Chapter 10: Problems of the Breast My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 10: Problems of the Breast

Test Bank

MULTIPLE CHOICE

1. A nurse providing breast care education should explain to the woman that fibrocystic changes in breasts are:

a.

A disease of the milk ducts and glands in the breasts

b.

A premalignant disorder characterized by lumps found in the breast tissue

c.

Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles

d.

Lumpiness accompanied by tenderness after menses

ANS: C

Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle.

Fibrocystic changes are palpable thickenings in the breast.

Fibrocystic changes are not premalignant changes. This information is inaccurate.

Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. Most often tenderness occurs prior to menses.

DIF: Cognitive Level: Knowledge REF: 211

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. A nurse who is teaching a group of women about breast cancer tells them that:

a.

Risk factors identify more than 50% of women who will develop breast cancer

b.

Nearly 90% of lumps found by women are malignant

c.

One in 10 women in the United States will develop breast cancer in her lifetime

d.

The exact cause of breast cancer is unknown

ANS: D

The exact cause of breast cancer is unknown.

Risk factors help identify 5% to 10% of women in whom breast cancer eventually will develop.

Women detect about 90% of all breast lumps. Of this 90%, only 20% to 25% are malignant.

One in eight women in the United States will develop breast cancer in her lifetime.

DIF: Cognitive Level: Comprehension REF: 214

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

3. Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?

a.

Mammogram

b.

Ultrasound

c.

Needle localization biopsy

d.

CA 15-3

ANS: C

When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by either a core needle biopsy or needle localization biopsy.

Mammography is a clinical screening tool that may aid early detection of breast cancers.

Transillumination, thermography, and ultrasound breast imaging are being explored as methods of detecting early breast carcinoma.

CA-15 is a serum tumor marker used to test for residual disease.

DIF: Cognitive Level: Knowledge REF: 220

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

4. A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her physician, concerned about the 3-week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make to this client?

a.

Do you have transportation to the teaching hospital so that you can get your mammogram?

b.

Im concerned that you missed your appointment; let me make another one for you.

c.

Its very dangerous to skip your mammograms; your breasts need to be checked.

d.

Would you like me to make an appointment for you to have your mammogram here?

ANS: D

Offering to make an appointment for the client at your location is nonjudgmental and gives her options as to where she may have her mammogram. Furthermore, it is an innocuous way to investigate the reasons the client missed her previous appointment.

African-American women often have the perception that they are treated with prejudice by health care providers. Questioning the potential lack of transportation may promote this perception.

Rather than reminding this woman that she has missed her appointment it might be preferable for the nurse to discuss the evidence behind the recommendations for a mammogram. The nurse can offer to reschedule should the client agree to return for the test.

Telling the client that it is dangerous to skip mammograms can be perceived as judgmental and derogatory. It may alienate and embarrass the client.

DIF: Cognitive Level: Application REF: 219

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

5. A clients oncologist has just finished explaining the diagnostic workup results to her, and she still has questions. The woman states, The doctor says I have a slow-growing cancer. Very few cells are dividing. How does she know this? What is the name of the test that gave the physician this information?

a.

Tumor ploidy

b.

S-phase index

c.

Nuclear grade

d.

Estrogen receptor assay

ANS: B

The S-phase index measures the number of cells in the synthesis phase of cell development. If the number of cells noted is high, the cancer is growing at a fast rate. In this clients case, her S-phase index is assumed to be low.

Tumor ploidy is the amount of DNA in a tumor cell compared with that in a normal cell.

Nuclear grade describes the degree of abnormalities present in the cancer cell tubules, nuclei morphology, and mitotic rates.

Estrogen and progesterone receptors are proteins found in the cell cytoplasm and surface of some breast cancer cells.

DIF: Cognitive Level: Comprehension REF: 221

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

6. The nurse must watch for what common complications in a client who has undergone a transverse rectus abdominis myocutaneous (TRAM) flap?

a.

Axillary edema and tissue necrosis

b.

Delayed wound healing and muscle contractions

c.

Delayed wound healing and axillary edema

d.

Delayed wound healing and hematoma

ANS: D

Postoperative care focuses on monitoring the skin flap for signs of decreased capillary refill, hematoma, infection, and necrosis.

Axillary edema and tissue necrosis are not common complications of TRAM flaps.

Delayed wound healing and muscle contractions are not common complications of TRAM flaps.

Delayed wound healing and axillary edema are not common complications of TRAM flaps.

DIF: Cognitive Level: Comprehension REF: 225

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

7. After a mastectomy, a woman should be instructed to perform the following except:

a.

Empty surgical drains twice a day and as needed

b.

Avoid lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon

c.

Wear clothing with snug sleeves to support the tissue of the arm on the operative side

d.

Report it immediately if inflammation develops at the incision site or in the affected arm

ANS: C

The woman should not be advised to wear snug clothing. She should be advised to avoid tight clothing, tight jewelry, and other causes of decreased circulation in the affected arm.

The woman should be instructed to empty surgical drains twice a day as part of the teaching plan.

The woman should be instructed to avoid lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon as part of the teaching plan.

The woman should be instructed to report immediately if inflammation develops at the incision site or in the affected arm as part of the teaching plan.

DIF: Cognitive Level: Application REF: 232

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

8. A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by:

a.

Inflammation of the milk ducts and glands behind the nipples

b.

Thick, sticky discharge from the nipple of the affected breast

c.

Lumpiness in both breasts that develops 1 week before menstruation

d.

A single lump in one breast that can be expected to shrink as the woman ages

ANS: D

Fibroadenomas are characterized by discrete, usually solitary lumps smaller than 3 cm in diameter. Fibroadenomas increase in size during pregnancy and shrink as the woman ages.

Inflammation of the milk ducts and glands behind the nipples is associated with mammary duct ectasia, not fibroadenoma.

Thick, sticky discharge form the nipple of the affected breast is associated with galactorrhea, not fibroadenoma.

Lumpiness in both breasts that develops 1 week before menstruation is associated with fibrocystic changes of the breast.

DIF: Cognitive Level: Knowledge REF: 212

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

9. What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?

a.

The blood pressure (BP) cuff should not be applied to the affected arm.

b.

Venipuncture for blood work should be performed on the affected arm.

c.

The affected arm should be used for IV therapy.

d.

The affected arm should be held down close to the womans side.

ANS: A

The affected arm should not be used for BP readings, IV therapy, or venipuncture.

Venipuncture should not be performed on the affected arm.

The affected arm should not be used for IV therapy.

The affected arm should be elevated with pillows above the level of the right atrium.

DIF: Cognitive Level: Application REF: 229

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

10. A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely:

a.

Fibroadenoma

b.

Lipoma

c.

Intraductal papilloma

d.

Mammary duct ectasia

ANS: C

Intraductal papilloma is the only benign breast mass that is nonpalpable.

Fibroadenoma is well delineated, palpable, and movable.

Lipoma is palpable and movable.

Mammary duct ectasia is not well delineated and is immobile, but it is palpable and painful.

DIF: Cognitive Level: Application REF: 213

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

MULTIPLE RESPONSE

1. The exact cause of breast cancer remains undetermined. Researchers have found a number of common risk factors that increase a womans chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of the following risk factors:

a.

Family history

b.

Late menarche

c.

Early menopause

d.

Race

e.

Nulliparity or first pregnancy after age 30

ANS: A, D, E

Family history, race, and nulliparity or first pregnancy after age 30 are known risk factors for the development of breast cancer. Others include age, personal history of cancer, high socioeconomic status, sedentary lifestyle, hormone replacement therapy, recent use of oral contraceptives, never having breastfed a child, and drinking more than one alcoholic beverage per day.

Early menarche and late menopause are risk factors for breast malignancy.

DIF: Cognitive Level: Comprehension REF: 214, 215

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

COMPLETION

1. A form of nipple discharge that is unrelated to malignancy is known as _____________.

ANS:

Galactorrhea

Galactorrhea manifests itself bilaterally as spontaneous, milky, sticky discharge. This is a normal finding during pregnancy; however, it also may occur as the result of elevated prolactin levels. Prolactin can become elevated as a result of a thyroid disorder, pituitary tumor, stress, coitus, trauma, or chest wall surgery.

DIF: Cognitive Level: Knowledge REF: 212

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

TRUE/FALSE

1. Macromastia, or breast hyperplasia, is a condition in which a woman has very large breasts. The size and weight of the breasts can cause chronic pain as well as a disruption in psychosocial functioning. Breast reduction surgery may be necessary. The nurse can advise her client that this will most likely be covered by her health insurance. Is this statement true or false?

ANS: T

Women considering reduction mammoplasty should review their health insurance policies to determine exact coverage. When this surgery is performed to relieve the symptoms of macromastia, it is considered reconstructive surgery and is usually covered by insurance.

DIF: Cognitive Level: Comprehension REF: 213

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

2. Being overweight or obese is linked to a lower risk of breast cancer, especially for postmenopausal women. Is this statement true or false?

ANS: F

Being overweight is linked to a higher risk of breast cancer, especially if the weight gain took place during adulthood. Also the risk appears higher still if the extra fat is in the waist area.

DIF: Cognitive Level: Comprehension REF: 215

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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