Chapter 52 Assessment and Management of Patients
With Breast Disorders
1. A 45-year-old woman comes into the health clinic for her annual check-up. She mentions
to the nurse that she has noticed dimpling of the right breast that has occurred in a few
months. What assessment would be most appropriate for the nurse to make?
A) Evaluate the patient's milk production.
B) Palpate the area for a breast mass.
C) Assess the patient's knowledge of breast cancer.
D) Assure the patient that this likely an age-related change. Ans:
B
Feedback:
It would be most important for the nurse to palpate the breast to determine the presence
of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin
may result from a neoplasm blocking lymphatic drainage, giving the skin an
orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer.
Evaluation of milk production is required in lactating women. There is no indication of
lactation in the scenario. The patient's knowledge of breast cancer is relevant, but is not a
time-dependent priority. This finding is not an age-related change.
2. The nurse leading an educational session is describing self-examination of the breast.
The nurse tells the women's group to raise their arms and inspect their breasts in a
mirror. A member of the women's group asks the nurse why raising her arms is
necessary. What is the nurse's best response?
A) ìIt helps to spread out the fat that makes up your breast.î
B) ìIt allows you to simultaneously assess for pain.î
C) ìIt will help to observe for dimpling more closely.î
D) ìThis is what the American Cancer Society recommends.î
Ans: C
Feedback:
,The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or
retraction that may otherwise go undetected, the examiner instructs the patient to raise both
arms overhead. Citing American Cancer Society recommendations does not address the
woman's question. The purpose of raising the arms is not to elicit pain or to redistribute
adipose tissue.
3. A woman aged 48 years comes to the clinic because she has discovered a lump in her
breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The
woman asks the nurse when her teenage daughters should begin mammography. What is the
nurse's best advice?
A) Age 28
B) Age 35
C) Age 38
D) Age 48
Ans: C
Feedback:
A general guideline is to begin screening 5 to 10 years earlier than the age at which the
youngest family member developed breast cancer, but not before age 25 years. In families
with a history of breast cancer, a downward shift in age of diagnosis of about
10 years is seen. Because their mother developed breast cancer at age 48 years, the
daughters should begin mammography at age 38 to 43 years.
4. A woman scheduled for a simple mastectomy in one week is having her preoperative
education provided by the clinic nurse. What educational intervention will be of primary
importance to prevent hemorrhage in the postoperative period?
A) Limit her intake of green leafy vegetables.
B) Increase her water intake to 8 glasses per day.
C) Stop taking aspirin.
D) Have nothing by mouth for 6 hours before surgery.
Ans: C
Feedback:
, The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect.
Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding.
Increasing fluid intake or being NPO before surgery will have no effect on bleeding.
5. The nurse is caring for a 52-year-old woman whose aunt and mother died of breast
cancer. The patient states, ìMy doctor and I talked about Tamoxifen to help prevent
breast cancer. Do you think it will work?î What would be the nurse's best response? A)
ìYes, it's known to have a slight protective effect.î
B) ìYes, but studies also show an increased risk of osteoporosis.î
C) ìYou won't need to worry about getting cancer as long as you take Tamoxifen.î
D) ìTamoxifen is known to be a highly effective protective measure.î
Ans: D
Feedback:
Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it
cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.
With Breast Disorders
1. A 45-year-old woman comes into the health clinic for her annual check-up. She mentions
to the nurse that she has noticed dimpling of the right breast that has occurred in a few
months. What assessment would be most appropriate for the nurse to make?
A) Evaluate the patient's milk production.
B) Palpate the area for a breast mass.
C) Assess the patient's knowledge of breast cancer.
D) Assure the patient that this likely an age-related change. Ans:
B
Feedback:
It would be most important for the nurse to palpate the breast to determine the presence
of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin
may result from a neoplasm blocking lymphatic drainage, giving the skin an
orange-peel appearance (peau d'orange), a classic sign of advanced breast cancer.
Evaluation of milk production is required in lactating women. There is no indication of
lactation in the scenario. The patient's knowledge of breast cancer is relevant, but is not a
time-dependent priority. This finding is not an age-related change.
2. The nurse leading an educational session is describing self-examination of the breast.
The nurse tells the women's group to raise their arms and inspect their breasts in a
mirror. A member of the women's group asks the nurse why raising her arms is
necessary. What is the nurse's best response?
A) ìIt helps to spread out the fat that makes up your breast.î
B) ìIt allows you to simultaneously assess for pain.î
C) ìIt will help to observe for dimpling more closely.î
D) ìThis is what the American Cancer Society recommends.î
Ans: C
Feedback:
,The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or
retraction that may otherwise go undetected, the examiner instructs the patient to raise both
arms overhead. Citing American Cancer Society recommendations does not address the
woman's question. The purpose of raising the arms is not to elicit pain or to redistribute
adipose tissue.
3. A woman aged 48 years comes to the clinic because she has discovered a lump in her
breast. After diagnostic testing, the woman receives a diagnosis of breast cancer. The
woman asks the nurse when her teenage daughters should begin mammography. What is the
nurse's best advice?
A) Age 28
B) Age 35
C) Age 38
D) Age 48
Ans: C
Feedback:
A general guideline is to begin screening 5 to 10 years earlier than the age at which the
youngest family member developed breast cancer, but not before age 25 years. In families
with a history of breast cancer, a downward shift in age of diagnosis of about
10 years is seen. Because their mother developed breast cancer at age 48 years, the
daughters should begin mammography at age 38 to 43 years.
4. A woman scheduled for a simple mastectomy in one week is having her preoperative
education provided by the clinic nurse. What educational intervention will be of primary
importance to prevent hemorrhage in the postoperative period?
A) Limit her intake of green leafy vegetables.
B) Increase her water intake to 8 glasses per day.
C) Stop taking aspirin.
D) Have nothing by mouth for 6 hours before surgery.
Ans: C
Feedback:
, The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect.
Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding.
Increasing fluid intake or being NPO before surgery will have no effect on bleeding.
5. The nurse is caring for a 52-year-old woman whose aunt and mother died of breast
cancer. The patient states, ìMy doctor and I talked about Tamoxifen to help prevent
breast cancer. Do you think it will work?î What would be the nurse's best response? A)
ìYes, it's known to have a slight protective effect.î
B) ìYes, but studies also show an increased risk of osteoporosis.î
C) ìYou won't need to worry about getting cancer as long as you take Tamoxifen.î
D) ìTamoxifen is known to be a highly effective protective measure.î
Ans: D
Feedback:
Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it
cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.
