Mammograms
A nurse is reviewing the EMR of a 50-year-old female client who lives in a rural area. It is documented that the client has not received their routine mammograms. Which of the following factors should the nurse identify as contributing to the client's health disparity?
A. Environment
B. Ethnicity
C. Age
D. Gender
A. Environment-Living in a rural area is a potential risk factor for accessing health care because there are limited resources available. This could be a barrier and a reason for the client's health disparity.
A 33-year-old patient tells the nurse that she has fibrocystic breasts but reducing her sodium and caffeine intake and other measures have not made a difference in the fibrocystic condition. An appropriate patient outcome for the patient is
A. calls the health care provider if any lumps are painful or tender.
B. states the reason for immediate biopsy of new lumps.
C. monitors changes in size and tenderness of all lumps in relation to her menstrual cycle.
D. has genetic testing for BRCA-1 and BRCA-2 to determine her risk for breast cancer.
Answer: C
Rationale: Because fibrocystic breasts may increase in size and tenderness during the premenstrual phase, the patient is taught to monitor for this change and to call if the changes persist after menstruation. Pain and tenderness are typical of fibrocystic breasts, and the patient should not call for these symptoms. New lumps may be need biopsy if they persist after the menstrual period, but the biopsy is not done immediately. The existence of fibrocystic breasts is not associated with the BRCA genes.
When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a
a. cousin who was diagnosed with breast cancer at age 38.
b. mother who was diagnosed with breast cancer at age 42.
c. sister who died from ovarian cancer at age 56.
d. grandmother who died from breast cancer at age 72.
Answer: B
Rationale: A significant family history of breast cancer means that the patient has a first-degree relative who developed breast cancer, especially if the relative was premenopausal.
Cognitive Level: Application Text Reference: p. 1348
Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance
A nurse is teaching a new mother about signs of effective breastfeeding of her newborn. Which of the following information should the nurse include in the teaching?
a. expect your baby to have less than 5 wet diapers per day after the fourth day of life
b. your baby can lose 5% of body weight during the first 3 days of life
c. your baby should gain 0.25 oz (7 grams) per day after the fourth day of life
d. expect your baby to feed constantly during the first week of life
b. your baby can lose 5% of body weight during the first 3 days of life
rationale: the nurse should instruct the mother that the baby can have a weight loss between 5-6% of their birth weight during the first 3 days of life. breastfed infants usually begin birth weight by their second or third week of life.
When teaching a 22-year-old patient about breast self-examination (BSE), the nurse will instruct the patient that
A. BSE will reduce the risk of dying from breast cancer.
B. performing BSE right after the menstrual period will improve comfort.
C. BSE should be done daily while taking a bath or shower.
D. annual mammograms should be scheduled in addition to BSE.
Answer: B
Rationale: 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 breast cancer mortality. BSE should be done monthly. Annual mammograms are not routinely scheduled for women under age 40.
A 20-year-old student comes to the student health center after discovering a small painless lump in her right breast. She is worried that she might have cancer because her mother had cervical cancer. The nurse's response to the patient is based on the knowledge that the most likely cause of the breast lump is
a. fibrocystic complex.
b. fibroadenoma.
c. breast abscess.
d. adenocarcinoma.
Answer: B
Rationale: Fibroadenoma is the most frequent cause of breast lumps in women under 25 years of age. Fibrocystic changes occur most frequently in women ages 35 to 50. Breast abscess is associated with pain and other systemic symptoms. Breast cancer is uncommon in women younger than 25.
A patient with a breast biopsy positive for cancer is to undergo lymphatic mapping and sentinel lymph node dissection (SLND). The nurse explains that this procedure
a. can identify specific lymph nodes that have malignant cells, so only involved nodes need to be excised.
b. reduces the need for extensive lymph node dissection for pathologic examination.
c. eliminates the need for excision of more than one lymph node for staging of breast cancer.
d. will confirm the absence of tumor spread if the sentinel lymph node is negative for malignant changes.
Answer: B
Rationale: The SLND may eliminate further lymph node dissection if the initial nodes are negative for malignancy. The procedure identifies which lymph nodes drain first from the tumor site, but not which ones are malignant. Several lymph nodes may be dissected for pathologic examination. Tumor may have distant metastases even when no malignancies are found in the lymph nodes.
Cognitive Level: Comprehension Text Reference: p. 1351
Nursing Process: Implementation NCLEX: Physiological Integrity
A nurse is caring for a client who is receiving chemotherapy for treatment of ovarian cancer and experiencing nausea. Which of the following actions should the nurse take?
a. advise the client to lie down after meals
b. instruct the client to restrict food intake prior to treatment
c. provide the client with an antiemetic 2 hr prior to the chemotherapy
d. encourage the client to drink a carbonated beverage 1 hr before meals.
d. encourage the client to drink a carbonated beverage 1 hr before meals
answer rationale: the nurse should instruct the client to drink a carbonated beverage 1 hr before or after meals to reduce risk for nausea
While the nurse is obtaining a nursing history from a 52-year-old patient who has found a small lump in her breast, which question is most pertinent?
A. "Do you currently smoke cigarettes?"
B. "Have you ever had any breast injuries?"
C. "Is there any family history of fibrocystic breast changes?"
D. "At what age did you start having menstrual periods?"
Answer: D
Rationale: 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.
During examination of a 67-year-old man, the nurse notes bilateral enlargement of the breasts. The nurse's first action should be to
a. palpate the breasts for the presence of any discrete lumps.
b. explain that this is a temporary condition caused by hormonal changes.
c. refer the patient for mammography and biopsy of the breast tissue.
d. teach the patient about dietary changes to reduce the breast size.
Answer: A
Rationale: If discrete, circumscribed lumps are present, the patient should be referred for further testing to determine whether breast cancer is present. Gynecomastia is usually a temporary change, but it can be caused by breast cancer. Mammography and biopsy will not be needed unless lumps are present in the breast tissue. Dietary changes will not affect the condition.
A woman with a positive biopsy for breast cancer is considering whether to have a modified radical mastectomy or breast conservation surgery (lumpectomy) with radiation therapy. Which information should the nurse provide?
a. The postoperative survival rate for each is about the same, but there is a decreased rate of cancer recurrence after mastectomy.
b. The lumpectomy and radiation will preserve the breast, but this method can cause changes in breast sensitivity.
c. The hair loss associated with post-lumpectomy chemotherapy is not acceptable to some patients.
d. The treatment period for the mastectomy is shorter, and breast reconstruction can provide a normal-appearing breast.
Answer: B
Rationale: The impact on breast function and appearance is less with lumpectomy and radiation, but there is some effect on breast sensitivity. The rate of cancer recurrence is the same for the two procedures. Chemotherapy may be used after either lumpectomy or mastectomy, but it is not always needed. The treatment period is shorter after mastectomy, but breast reconstruction does not provide a normal-appearing breast.
Cognitive Level: Application Text Reference: pp. 1352-1353
Nursing Process: Implementation NCLEX: Physiological Integrity
A nurse is caring for a new mother who is breastfeeding her term newborn. The newborn weighed 3.4 kg (7.5 lb) at birth, and weighs 3.3 kg (7.3 lb) on the second day of life. The mother expresses concern about the weight loss and asks the nurse about the amount of her breast milk. Which of the following responses by the nurse is appropriate?
a."Why don't you switch to formula to make sure your baby is eating enough?"
b. "It is common for new mothers to worry that they are not making enough milk for their baby."
c. "A healthy newborn can lose 6% of his birth weight before starting to gain weight."
d. "Your newborn will need to remain in the hospital so his weight can be monitored."
c. "A healthy newborn can lose 6% of his birth weight before starting to gain weight."
Answer Rationale:
This newborn has lost less than 6% of the recorded birth weight. A healthy newborn can lose up to 6% of his body weight before beginning to gain weight. This response gives the mother the information that she needs about expected newborn weight loss while also reassuring her that the weight loss is not related to her ability to produce milk for the infant.
A 62-year-old patient complains to the nurse that mammograms are painful and a source of radiation exposure. She says she does breast self-examination (BSE) monthly and asks whether it is necessary to have an annual mammogram. The nurse's best response to the patient is,
A. "If your mammogram was painful, it is especially important that you have it done annually."
B. "An ultrasound examination of the breasts, which is not painful or a source of radiation, can be substituted for a mammogram."
c. "Because of your age, it is even more important for you to have annual mammograms."
d. "Unless you find a lump while examining your breasts, a mammogram every 2 years is recommended after age 60."
Answer: C
Rationale: Annual mammograms are recommended for women over age 40 as long as they are in good health. The incidence of breast cancer increases in women over 60. Pain with a mammogram does not indicate any greater risk for breast cancer. Ultrasound may be used in some situations to differentiate cystic breast problems from cancer but is not a substitute for annual mammograms.
A 51-year-old woman at menopause is considering the use of hormone replacement therapy (HRT) but is concerned about the risk of breast cancer. When discussing this issue with the patient, the nurse explains that
a. HRT does not appear to increase the risk for breast cancer unless there are other risk factors.
b. she and her health care provider must weigh the benefits of HRT against the possible risks of breast cancer.
c. HRT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes.
d. alternative therapies with herbs and natural drugs are as effective as estrogen in relieving the symptoms of menopause.
Answer: B
Rationale: Because HRT has been linked to increased risk for breast cancer, the patient and provider must determine whether or not to use HRT. Breast cancer incidence is increased in women using HRT, independent of other risk factors. HRT increase the risk for non-BRCA-associated cancer as well as for BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.
Cognitive Level: Application Text Reference: p. 1348
Nursing Process: Implementation NCLEX: Physiological Integrity
Following a modified radical mastectomy, the health care provider recommends chemotherapy even though the lymph nodes were negative for cancer cells. The patient tells the nurse that she does not know what to do about chemotherapy because she has heard that she may not even need chemotherapy and that the side effects are uncomfortable. The nursing diagnosis that best reflects the patient's problem is
a. anxiety related to prospect of additional cancer therapy.
b. fear related to uncomfortable side effects of chemotherapy.
c. decisional conflict related to lack of knowledge about prognosis and treatment options.
d. risk for ineffective health maintenance related to reluctance to consider additional treatment.
Answer: C
Rationale: The patient's statements indicate that she is having difficulty making a decision about treatment because of a lack of understanding about prognosis and treatment. Although she may have some anxiety and fear, these are not the priorities at this time. The patient expresses concerns about chemotherapy rather than reluctance to consider additional treatment.
Cognitive Level: Application Text Reference: p. 1356
Nursing Process: Diagnosis NCLEX: Psychosocial Integrity
A nurse is collecting data from a newborn who weighs 5,160 g (11 lb, 6 oz) and whose mother has diabetes mellitus. For which of the following data should the nurse monitor?
a. hypoglycemia
b. decreased RBC
c. hypobilirubinemia
d. hypercalcemia
a. Hypoglycemia
Answer Rationale:
Newborns of clients who have diabetes are at high risk for hypoglycemia as the constant supply of glucose creates fetal hyperinsulinemia. It can take several days for the newborn to adjust to secreting appropriate amounts of insulin for the new, lesser supply of glucose. Because severe hypoglycemia can lead to cyanosis and seizures, which pose the greatest risk to the newborn at this time, this is the nurse’s highest priority.
A patient with a small breast lump is advised to have a fine needle aspiration (FNA) biopsy. The nurse explains that an advantage to this procedure is that
A. only a small incision is necessary, resulting in minimal breast pain and scarring.
B. if the specimen is positive for malignancy, the patient can be told at the visit.
C. if the specimen is negative for malignancy, the patient's fears of cancer can be put to rest.
D. FNA is guided by a mammogram, ensuring that cells are taken from the lesion.
Answer: B
Rationale: An FNA should only be done when an experienced cytologist is available to read the specimen immediately. If the specimen is positive for malignancy, the patient can be given this information immediately. No incision is needed. If the specimen is negative for malignancy, the patient will require biopsy of the lump. FNA is not guided by mammography.
At a routine health examination, a woman whose mother had breast cancer asks the nurse about the genetic basis of breast cancer and the genes involved. The nurse explains that
a. her risk of inheriting BRCA gene mutations is small unless her mother had both ovarian and breast cancer.
b. changes in BRCA genes that normally suppress cancer growth can be passed to offspring, increasing the risk for breast cancer.
c. because her mother had breast cancer, she has inherited a 50% to 85% chance of developing breast cancer from mutated genes.
d. genetic mutations increase cancer risk only in combination with other risk factors such as obesity.
Answer: B
Rationale: Family history is a risk factor for breast cancer, and the nurse should discuss testing for BRCA genes with the patient. Although the BRCA gene is associated with increased risk for breast and ovarian cancer, the patient may be at risk if her mother had either one. About 5% to 10% of patients with breast cancer may have a genetic abnormality that contributes to breast cancer development. Risk factors are cumulative, but a family history alone will increase breast cancer risk.
Cognitive Level: Application Text Reference: p. 1349
Nursing Process: Implementation NCLEX: Physiological Integrity
A patient at the clinic who has metastatic breast cancer has a new prescription for trastuzumab (Herceptin). The nurse will plan to
a. teach the patient about the need to monitor serum electrolyte levels.
b. ask the patient to call the health care provider before using any over-the-counter (OTC) pain relievers.
c. instruct the patient to call if she notices ankle swelling.
d. have the patient schedule frequent eye examinations.
Answer: C
Rationale: Herceptin 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. OTC pain relievers do not interact with Herceptin. Changes in visual acuity may occur with tamoxifen, but not with Herceptin.
Cognitive Level: Analysis Text Reference: p. 1356
Nursing Process: Implementation NCLEX: Physiological Integrity
A nurse is caring for a client who is postpartum. The client states, "I am concerned about my baby's hearing because my mother was born deaf." Which of the following statements should the nurse make?
a. "There is no need to worry about that. Most forms of hearing loss are not inherited."
b. "Look at how she looks as you when you speak. That’s a good sign."
c. "We do routine hearing screenings on newborns. You’ll know the results before you leave the hospital."
d. "The best way to determine if your baby can hear is to clap your hands loudly and see if she startles."
c. "We do routine hearing screenings on newborns. You’ll know the results before you leave the hospital."
Answer Rationale:
Most states mandate hearing screening for all newborns. The two tests in use do not diagnose hearing loss, but determine whether a newborn requires further evaluation.