany
menopause."
D. "It's imperative that you abstain from drinking alcohol after you begin taking
tamoxifen."

Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to
exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not
associated with tamoxifen, and it is not necessary for the patient to abstain from
alcohol.
69. When doing breast self-examination, the female patient should report which
findings to her physician?

A. Palpable rib margins

B. Denser breast tissue
C. Left nipple deviation
D. Different sized breasts

Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other

problem and should be reported to the health care provider. Dense breast tissue,
palpable rib margins, and different sized breasts are all normal findings.

70. The patient with breast cancer has a left mastectomy with axillary node dissection.
Ten lymph nodes are resected with three positives for malignant cells. The patient has
stage IIB breast cancer. What is the best nursing intervention to use in planning care?

A. Evaluate left arm lymphatic accumulation. Incorrect

B. Maintain joint flexibility and left arm function.
C. Teach her about chemotherapy and radiation therapy.
D. Assess the patient's response to the diagnosis of breast cancer.

Assessment is the first step in planning patient care. Because the nurse is the patient's
advocate and this is an extremely stressful time for the patient and family, the nurse
should focus on the patient's response to the diagnosis of breast cancer when planning
care for this patient. The approach for the care of the left arm and teaching the patient
about further therapy will be based on this assessment.

71. A 72-year-old patient who had a mastectomy for breast cancer 6 months ago
wants to have breast reconstructive surgery. The nurse knows that what is the most
likely motivation for this patient seeking this surgery?

A. Improve the woman's self-image

B. Be able to experience sexual arousal
C. To get a tummy tuck as well as the breast mound
D. Restore the pre-mastectomy appearance of the breast

The most likely motivation for this patient to seek breast reconstructive surgery is to
improve her self-esteem. With this surgery, she will not be able to experience sexual
arousal or restore the pre-mastectomy appearance of the breast. The abdominoplasty
(tummy tuck) effect will only be a possibility with the transverse rectus abdominis
musculocutaneous (TRAM) flap, not with a breast implant or tissue expansion.

72. The nurse teaches a 53-year-old patient about screening for early detection of
breast cancer. Which statement by the patient requires an intervention by the nurse?

A. "I should plan to have a mammogram every year."

B. "I will see a health care provider every year for a breast examination."
C. "A breast examination should be done right after my menstrual period."
D. "Self-breast examination is a reliable way to detect breast cancer early."
Screening for the early detection of breast cancer includes yearly mammograms
starting at age 40 and clinical breast examination every year at age 40. An alternative
suggestion is to begin screening mammograms at age 50. Breast self-examination has
benefits and limitations and may not be a reliable method for early detection of breast
cancer. BSE is optional but should be done in premenopausal women right after the
menstrual period when the breasts are less lumpy and tender.

73. The nurse caring for patients in a primary care clinic identifies which patient as
being the most at risk for the development of breast cancer?

A. A 25-year-old female with fibrocystic breast disease

B. A 59-year-old male who has inherited the APC gene
C. A 72-year-old female with a family history of breast cancer
D. A 43-year-old male who is obese and leads a sedentary lifestyle

The risk factors most associated with breast cancer are female gender, advancing age,
and family history. The incidence of breast cancer increases dramatically after age 60.
Mutations in BRCA genes may cause 5% to 10% of breast cancers; APC gene is
associated with colon cancer. Obesity and physical inactivity increase the risk for
breast cancer. Fibrocystic breast disease is not associated with the development of
breast cancer.

74. The nurse performs a breast examination on a 68-year-old female patient. Which
clinical manifestation, if assessed by the nurse, indicates that further evaluation for
breast cancer is needed?

A. Bilateral pendulous breasts

B. Right breast is warm, painful to touch
C. Irregular, nontender lump with induration
D. Palpable lump that is tender and movable

Clinical manifestations of breast cancer may include a palpable lump that is hard,
irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau
d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis
presents with breasts that are warm to touch, indurated, and painful. Atrophy of the
mammary glands associated with aging may result in pendulous breasts.
Manifestations of fibrocystic breast changes include palpable lumps that are round,
well delineated, and freely movable. The lump is usually tender and increases in size
and tenderness before menstruation.

75. The nurse is caring for a 52-year-old woman with breast cancer who is receiving
high-dose doxorubicin (Adriamycin). Which assessment 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.
Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The
nurse should monitor for cardiac dysrhythmias, electrocardiogram changes, and
clinical manifestations of heart failure. Other adverse effects of doxorubicin include
stomatitis and alopecia, but these effects are not as serious as cardiac problems.
Tamoxifen may cause visual changes.

76. 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."

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 exercises 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.

77. 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

Although these symptoms can indicate benign mastalgia, mammography is

anticipated to exclude cancer and provide information 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 result 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.

78. 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

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.

79. 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.

In a crisis, talking about feelings and letting the patient take the lead is the best
approach.

80. 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

When teaching women about breast cancer screening guidelines, 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.

81. 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.

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.
82. 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.

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
dramatically.

83. 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

In general, the more well differentiated the tumor, the less aggressive it is. Poorly
differentiated tumors appear morphologically disorganized and are more aggressive.
Other information useful for treatment decisions and determining the prognosis is the
patient's estrogen and progesterone receptor status. Receptor-positive 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.

84. A modified radical mastectomy with an axillary lymph node dissection 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 increase 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 instituted 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.

85. Preoperatively, to meet the psychologic needs of a woman scheduled 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.

Throughout interactions with a woman with breast cancer, you should be aware of the
extensive psychologic impact of the disease. 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.