NRSG110 Breast Cancer Case Study; Chandra Marshall is a 48-year-old African American woman ; Answered 100% latest 2025/26.

NRSG110 Breast Cancer Case Study Directions: Complete the case study in your group. Add notes, diagrams, charts, etc. to augment your understanding and justify your answer choice. Chandra Marshall is a 48-year-old African American woman who is married and has two daughters, ages 20 years and 18 years. Chandra and her daughters attend a community education program designed to increase awareness of breast cancer screening techniques. At the community education program, Chandra learns that BSE is best performed 7 days after the start of the menstrual flow when the breast are least engorged and tender. Since Chandra had a hysterectomy 5 years ago, she does not have periods. She asks the nurse if she still needs to perform BSE, and if so, when? 1. What is the best response by the nurse? A. If you take hormone replacement therapy (HRT), you should perform BSE every week B. Since you have had a hysterectomy, performing BSE twice a year is adequate C. Follow the same timing cycle you used when you had a regular menstrual period D. Select whatever day you can best remember to perform BSE consistently each month Chandra demonstrates BSE technique for the nurse using a practice model. She uses her finger pads and states that when lying down, her arm should be relaxed at her side.2. What instructions should the nurse provide? A. You have demonstrated BSE successfully, be sure to practice this every month B. Use your fingertips, rather than the pads of your fingers C. When you are lying down, your arm should be positioned over your head D. Place your hand on your hip and flex your arm while lying down Another women in the class said she had heard that clinical breast examination (CBE) is better than breast self-examination (BSE). 3. How should the nurse respond? A. The combination of yearly CBE and monthly BSE is the best approach for early detection B. If your doctor is doing CBE every year, doing BSE monthly isn’t really necessary to detect cancer C. Doing BSE every month offers a better chance of finding a lump early than doing CBE once a year D. CBE is only performed after a problem is detected during BSE, so it is very important to perform BSE Diagnostic Testing While performing BSE, Chandra discovers a lump. After seeing her doctor, Chandra is scheduled for a mammogram. Chandra brings her 50 year old sister in-law, Barb for support and to learn more about mammograms. Barb tells the nurse that she does not need a mammogram annually because she has no risk factors for breast cancer, except that her father’s sister had breast cancer when she was 50. 4. What intervention should the nurse implement first? A. Teach Barb that even women with no identified risk factors are at risk B. Reassure Barb that her father’s sister is not a first-degree relative C. Schedule Barb for a mammogram as soon as it can be arranged D. Show barb the equipment used to perform a mammogram. Barb states that she will schedule a mammogram and she asks the nurse if the x-ray is painful. 5. How should the nurse respond?A. The pain of the procedure is worth the benefit you will gain B. Tell me what your concerns are related to experiencing pain C. X-ray procedures do not typically cause any sort of discomfort D. You may experience some discomfort, but only for a few minutes A mass is seen on Chandra’s mammogram, and a follow-up stereotactic core needle biopsy is performed. The tumor specimen is found to be cancerous. Chandra learns that she has a cancerous tumor requiring surgery. She tells the nurse, “They make mistakes. I know that happens. My specimen probably got switched with someone else’s, right? 6. What is the best response by the nurse? A. I will notify the health care provider that you would like the test repeated B. It’s hard to believe that this is happening, isn’t it? C. Tell my why you feel an error was made on the test? D. Right now you are feeling denial. It takes time to accept this. 7. How should the nurse respond? A. You need to recognize that you have cancer that needs surgery B. Tell me what kind of diet changes you are planning to make C. Have you considered vitamin and herbal alternatives? D. Are you saying that you do not want to have the surgery? Preoperative CareChandra decides to have the surgery and is scheduled for a modified radical mastectomy with immediate abdominal myocutaneous flap reconstruction. A modified radical mastectomy involves removal of breast tissue and lymph nodes, but it conserves the pectoralis major muscle. The reconstruction involves the use of a flap of skin and muscle from the abdomen to create a breast mound. Chandra arrives at the Surgery Center two hours before her scheduled surgery. The nurse confirms Chandra’s NPO status. Chandra states, “I had alittle snack this morning before I came here. I am so nervous. I have to have this surgery today, or I will back out. Please don’t tell anyone.” 8. What is the best response by the nurse? A. Since it was a small snack that won’t be harmful, I won’t record it in the chart. B. I know how important this is to you, so we’ll keep this between us C. To ensure your safety, I need to notify the surgeon of the snack you ate D. You should not have eaten the snack. Any intake means a delay in surgery. 9. Which ethical principle has the greatest weight in the nurse’s decision to inform Chandra’s surgeon about the snack? A. Justice B. Nonmaleficence C. Autonomy D. Confidentiality The nurse confirms that Chandra has signed the informed consent for surgery, but learns that Chandra does not understand the procedure for the breast reconstruction that is to be performed. 10. What action should the nurse implement? A. Describe the procedure to Chandra using simple language and drawings B. Offer reassurance and support, since the consent is already signed C. Affirm that Chandra has made a good choice in having immediate reconstruction D. Notify the surgeon that further explanation of the procedure is required Post-Mastectomy Nursing ManagementAfter surgery, Chandra is admitted to the PACU for immediate postoperative management. 11. Which nursing actions have the highest priority in the initial postoperative period? (Select all that apply) A. Review hand and wrist exercises with Chandra B. Observe the Jackson-Pratt drainage device C. Administer a dose of prescribed analgesic D. Provide privacy for Chandra and her husband E. Monitor vital signs and pulse oximetry After Chandra is awake and stable, she is moved from the PACU to the regular post-op unit. The nurse observes Chandra performing wrist flexion and extension exercises 4 hours after surgery. 12. What action should the nurse take? A. Encourage Chandra to continue performing these exercises B. Advise her to exercise only her fingers for the first 24 hours C. Instruct her to avoid any exercises until the morning D. Remind her that she can also begin arm range of motion activities Collaboration of CareThe nurse enters Chandra’s room and observes that a Nurse Intern is assessing Chandra’s dressing while the UAP takes postoperative VS’s. The UAP is preparing to take Chandra’s BP on her operative side because there is an IV in the other arm. 13. What action should the nurse implement first? A. Assign the UAP to pace a sign over the bed to avoid BP’s on the operative side B. Tell the Nurse Intern that it is a nursing responsibility to supervise the UAP correctly C. Advise the UAP to immediately stop and obtain a larger cuff, so the BP reading can be taken in the leg D. Leave the room with the Nurse Intern and UPA to discuss the situation in the conference room. The nurse is discussing the situation with the Nurse Intern and the UAP. 14. What should the nurse emphasize in the discussion? A. Assessment of postoperative VS should not be assigned to a UAP B. As the supervising nurse, the Nurse Intern is fully responsible for the incorrect action taken C. Both the Nurse Intern and the UAP are at fault for the incorrect action of the UAP D. The UPA is certified to take VS and is fully responsible for the action taken Hormone TherapyChandra seems happy and she tells the nurse that she received some good news. She states that her tumor was negative for estrogen receptor sites. She continues, “That means I have less likelihood of a recurrence or spread of the cancer.” 15. What action should the nurse take first? A. Review the meaning of negative estrogen receptor sites with Chandra B. Contact Chandra’s surgeon to confirm the test results C. Review the operative report and tissue analysis in Chandra’s medical record D. Ask Chandra to clarify how she learned this information so that a plan for further teaching can be developed Since the tumor is estrogen-receptor negative, she is not a candidate for hormonal therapy. Tamoxifen (Nalvadex) is an anti-estrogen drug that is often used to prevent or treat recurrent breast cancer. Chandra states that a friend of hers took this drug and has had no recurrence of her breast cancer. The nurse asks Chandra if her friend experience any problems when taking Tamoxifen. 16. What complication is most often associated with Tamoxifen? A. Ototoxicity B. Blood clots C. HTN D. Anemia Chandra is disappointed to learn that she will not benefit for hormonal therapy, but states that her friend indicated that taking the medication was “like experiencing menopause.” 17. How should the nurse respond? A. The medication decreases estrogen levels, which is what also causes the symptoms of menopause B. With the medication, the effects of estrogen are enhanced, which is what women in menopause experience C. The medication was probably not the cause of her symptoms. They were probably related to the cancer D. If she also had breast surgery, she probably would have those symptoms even without the medication ChemotherapyBecause of her relatively young age, and the presence of a positive lymph node, Chandra elects to take chemotherapy to reduce her rise for recurrence. The nurse prepares Chandra for common adverse effects that she may experience. 18. What adverse effects most often associated with antineoplastic chemotherapy used to treat breast neoplasms should be included in this discussion? (Select all that apply.) a. Loss of vision. b. Diarrhea c. Seizures d. Tinnitus e. Alopecia A multi-lumen central line has been inserted, and the nurse is preparing to administer a dose of chemotherapy through a central line by first flushing the IV lumens. The nurse notes that two of the four lumens do not flush easily. 19. What intervention is appropriate for the nurse to implement? a. Hold the scheduled dose of chemotherapy until a chest x-ray is done. b. Ask Chandra to preform Valsalva maneuver while flushing the lines. c. Notify the HCP that the central line is no longer functional. d. Label the two lumens as non-functional, and use one of the remaining lumens.Central Venous Catheter Examples: A, Implanted venous access device or port. B, Tunneled external venous access device (Groshong). These can be single-, double-, or triple-lumen catheters. C, Peripherally inserted central catheter (PICC). D, Subclavian catheter. These can be single-, double-, or triplelumen catheters.The nurse is aware that treatment with antineoplastic chemotherapeutic agents can cause immunosuppression, which predisposed the client to infection. 20. Which assessment finding would cause the nurse to suspect that an immunosuppressed client has an infection? a. Tingling in fingers b. Nausea c. Oral temperature of 99.5F. d. Epistaxis A Complication Occurs: Cellulitis and Lymphedema Chandra has completed her first round of chemotherapy. She calls the nurse to report that she cut her arm on the operative side while helping her husband with yard work the previous day, and now her arm appears very swollen and tender. Chandra is admitted to the hospital with a medical diagnosis of lymphedema and possible cellulitis. Nursing assessment indicates that Chandra’s operative arm is swollen from her fingers to her axilla. The wound is located on her forearm and is inflamed and tender in a 2-cm area surrounding the wound. The nurse identifies several nursing diagnoses important in planning Chandra’s care. 21. Which nursing diagnosis has the highest priority when the nurse is planning care for Chandra? a. Self-care deficit b. Impaired mobility c. Acute pain d. Altered tissue perfusion 22. Which nursing care measure(s) will be most beneficial in the management of Chandra’s highest priority problem? (Select all that apply) a. Place Chandra in a semi-Fowler’s position. b. Apply a sequential compression device. c. Review hand exercises Chandra can perform. d. Provide high protein snacks between meals. e. Elevate the affected arm.Chandra’s prescriptions include: Vancomycin (Vancomycin) IV, 1gram every 12 hours, obtain peak and trough levels, and acetaminophen 500 mg PO for fever > 100F. 23. When is the best time to obtain the vancomycin serum trough level? a. When all the prescribed doses have been administered. b. Thirty minutes after the administration of the most recent dose of the drug. c. Fifteen minutes prior to administration of the next dose of the drug. d. Prior to initiating the first dose of the prescription. 24. It is time for Chandra’s Vancomycin. The Vancomycin IV 1 g is in a 250 ml bag of 0.9% normal saline to be delivered in 2 hours. What would the nurse set the volume on the IV pump? (Enter the numerical value only. If rounding is necessary, round to the whole number.) Answer: _____125m_________________________ After receiving the vancomycin for 7 days, Chandra complains that her mouth is painful when she swallows. When assessing her mouth, the nurse visualizes white, patchy lesions. 25. What is the most probable cause of this finding? a. Candida superinfection. b. Non-healing skin lesion.c. Anemia. d. Metastasis of the cancer. Chandra’s resulting cellulitis from her injury and the complication of lymphedema are resolved and she is discharged. She will continue with further chemotherapy, and she is aware of the need for regular follow-up to assess for cancer recurrence both locally and distally. Chandra is asked to speak at a women’s health symposium to share her experiences with breast cancer. She works with the nurse to develop her presentation. The nurse begins by discussing risk factors for breast cancer. 26. Which client’s history indicates the person at highest risk for breast cancer? a. A 35-year-old unemployed, obese woman, who has 5 children and 2 grandchildren. b. A 40-year-old female attorney with delayed pubertal development, including starting her period at age 17. c. A 45-year-old nurse who is starting to experience menopausal symptoms. d. A 65-year-old women, who is a retired teacher and who never married or had children. Chandra talks about her own risk factors. 27. The development of breast cancer by which family member indicates Chandra’s increased risk? a. Maternal aunt. b. Younger sister. c. Mother-in-law. d. Older female cousin. Clinical Manifestations The nurse reviews signs and symptoms of breast cancer, including nipple discharge and retraction. The nurse describes a change called peau d’orange. 28. Which symptom of breast cancer does this describe? a. Alteration in the shape of the breast. b. Change in the color of the skin. c. Pain and ulceration in the skin.d. Unusual skin texture. Chandra shares with the group that a lump she felt during breast self-exam was the only symptom she had. 29. Which description of a breast lump is most typical of breast cancer? a. Hard, irregular, and does not move freely. b. Soft and mashes down easily when touched. c. Raised, warm, and tender when palpated. d. Moves easily under the skin with very defined borders. Case Outcome Chandra emphasizes the importance of monthly breast self-exams and annual clinical breast exams. She reminds the women that annual mammograms are important in early detection and that the slightly discomfort is well worth the benefit. She thanks the nurse for all the help she received in her fight with breast cancer and states that she expects to live every day to the fullest, devoting much of her time to helping other women get early treatment for breast cancer. More Information Located Below1. Lie down and place your left arm behind your head. Lying down spreads the breast tissue evenly and thinly over the chest wall, making it easier to feel the tissue. 2. Use finger pads of the three middle fingers on your right hand to feel for lumps in the left breast. Use overlapping dime-sized circular motions to feel the breast tissue. Use three different levels of pressure to feel the breast tissue. Light pressure to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. A firm ridge in the lower curve of each breast is normal. 3. The up-and-down (vertical) pattern is recommended for examining the entire breast. Move around the breast in an up-and-down pattern starting at an imaginary line straight down your side from the underarm and moving across the breast to the middle of the sternum. Examine the entire breast going down until you feel only ribs and up to the neck or clavicle. Repeat the procedure while examining your right breast. 4. Stand in front of a mirror. Place your hands firmly on your hips, which will tighten the pectoral muscles. Look at your breasts for size, shape, redness, scaliness, or dimpling of the breast skin or nipple. 5. Examine each underarm while standing or sitting with arm slightly raised. Check for any lump, hard knot, or thickening of tissue. Client Education Guide for Postmastectomy Exercises: BSE Explained!Getting To The Right Answers For The 5 Rights – Delegation!