,CHAPTER LIST
Chapter 1: Coordination of Care
Chapter 2: Diagnosis and Staging
Chapter 3: Treatment Modalities: Local and Systemic
Chapter 4: Nursing Practice: Symptom Management
Chapter 5: Psychosocial and Spiritual
Chapter 6: Survivorship
Chapter 7: End of Life Care
Chapter 8: Professional Performance and Education
,Chapter 1: Breast Health — Risk Assessment and
Reduction, Screening, Early Detection
The questions are advanced, university-level, emphasize clinical decision-making,
and reflect how content is tested on breast care and oncology nursing certification
exams.
Question 1
A 42-year-old woman has a mother diagnosed with breast cancer at age 48 and a
maternal aunt diagnosed at 52. She asks whether her risk is “high enough” to justify
additional screening beyond mammography. Which assessment tool is most
appropriate to guide this discussion?
A. Gail model
B. Claus model
C. Tyrer-Cuzick (IBIS) model
D. Nottingham Prognostic Index
Answer: C
Rationale:
The Tyrer-Cuzick model incorporates extensive family history (first- and second-degree
relatives), hormonal factors, and genetic predisposition, making it superior for
identifying women who may qualify for high-risk screening strategies such as MRI. The
Gail model underestimates risk in women with strong family histories and does not
include second-degree relatives.
Key words: Tyrer-Cuzick, family history, high-risk screening, risk stratification
Question 2
,Which patient meets criteria for annual breast MRI in addition to mammography?
A. A 50-year-old with dense breasts and no family history
B. A 45-year-old with a lifetime breast cancer risk of 22%
C. A 60-year-old with a prior benign breast biopsy
D. A 40-year-old with early menarche and late menopause
Answer: B
Rationale:
Women with a ≥20% lifetime risk of breast cancer are candidates for annual MRI plus
mammography. Dense breasts alone or reproductive risk factors without elevated
calculated lifetime risk do not meet MRI screening thresholds.
Key words: MRI screening, lifetime risk, ≥20%, high-risk criteria
Question 3
A nurse counseling a woman about modifiable breast cancer risk factors should
prioritize education about which intervention?
A. Delaying age at first childbirth
B. Reducing alcohol consumption
C. Avoiding all estrogen exposure
D. Increasing dietary soy intake
Answer: B
Rationale:
Alcohol consumption is a well-established, modifiable risk factor with a dose-
dependent relationship to breast cancer. While reproductive factors influence risk, they
are not modifiable at the time of counseling. Estrogen avoidance is neither realistic nor
evidence-based for prevention in average-risk women.
Key words: modifiable risk factors, alcohol, prevention counseling
Question 4
,Which limitation of the Gail model is most clinically significant?
A. It overestimates risk in postmenopausal women
B. It excludes reproductive history
C. It fails to account for extensive family history
D. It requires genetic testing
Answer: C
Rationale:
The Gail model focuses on limited family history (first-degree relatives only) and does
not capture genetic mutations or second-degree relatives, making it unreliable for high-
risk assessment.
Key words: Gail model, limitations, family history
Question 5
A 38-year-old BRCA1 mutation carrier asks about risk-reduction options. Which
intervention provides the greatest reduction in breast cancer risk?
A. Annual MRI and mammography
B. Tamoxifen chemoprevention
C. Bilateral prophylactic mastectomy
D. Oophorectomy alone
Answer: C
Rationale:
Bilateral prophylactic mastectomy reduces breast cancer risk by up to 90–95% in
BRCA mutation carriers. Surveillance and chemoprevention reduce risk but do not
approach this magnitude of risk reduction.
Key words: BRCA, prophylactic mastectomy, risk reduction
Question 6
Which screening strategy best reflects population-based screening?
,A. MRI beginning at age 25 for all women
B. Annual ultrasound for women with dense breasts
C. Mammography beginning at age 40–50 for average-risk women
D. Genetic testing for all women over age 30
Answer: C
Rationale:
Population-based screening targets average-risk women, primarily using
mammography starting between ages 40–50 depending on guidelines. MRI and
genetic testing are reserved for high-risk populations.
Key words: population screening, average risk, mammography
Question 7
A patient asks why ultrasound is recommended after an abnormal mammogram. The
nurse explains that ultrasound is particularly useful for:
A. Detecting microcalcifications
B. Distinguishing solid from cystic masses
C. Replacing biopsy
D. Screening asymptomatic average-risk women
Answer: B
Rationale:
Ultrasound is valuable for characterizing masses seen on mammography, particularly in
determining whether a lesion is solid or cystic. It does not reliably detect
microcalcifications and does not replace tissue diagnosis.
Key words: breast ultrasound, diagnostic imaging, cystic vs solid
Question 8
Which patient is the best candidate for chemoprevention with tamoxifen?
, A. A 70-year-old with prior breast cancer
B. A 45-year-old with a 5-year Gail risk of 2.0%
C. A 30-year-old BRCA mutation carrier
D. A 55-year-old with dense breasts only
Answer: B
Rationale:
Chemoprevention is recommended for women with a 5-year breast cancer risk
≥1.67%, particularly for estrogen receptor–positive risk reduction. BRCA carriers often
require more aggressive strategies.
Key words: chemoprevention, tamoxifen, Gail risk
Question 9
Which statement best reflects the nurse’s role in shared decision-making for
screening?
A. “I will tell you which screening test is best.”
B. “MRI is always superior to mammography.”
C. “Let’s review your risk factors and preferences together.”
D. “Screening decisions should follow age-based rules only.”
Answer: C
Rationale:
Shared decision-making integrates individual risk, patient values, and evidence-
based recommendations. Nurses facilitate understanding rather than dictating choices.
Key words: shared decision-making, patient education, advocacy
Question 10
Which environmental exposure is most strongly associated with increased breast cancer
risk?
Chapter 1: Coordination of Care
Chapter 2: Diagnosis and Staging
Chapter 3: Treatment Modalities: Local and Systemic
Chapter 4: Nursing Practice: Symptom Management
Chapter 5: Psychosocial and Spiritual
Chapter 6: Survivorship
Chapter 7: End of Life Care
Chapter 8: Professional Performance and Education
,Chapter 1: Breast Health — Risk Assessment and
Reduction, Screening, Early Detection
The questions are advanced, university-level, emphasize clinical decision-making,
and reflect how content is tested on breast care and oncology nursing certification
exams.
Question 1
A 42-year-old woman has a mother diagnosed with breast cancer at age 48 and a
maternal aunt diagnosed at 52. She asks whether her risk is “high enough” to justify
additional screening beyond mammography. Which assessment tool is most
appropriate to guide this discussion?
A. Gail model
B. Claus model
C. Tyrer-Cuzick (IBIS) model
D. Nottingham Prognostic Index
Answer: C
Rationale:
The Tyrer-Cuzick model incorporates extensive family history (first- and second-degree
relatives), hormonal factors, and genetic predisposition, making it superior for
identifying women who may qualify for high-risk screening strategies such as MRI. The
Gail model underestimates risk in women with strong family histories and does not
include second-degree relatives.
Key words: Tyrer-Cuzick, family history, high-risk screening, risk stratification
Question 2
,Which patient meets criteria for annual breast MRI in addition to mammography?
A. A 50-year-old with dense breasts and no family history
B. A 45-year-old with a lifetime breast cancer risk of 22%
C. A 60-year-old with a prior benign breast biopsy
D. A 40-year-old with early menarche and late menopause
Answer: B
Rationale:
Women with a ≥20% lifetime risk of breast cancer are candidates for annual MRI plus
mammography. Dense breasts alone or reproductive risk factors without elevated
calculated lifetime risk do not meet MRI screening thresholds.
Key words: MRI screening, lifetime risk, ≥20%, high-risk criteria
Question 3
A nurse counseling a woman about modifiable breast cancer risk factors should
prioritize education about which intervention?
A. Delaying age at first childbirth
B. Reducing alcohol consumption
C. Avoiding all estrogen exposure
D. Increasing dietary soy intake
Answer: B
Rationale:
Alcohol consumption is a well-established, modifiable risk factor with a dose-
dependent relationship to breast cancer. While reproductive factors influence risk, they
are not modifiable at the time of counseling. Estrogen avoidance is neither realistic nor
evidence-based for prevention in average-risk women.
Key words: modifiable risk factors, alcohol, prevention counseling
Question 4
,Which limitation of the Gail model is most clinically significant?
A. It overestimates risk in postmenopausal women
B. It excludes reproductive history
C. It fails to account for extensive family history
D. It requires genetic testing
Answer: C
Rationale:
The Gail model focuses on limited family history (first-degree relatives only) and does
not capture genetic mutations or second-degree relatives, making it unreliable for high-
risk assessment.
Key words: Gail model, limitations, family history
Question 5
A 38-year-old BRCA1 mutation carrier asks about risk-reduction options. Which
intervention provides the greatest reduction in breast cancer risk?
A. Annual MRI and mammography
B. Tamoxifen chemoprevention
C. Bilateral prophylactic mastectomy
D. Oophorectomy alone
Answer: C
Rationale:
Bilateral prophylactic mastectomy reduces breast cancer risk by up to 90–95% in
BRCA mutation carriers. Surveillance and chemoprevention reduce risk but do not
approach this magnitude of risk reduction.
Key words: BRCA, prophylactic mastectomy, risk reduction
Question 6
Which screening strategy best reflects population-based screening?
,A. MRI beginning at age 25 for all women
B. Annual ultrasound for women with dense breasts
C. Mammography beginning at age 40–50 for average-risk women
D. Genetic testing for all women over age 30
Answer: C
Rationale:
Population-based screening targets average-risk women, primarily using
mammography starting between ages 40–50 depending on guidelines. MRI and
genetic testing are reserved for high-risk populations.
Key words: population screening, average risk, mammography
Question 7
A patient asks why ultrasound is recommended after an abnormal mammogram. The
nurse explains that ultrasound is particularly useful for:
A. Detecting microcalcifications
B. Distinguishing solid from cystic masses
C. Replacing biopsy
D. Screening asymptomatic average-risk women
Answer: B
Rationale:
Ultrasound is valuable for characterizing masses seen on mammography, particularly in
determining whether a lesion is solid or cystic. It does not reliably detect
microcalcifications and does not replace tissue diagnosis.
Key words: breast ultrasound, diagnostic imaging, cystic vs solid
Question 8
Which patient is the best candidate for chemoprevention with tamoxifen?
, A. A 70-year-old with prior breast cancer
B. A 45-year-old with a 5-year Gail risk of 2.0%
C. A 30-year-old BRCA mutation carrier
D. A 55-year-old with dense breasts only
Answer: B
Rationale:
Chemoprevention is recommended for women with a 5-year breast cancer risk
≥1.67%, particularly for estrogen receptor–positive risk reduction. BRCA carriers often
require more aggressive strategies.
Key words: chemoprevention, tamoxifen, Gail risk
Question 9
Which statement best reflects the nurse’s role in shared decision-making for
screening?
A. “I will tell you which screening test is best.”
B. “MRI is always superior to mammography.”
C. “Let’s review your risk factors and preferences together.”
D. “Screening decisions should follow age-based rules only.”
Answer: C
Rationale:
Shared decision-making integrates individual risk, patient values, and evidence-
based recommendations. Nurses facilitate understanding rather than dictating choices.
Key words: shared decision-making, patient education, advocacy
Question 10
Which environmental exposure is most strongly associated with increased breast cancer
risk?
