NURSING 1 Care of Patients with Breast Disorders

Care of Patients with Breast Disorders MULTIPLE CHOICE 1. The nurse is teaching a 45-year-old woman about her fibrocystic breast condition. Which statement by the client indicates a lack of understanding? a. “This condition will become malignant over time.” b. “I should refrain from using hormone replacement therapy.” c. “One cup of coffee in the morning should be enough for me.” d. “This condition makes it more difficult to examine my breasts.” ANS: A Fibrocystic breast condition does not increase a woman’s chance of developing breast cancer. Hormone re- placement therapy is not indicated since the additional estrogen may aggravate the condition. Limiting caffeine intake may give relief for tender breasts. The fibrocystic changes to the breasts make it more difficult to exam- ine the breasts because of fibrotic changes and lumps. DIF: Applying/Application REF: 1462 KEY: Reproductive problems| physiology| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 2. The nurse is examining a woman’s breast and notes multiple small mobile lumps. Which question would be the most appropriate for the nurse to ask? a. “When was your last mammogram at the clinic?” b. “How many cans of caffeinated soda do you drink in a day?” c. “Do the small lumps seem to change with your menstrual period?” d. “Do you have a first-degree relative who has breast cancer?” ANS: C The most appropriate question would be one that relates to benign lesions that usually change in response to hormonal changes within a menstrual cycle. Reduction of caffeine in the diet has been shown to give relief in fibrocystic breast conditions, but research has not found that it has a significant impact. Questions related to the client’s last mammogram or breast cancer history are not related to the nurse’s assessment. DIF: Applying/Application REF: 1462 KEY: Reproductive problems| nursing assessment| physiology MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 3. A client is diagnosed with a fibrocystic breast condition while in the hospital and is experiencing breast dis- comfort. What comfort measure would the nurse delegate to the unlicensed assistive personnel (UAP)? a. Aid in the draining of the cysts by needle aspiration. b. Teach the client to wear a supportive bra to bed. c. Administer diuretics to decrease breast swelling. d. Obtain a cold pack to temporarily relieve the pain. ANS: D All of the options would be comfort measures for a client with a fibrocystic breast condition. The UAP can ob- tain the cold or heat therapy. Only the nurse should aid the health care provider with a needle aspiration, teach, and administer medications. DIF: Applying/Application REF: 1462 KEY: Reproductive problems| delegation| unlicensed assistive personnel (UAP)| comfort measures MSC: Inte- grated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 4. Which finding in a female client by the nurse would receive the highest priority of further diagnostics? a. Tender moveable masses throughout the breast tissue b. A 3-cm firm, defined mobile mass in the lower quadrant of the breast c. Nontender immobile mass in the upper outer quadrant of the breast d. Small, painful mass under warm reddened skin ANS: C Malignant lesions are hard, nontender, and usually located in the upper outer quadrant of the breast and would be the priority for further diagnostic study. The other lesions are benign breast disorders. The tender moveable masses throughout the breast tissue could be a fibrocystic breast condition. A firm, defined mobile mass in the lower quadrant of the breast is a fibroadenoma, and a painful mass under warm reddened skin could be a local abscess or ductal ectasia. DIF: Applying/Application REF: 1469 KEY: Reproductive problems| cancer| assessment MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 5. The nurse is taking the history of a client who is scheduled for breast augmentation surgery. The client re- veals that she took two aspirin this morning for a headache. Which action by nurse is best? a. Take the client’s vital signs and record them in the chart. b. Notify the surgeon about the aspirin ingestion by the client. c. Warn the client that health insurance may not pay for the procedure. d. Teach the client about avoiding twisting above the waist after the operation. ANS: B The surgeon must be notified immediately since the aspirin could cause increased bleeding during the proce- dure. Vital signs should be recorded and postoperative teaching should be completed in the preoperative time frame, but these are not the priority since the procedure may be rescheduled. The warning about the client’s health insurance is not appropriate at this time. DIF: Applying/Application REF: 1463 KEY: Reproductive problems| surgical care| patient safety MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 6. A 68-year-old male client is embarrassed about having bilateral breast enlargement. Which statement by the nurse is the most appropriate? a. “Breast cancer in men is quite rare.” b. “It is good that you came to be carefully evaluated.” c. “Gynecomastia usually comes from overeating.” d. “When you get older, the male breast always enlarges.” ANS: B The most appropriate statement is the one that is supportive of the client. A breast mass should be carefully evaluated for breast cancer, even if it is not common. Gynecomastia as a symptom can be related to antiandro- gen agents, aging, obesity, estrogen excess, or lack of androgens. DIF: Applying/Application REF: 1463 KEY: Reproductive problems| caring| patient-centered care MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Psychosocial Integrity