Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 52

Chapter 52: Nursing Management: Breast Disorders
Test Bank
MULTIPLE CHOICE
1. The nurse teaching a young womens community service group about breast self-examination
(BSE) will include that
a. BSE will reduce the risk of dying from breast cancer.
b. BSE should be done daily while taking a bath or shower.
c. annual mammograms should be scheduled in addition to BSE.
d. performing BSE after the menstrual period is more comfortable.
ANS: D
Performing BSE at the end of the menstrual period will reduce the breast tenderness
associated with the procedure. The evidence is not clear that BSE reduces mortality from
breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled
for women under age 40, and newer guidelines suggest delaying them until age 50.
DIF: Cognitive Level: Apply (application) REF: 1239

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
2. During a well woman physical exam, a 43-year-old patient asks about her risk for breast
cancer. Which question is most pertinent for the nurse to ask?
a. Do you currently smoke tobacco?
b. Have you ever had a breast injury?
c. At what age did you start having menstrual periods?
d. Is there a family history of fibrocystic breast changes?
ANS: C
Early menarche and late menopause are risk factors for breast cancer because of the prolonged
exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast
changes are not associated with increased breast cancer risk.

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. A 51-year-old patient with a small immobile breast lump is considering having a fine-needle
aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that
a. FNA is done in the outpatient clinic and results are available in 1 to 2 days.
b. only a small incision is needed, resulting in minimal breast pain and scarring.
c. if the biopsy results are negative, no further diagnostic testing will be needed.
d. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
ANS: A
FNA is done in outpatient settings and results are available in 24 to 48 hours. No incision is
needed. FNA may be guided by ultrasound, but not by mammogram. Because the immobility
of the breast lump suggests cancer, further testing will be done if the FNA is negative.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. Which assessment finding in a 36-year-old patient is most indicative of a need for further
evaluation?
a. Bilateral breast nodules that are tender with palpation
b. A breast nodule that is 1 cm in size, nontender, and fixed
c. A breast lump that increases in size before the menstrual period
d. A breast lump that is small, mobile, with a rubbery consistency
ANS: B
Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of
benign processes such as fibrocystic breasts and fibroadenoma.

5. A 53-year-old woman at menopause is discussing the use of hormone therapy (HT) with the
nurse. Which information about the risk of breast cancer will the nurse provide?
a. HT is a safe therapy for menopausal symptoms if there is no family history of
BRCA genes.
b. HT does not appear to increase the risk for breast cancer unless there are other risk
factors.
c. The patient and her health care provider must weigh the benefits of HT against the
risks of breast cancer.
d. Natural herbs are as effective as estrogen in relieving symptoms without
increasing the risk of breast cancer.
ANS: C
Because HT has been linked to increased risk for breast cancer, the patient and provider must
determine whether or not to use HT. Breast cancer incidence is increased in women using HT,
independent of other risk factors. HT increases the risk for both nonBRCA-associated cancer
and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving
menopausal symptoms.

6. A 58-year-old woman tells the nurse, I understand that I have stage II breast cancer and I
need to decide on a surgery, but I feel overwhelmed. What do you think I should do? Which
response by the nurse is best?
a. I would have a lumpectomy, but you need to decide what is best for you.
b. Tell me what you understand about the surgical options that are available.
c. It would not be appropriate for me to make a decision about your health.
d. There is no need to make a decision rapidly; you have time to think about this.
ANS: B
Inquiring about the patients understanding shows the nurses willingness to assist the patient
with the decision-making process without imposing the nurses values or opinions. Treatment
decisions for breast cancer do need to be made relatively quickly. Imposing the nurses
opinions or showing an unwillingness to discuss the topic could cut off communication.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. The nurse will teach a patient with metastatic breast cancer who has a new prescription for
trastuzumab (Herceptin) that
a. hot flashes may occur with the medication.
b. serum electrolyte levels will be drawn monthly.
c. the patient will need frequent eye examinations.
d. the patient should call if she notices ankle swelling.
ANS: D
Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for
symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or
changes in visual acuity may occur with tamoxifen, but not with trastuzumab.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
8. After a 48-year-old patient has had a modified radical mastectomy, the pathology report
identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan to
teach the patient about
a. estradiol (Estrace).
b. raloxifene (Evista).
c. tamoxifen (Nolvadex).
d. trastuzumab (Herceptin).
ANS: C
Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women.
Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast
cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used
to treat tumors that have the HER-2 receptor.

9. Which nursing action should be included in the plan of care for a patient returning to the
surgical unit following a left modified radical mastectomy with dissection of axillary lymph
nodes?
a. Obtain a permanent breast prosthesis before the patient is discharged from the
hospital.
b. Teach the patient to use the ordered patient-controlled analgesia (PCA) every 10
minutes.
c. Post a sign at the bedside warning against venipunctures or blood pressures in the
left arm.
d. Insist that the patient examine the surgical incision when the initial dressings are
removed.
ANS: C
The patient is at risk for lymphedema and infection if blood pressures or venipuncture are
done on the right arm. The patient is taught to use the PCA as needed for pain control rather
than at a set time. The nurse allows the patient to examine the incision and participate in care
when the patient feels ready. Permanent breast prostheses are usually obtained about 6 weeks
after surgery.
10. The nurse provides discharge teaching for a 61-year-old patient who has had a left modified
radical mastectomy and lymph node dissection. Which statement by the patient indicates that
teaching has been successful?
a. I will need to use my right arm and to rest the left one.
b. I will avoid reaching over the stove with my left hand.
c. I will keep my left arm in a sling until the incision is healed.
d. I will stop the left arm exercises if moving the arm is painful.
ANS: B
The patient should avoid any activity that might injure the left arm, such as reaching over a
burner. If the left arm exercises are painful, analgesics should be used and the exercises
continued in order to restore strength and range of motion. The left arm should be elevated at
or above heart level and should be used to improve range of motion and function.

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
11. A 33-year-old patient has a saline breast implant inserted in the outpatient surgery area. Which
instruction will the nurse include in the discharge teaching?
a. Take aspirin every 4 hours to reduce inflammation.
b. Check wound drains for excessive blood or a foul odor.
c. Wear a loose-fitting bra to decrease irritation of the sutures.
d. Resume normal activities 2 to 3 days after the mammoplasty.
ANS: B
The patient should be taught drain care because the drains will be in place for 2 or 3 days after
surgery. Normal activities can be resumed after 2 to 3 weeks. A bra that provides good support
is typically ordered. Aspirin will decrease coagulation and is typically not given after surgery.

12. The nurse is providing preoperative teaching about the transverse rectus abdominis
musculocutaneous (TRAM) procedure to a patient. Which information will the nurse include?
a.Saline-filled implants are placed under the pectoral muscles.
b.Recovery from the TRAM surgery takes at least 6 to 8 weeks.
c.Muscle tissue removed from the back is used to form a breast.
d.TRAM flap procedures may be done in outpatient surgery centers.
ANS: B
Patients take at least 6 to 8 weeks to recover from the TRAM surgery. Tissue from the
abdomen is used to reconstruct the breast. The TRAM procedure can take up to 8 hours and
requires postoperative hospitalization. Saline implants are used in mammoplasty.

13. A patient newly diagnosed with stage I breast cancer is discussing treatment options with the
nurse. Which statement by the patient indicates that additional teaching may be needed?
a. There are several options that I can consider for treating the cancer.
b. I will probably need radiation to the breast after having the surgery.
c. Mastectomy is the best choice to decrease the chance of cancer recurrence.
d. I can probably have reconstructive surgery at the same time as a mastectomy.
ANS: C
The survival rates with lumpectomy and radiation or modified radical mastectomy are
comparable. The other patient statements indicate a good understanding of stage I breast
cancer treatment.

14. Which information will the nurse include in patient teaching for a 36-year-old patient who is
scheduled for stereotactic core biopsy of the breast?
a. A local anesthetic will be given before the biopsy specimen is obtained.
b. You will need to lie flat on your back and lie very still during the biopsy.
c. A thin needle will be inserted into the lump and aspirated to remove tissue.
d. You should not have anything to eat or drink for 6 hours before the procedure.
ANS: A
A local anesthetic is given before stereotactic biopsy. NPO status is not needed because no
sedative drugs are given. The patient is placed in the prone position. A biopsy gun is used to
obtain the specimens.

15. A student nurse prepares a list of teaching topics for a patient with a new diagnosis of breast
cancer. Which item should the charge nurse suggest that the student nurse omit from the
teaching topic list about breast cancer diagnostic testing?
a. CA 15-3 level testing
b. HER-2 receptor testing
c. Estrogen receptor testing
d. Oncotype DX assay testing
ANS: A
Tumor markers such as CA 15-3 are used to monitor response to treatment for breast cancer,
not to detect or diagnose breast cancer. The other tests are likely to be used for additional
diagnostic testing in a patient with breast cancer.

TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
16. The nurse will anticipate teaching a 56-year-old patient who is diagnosed with lobular
carcinoma in situ (LCIS) about
a. lumpectomy.
b. lymphatic mapping.
c. MammaPrint testing.
d. tamoxifen (Nolvadex).
ANS: D
Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other
diagnostic tests and therapies are not needed because LCIS does not usually require treatment.
DIF: Cognitive Level: Apply (application) REF: 1245 | 1251

17. Which information should the nurse include in teaching a patient who is scheduled for
external beam radiation to the breast?
a. The radiation therapy will take a week to complete.
b. Careful skin care in the radiated area will be necessary.
c. Visitors are restricted until the radiation therapy is completed.
d. Wigs may be used until the hair regrows after radiation therapy.
ANS: B
Skin care will be needed because of the damage caused to the skin by the radiation. External
beam radiation is done over a 5- to 6-week period. Scalp hair loss does not occur with breast
radiation therapy. Because the patient does not have radioactive implants, no visitor
restrictions are necessary.

18. Which patient statement indicates that the nurses teaching about tamoxifen (Nolvadex) has
been effective?
a. I can expect to have leg cramps.
b. I will call if I have any eye problems.
c. I should contact you if I have hot flashes.
d. I will be taking the medication for 6 to 12 months.
ANS: B
Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it
is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally
lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign
of deep vein thrombosis, and the patient should immediately notify the health care provider if
pain occurs.

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
19. The nurse is admitting a patient scheduled this morning for lumpectomy and axillary lymph
node dissection. Which action should the nurse take first?
a. Teach the patient how to deep breathe and cough.
b. Discuss options for postoperative pain management.
c. Explain the postdischarge care of the axillary drains.
d. Ask the patient to describe what she knows about the surgery.
ANS: D
Before teaching, the nurse should assess the patients current knowledge level. The other
teaching also may be appropriate, depending on the assessment findings.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
20. When the nurse is working in the womens health care clinic, which action is appropriate to
take?
a. Teach a healthy 30-year-old about the need for an annual mammogram.
b. Discuss scheduling an annual clinical breast examination with a 22-year-old.
c. Explain to a 60-year-old that mammography frequency can be reduced to every 3
years.
d. Teach a 28-year-old with a BRCA-1 mutation about magnetic resonance imaging
(MRI).
ANS: D
MRI (in addition to mammography) is recommended for women who are at high risk for
breast cancer. A young woman should have a clinical breast exam every 3 years. Annual
mammograms are recommended for women over 50.

TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
21. Which action will the nurse include in the plan of care for a patient with right arm
lymphedema?
a. Check blood pressure (BP) on both right and left arms.
b. Avoid isometric exercise on the right arm.
c. Assist with application of a compression sleeve.
d. Keep the right arm at or below the level of the heart.
ANS: C
Compression of the arm assists in improving lymphatic flow toward the heart. Isometric
exercises may be prescribed for lymphedema. BPs should only be done on the patients right
arm. The arm should not be placed in a dependent position.

22. A 36-year-old who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic
with symptoms. Which is most important to report to the health care provider?
a. There is yellow-green discharge from the patients right nipple.
b. There is an area on the breast that is hot, pink, and tender to touch.
c. The lumps are firm and most are in the upper outer breast quadrants.
d. The lumps are larger and painful before the patients menstrual period.
ANS: B
An area that is hot or pink suggests an infectious process such as mastitis, which would
require further assessment and treatment. The other information also will be reported, but
these findings are typical in fibrocystic breasts.

23. The nurse notes bilateral enlargement of the breasts during examination of a 62-year-old man.
Which action should the nurse take first?
a. Teach the patient how to palpate the breast tissue for lumps.
b. Question the patient about medications being currently used.
c. Refer the patient for mammography and biopsy of the breast tissue.
d. Explain that this is a temporary condition due to hormonal changes.
ANS: B
The first action should be further assessment. Because gynecomastia is a possible side effect
of drug therapy, asking about the current drug regimen is appropriate. The other actions may
be needed, depending on the data that are obtained with further assessment.

24. A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph
node dissection. Which nursing intervention is appropriate to delegate to a licensed
practical/vocational nurse (LPN/LVN)?
a. Teaching the patient how to avoid injury to the left arm
b. Assessing the patients range of motion for the left arm
c. Evaluating the patients understanding of instructions about drain care
d. Administering an analgesic 30 minutes before scheduled arm exercises
ANS: D
LPN/LVN education and scope of practice include administration and evaluation of the effects
of analgesics. Assessment, teaching, and evaluation of a patients understanding of
instructions are more complex tasks that are more appropriate to RN level education and
scope of practice.
DIF: Cognitive Level: Apply (application) REF: 15-16

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
25. The nurse is caring for a 52-year-old patient with breast cancer who is receiving
chemotherapy with doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan). Which
assessment finding is most important to communicate to the health care provider?
a. The patient complains of fatigue.
b. The patient eats only 25% of meals.
c. The patients apical pulse is irregular.
d. The patients white blood cell (WBC) count is 5000/L.
ANS: C
Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may
indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are
expected effects of chemotherapy.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
26. A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the
nurse, I would rather not know much about the surgery. Which response by the nurse is
best?
a. Tell me what you think is important to know about the surgery.
b. It is essential that you know enough to provide informed consent.
c. Many patients do better after surgery if they have more information.
d. You can wait until after surgery for teaching about pain management.
ANS: A
This response shows sensitivity to the individual patients need for information about the
surgery. The other responses are also accurate, but the nurse should tailor patient teaching to
individual patient preferences.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
27. The outpatient clinic receives telephone calls from four patients. Which patient should the
nurse call back first?
a. 57-year-old with ductal ectasia who has sticky multicolored nipple discharge and
severe nipple itching
b. 21-year-old with a family history of breast cancer who wants to discuss genetic
testing for the BRCA gene
c. 40-year-old who still has left side chest and arm pain 2 months after a left
modified radical mastectomy
d. 50-year-old with stage 2 breast cancer who is receiving doxorubicin (Adriamycin)
and has ankle swelling and fatigue
ANS: D
Although all the patients have needs that the nurse should address, the patient who is
receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by
the nurse first. BRCA testing may be appropriate for the 21-year-old, but it does not need to be
done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple
discharge and itching is a common finding with ductal ectasia.
DIF: Cognitive Level: Analyze (analysis) REF: 1250

OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
28. When using the accompanying illustration to teach a patient about breast self-examination, the
nurse will include the information that most breast cancers are located in which part of the
breast?
a. 1
b. 2
c. 3
d. 4
e. 5
ANS: A
The upper outer quadrant is the location of most of the glandular tissue of the breast.
DIF: Cognitive Level: Understand (comprehension) REF: 1245


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Chapter 52: Nursing Management: Breast Disorders

DIF: Cognitive Level: Apply (application) REF: 1239

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DIF: Cognitive Level: Analyze (analysis) REF: 1250

DIF: Cognitive Level: Understand (comprehension) REF: 1245

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