Chapter 44 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 44

Question 1

Type: MCSA

A patient is recovering from breast cancer surgery that included axillary node dissection. The nurse realizes that this patient will need education regarding which potential complication of axillary node dissection?

1. Lymphedema

2. Metastasis

3. Bleeding from the incision site

4. Altered neck movement

Correct Answer: 1

Rationale 1: Lymphedema is a common complication of axillary node dissection.

Rationale 2: The lymph nodes are removed to reduce the risk of metastasis.

Rationale 3: There is no greater risk of bleeding from the incision site than there would be from any other surgery.

Rationale 4: Removal of the axillary lymph nodes should not adversely affect neck movement.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-4

Question 2

Type: MCSA

During a routine physical examination, a 22-year-old patient asks if she is at risk of developing breast cancer. Which reported factors would the nurse confirm as increasing this patients risk?

1. Hispanic heritage

2. Onset of menarche at age 11

3. Breastfed her two children for 6 months

4. Use of the female condom

Correct Answer: 2

Rationale 1: Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.

Rationale 2: The early onset of menarche contributes to the risk for breast cancer because the woman is exposed to higher levels of estrogen and progestin for a longer period.

Rationale 3: Some studies suggest that breastfeeding reduces the risk of breast cancer.

Rationale 4: The female condom does not have hormonal ingredients and does not impact breast cancer risk.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 3

Type: MCSA

A patient presents to the clinic after discovering a lump in her breast. Which finding would alert the nurse to a probable malignancy?

1. The patient reports tenderness with palpation.

2. The skin over the mass is smooth.

3. The mass is readily moved beneath the skin.

4. The borders of the mass are uneven.

Correct Answer: 4

Rationale 1: Tenderness on palpation is a finding associated with benign masses.

Rationale 2: The skin overlying malignant masses is often irregular or has the appearance of peau dorange.

Rationale 3: Malignant masses are often fixed to underlying tissue.

Rationale 4: Irregular borders are characteristic of malignancy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 44-2

Question 4

Type: MCSA

A female patient is scheduled for a stereotactic needle biopsy of a left breast lesion. What information should the nurse provide about this test?

1. This is a three-dimensional mammogram in which a fine-needle aspirate of the mass is taken.

2. This is the gold standard for diagnosis in which a small cut is made in the breast under intravenous sedation.

3. A needle will be inserted into the lesion, guided by ultrasound, and the contents aspirated.

4. The entire lesion is removed along with some of the surrounding tissue.

Correct Answer: 1

Rationale 1: A stereotactic needle biopsy is a three-dimensional mammogram in which the patient lies on the stomach and a fine needle is used to aspirate the mass.

Rationale 2: The gold standard for breast biopsy is the surgical incisional biopsy, in which a less-than-2-inch incision is made in the breast under local anesthesia or intravenous sedation.

Rationale 3: In a fine-needle aspiration, a fine needle is inserted into the lesion, guided by ultrasound, and the contents are removed.

Rationale 4: An excisional biopsy involves complete removal of the abnormality and some surrounding tissue.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 5

Type: MCSA

The nurse is discussing breast self-examination with a 20-year-old patient. Which statement by the patient indicates the need for further education?

1. Lying down will help me to feel all of my breast tissue.

2. A firm ridge in the lower curve of my breast is normal.

3. I should examine my breasts on the first day of my menstrual period.

4. The fact that I have breast implants does not negate my need to perform a monthly breast self-examination.

Correct Answer: 3

Rationale 1: When the patient lies down, the breast tissue is spread and is as thin as possible. This helps the patient feel all the tissue.

Rationale 2: A firm ridge in the lower curve of each breast is normal.

Rationale 3: The breast examination should be performed between days 4 and 7 of the menstrual period. On day 1 of the menstrual period, the breasts may be tender or swollen.

Rationale 4: Women who have breast implants should perform breast self-examinations.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-5

Question 6

Type: MCSA

A 20-year-old patient is being seen at the health care providers office for an annual physical examination. During the data collection period, the patient indicates she does not believe she is old enough to be concerned about performing breast self-examination (BSE). What information should the nurse provide?

1. The BSE is not necessary if the patient has an annual gynecological examination that includes a medical breast examination.

2. Women should begin to perform a monthly BSE by the age of 20.

3. If there is no family history of breast cancer, the patient does not yet need to begin performing BSE.

4. The BSE should become a regular part of a womans monthly regimen beginning at age 30.

Correct Answer: 2

Rationale 1: The annual gynecological examination likely includes a breast examination, but the exam should be performed more frequently.

Rationale 2: The BSE should be performed monthly by all women. Age 20 is a recommended starting point.

Rationale 3: Not all breast cancer has been linked to genetic factors. Family history is an inadequate means for determining the need to perform BSE.

Rationale 4: The BSE should be performed monthly by all women. Age 20 is a recommended starting point.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-5

Question 7

Type: MCMA

A patient who has just been diagnosed with a fibroadenoma in her left breast begins to cry. What information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fibroadenomas are a nonproliferative type of tumor.

2. The next treatment step will be biopsy.

3. This tumor is caused by normal hormonal fluctuations.

4. The patient will need regular mammograms and other breast screening exams.

5. Fibroadenomas are fluid-filled cysts that may rupture.

Correct Answer: 1,3,4

Rationale 1: Fibroadenomas are tumors that consist of nonproliferative cells.

Rationale 2: There is no reason to biopsy a fibroadenoma because they are, by definition, benign.

Rationale 3: Fibroadenomas result from the waxing and waning of hormones in the normal menstrual cycle.

Rationale 4: The presence of a fibroadenoma does not prevent the development of other breast tumors. Normal surveillance should continue.

Rationale 5: Fibroadenomas are solid mass tumors.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-1

Question 8

Type: MCSA

Biopsy reveals that a patient has a single papilloma in her right breast. The lesion was completely removed during the biopsy procedure. What information would the nurse reinforce regarding this patients future breast cancer risk?

1. The patient has breast cancer at present.

2. The patient is at no greater risk for breast cancer in the future.

3. The patient is at some increased risk for breast cancer, generally about 1.5 to 2 times the normal risk.

4. The patients risk for future breast cancer is very high, generally 10 to 20 times the normal risk.

Correct Answer: 3

Rationale 1: Papillomas are benign lesions without atypia.

Rationale 2: This patient does have a higher risk of developing breast cancer.

Rationale 3: The patient who experiences a proliferative breast lesion without atypia is at 1.5 to 2 times the normal risk for developing future breast cancer.

Rationale 4: The patient is at increased risk, but the risk is not 10 to 20 times the normal risk.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-1

Question 9

Type: MCMA

A 40-year-old patient says, I am afraid to have a mammogram. I have heard that they hurt and I am afraid to have radiation to my breasts. What information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Mammograms are required every 1 to 2 years for women over age 40.

2. The amount of radiation used in mammograms is very low.

3. Mammograms can detect breast masses up to 2 years before they can be felt from the outside.

4. The pain you experience in mammography is well worth the benefits.

5. Mammograms can help us see small deposits of calcium that sometimes occur with cancerous lesions.

Correct Answer: 2,3,5

Rationale 1: The CDC recommends that women over age 40 have a mammogram every 1 to 2 years, but the patient has the right to refuse this screening.

Rationale 2: Mammography is a low-dose X-ray procedure.

Rationale 3: Mammograms can detect masses long before the woman or her health care provider can palpate them.

Rationale 4: The nurse should focus on explaining mammogram techniques that reduce the patients discomfort. The nurse cannot assume the value the patient will place on the mammogram versus the discomfort she anticipates.

Rationale 5: Mammograms can detect microcalcifications that may indicate a cancerous lesion.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 10

Type: MCSA

A patient presents to the clinic with complaints of breast pain that is continuous. Which assessment question is most pertinent?

1. Are you taking any vitamins?

2. Have you had back pain recently?

3. Has anyone in your family had breast cancer?

4. How old were you when your periods started?

Correct Answer: 3

Rationale 1: Vitamin use is not associated with mastalgia.

Rationale 2: It is important to assess any painful areas, but back pain is not specifically related to mastalgia.

Rationale 3: History of a close family member with breast cancer will alter the patients treatment plan.

Rationale 4: Age of menarche is always important to breast assessment but is not the most pertinent question in this situation.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 44-2

Question 11

Type: MCMA

A patient has been diagnosed with mastalgia. Mammogram results are negative. Which instructions should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Wear a properly fitting bra.

2. Increase the amount of polyunsaturated fats in your diet.

3. Some women find that taking evening primrose oil helps reduce the symptoms of mastalgia.

4. Smoking cessation may help to reduce your symptoms.

5. Some women report that drinking hot tea or flavored coffee helps reduce their symptoms.

Correct Answer: 1,3,4

Rationale 1: The pain of mastalgia may be lessened by wearing a bra that fits well and provides support of breast tissue.

Rationale 2: Decreasing fat intake is recommended to reduce mastalgia.

Rationale 3: There is some scientific research supporting the effectiveness of evening primrose oil in reducing the symptoms of mastalgia.

Rationale 4: Cessation of smoking should be recommended to reduce mastalgia.

Rationale 5: Caffeine intake should be reduced.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 12

Type: MCSA

A patient has experienced galactorrhea. Cytology is negative. Which nursing statement is indicated?

1. It is good that your breast mass is not malignant.

2. At least you dont have cancer.

3. Even though this is a good report, more tests will be necessary.

4. This result means your discharge is probably from a malignant change in your breast.

Correct Answer: 3

Rationale 1: Galactorrhea does not always present with a palpable breast mass.

Rationale 2: Negative cytology on this fluid does not assure the absence of cancer.

Rationale 3: The fact that cytology is negative is a good report. However, more tests will be necessary to determine the reason for the galactorrhea.

Rationale 4: The presence of negative cytology on the discharge does not indicate that malignant changes are present.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 13

Type: MCSA

A patient who has breast cancer is being treated with tamoxifen. Which statement indicates that the patient has understood the nurses instruction regarding this medication?

1. I should avoid over-the-counter pain relievers while taking tamoxifen.

2. I will report any swelling in my legs or shortness of breath.

3. I will avoid eating green, leafy vegetables while taking tamoxifen.

4. I will sleep with my head on two pillows while taking tamoxifen.

Correct Answer: 2

Rationale 1: Discomfort may occur as the tumor responds to tamoxifen. The patient should be taught to take analgesics, including over-the-counter products, if this occurs.

Rationale 2: Adverse effects of tamoxifen include deep vein thrombosis and pulmonary embolism.

Rationale 3: There is no indication that ingestion of green, leafy vegetables is contraindicated when taking tamoxifen.

Rationale 4: It is not necessary for the patient to sleep on two pillows while taking tamoxifen.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-3

Question 14

Type: MCMA

A patient has been prescribed danazol for treatment of mastalgia. Which patient statements indicate that the patient understands the nurses instructions about this drug?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I must avoid becoming pregnant while taking danazol.

2. I may stop having periods while on this medication.

3. This is the most effective drug for this condition.

4. I will apply this gel to my breasts twice a day.

5. I should watch for easy bruising and tarry stools while taking danazol.

Correct Answer: 1,2,3

Rationale 1: Danazol is a pregnancy category X drug.

Rationale 2: Danazol causes amenorrhea.

Rationale 3: Danazol is the most effective treatment for mastalgia.

Rationale 4: Afimoxifene gel, not danazol, is applied to the breasts.

Rationale 5: There is no indication that danazol increases bleeding tendencies.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-3

Question 15

Type: MCSA

Which information should the nurse include in medication teaching for the patient prescribed clindamycin for mastitis?

1. Let the prescriber know if you develop diarrhea.

2. This medication may cause insomnia.

3. You may experience dizziness while taking clindamycin.

4. You may notice that your urine is a greenish-yellow color while taking this drug.

Correct Answer: 1

Rationale 1: One of the adverse reactions of clindamycin is pseudomembranous colitis, which can be fatal. Diarrhea should be reported immediately.

Rationale 2: Insomnia is not related to use of clindamycin.

Rationale 3: Dizziness is not an expected effect of clindamycin.

Rationale 4: A greenish-yellow coloration of the urine is not expected with clindamycin.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-3

Question 16

Type: MCMA

A patient with breast cancer is being treated with docetaxel (Taxotere). Which nursing diagnoses (NDX) would the nurse include in the plan of care to address common side effects?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Risk for Injury: Falls

2. Risk for Infection

3. Ineffective Airway Clearance

4. Impaired Tissue Perfusion: Cardiovascular

5. Ineffective Individual Coping

Correct Answer: 1,2

Rationale 1: The patient taking docetaxel may experience impaired walking, which would put her at risk for falling.

Rationale 2: Leukopenia is an effect of docetaxel. The patient will be at risk for infection.

Rationale 3: There is no reason that taking docetaxel would adversely affect the patients airway clearance.

Rationale 4: Docetaxel does not increase the risk of myocardial infarction.

Rationale 5: The patient with breast cancer will need to cope with many changes, but the use of docetaxel does not reduce the ability to cope.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 44-4

Question 17

Type: MCSA

A woman who has never been pregnant is being treated for mastitis. Which information should the nurse provide?

1. Because you have never been pregnant, having mastitis increases your risk of breast cancer.

2. Mastitis is rare in women who are not breastfeeding.

3. We must differentiate between mastitis and a phyllodes tumor before we can predict whether your condition is malignant.

4. We should run a pregnancy test because some patients develop mastitis as an initial sign of pregnancy.

Correct Answer: 2

Rationale 1: Mastitis in lactating and nonlactating women is not a risk factor for breast cancer.

Rationale 2: In nonlactating women, mastitis is rare but may occur when ducts become plugged with fatty material.

Rationale 3: Mastitis and phyllodes tumor are not similar in manifestation. Neither is initially malignant, although phyllodes tumors may become so over time.

Rationale 4: Mastitis is not an initial sign of pregnancy.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 18

Type: MCSA

Which statement would the nurse evaluate as indicating the patient needs further education about mastitis and breastfeeding?

1. If I wear a plastic-backed breast pad, I can continue to breastfeed.

2. If I develop discharge from the mastitis, I should avoid feeding the baby on that side.

3. My breast milk will help protect the baby from infection from my mastitis.

4. If the baby is not emptying my breast, I should use a breast pump after feeding.

Correct Answer: 1

Rationale 1: The patient can continue to breastfeed. Wearing a plastic-backed breast pad is not necessary and may be a risk factor for the development of mastitis.

Rationale 2: The baby should not be exposed to purulent discharge.

Rationale 3: It has been shown that milk from the breast with mastitis offers anti-inflammatory components that will protect the infant from infection.

Rationale 4: The breast should be emptied of milk at each feeding. If the baby is not emptying the breast, the patient should use a breast pump after feeding.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-3

Question 19

Type: MCMA

The nurse is discussing the use of illegal substances with a group of teenage boys and wishes to approach the topic from a unique perspective. The nurse would tell this group that which drugs are implicated in the development of larger breasts in men?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Marijuana

2. Alcohol

3. Heroin

4. Cocaine

5. Amphetamines

Correct Answer: 1,2,3,5

Rationale 1: Marijuana can cause gynecomastia.

Rationale 2: Alcohol can cause gynecomastia.

Rationale 3: Heroin use can result in gynecomastia.

Rationale 4: Cocaine is not implicated in the development of gynecomastia.

Rationale 5: Amphetamines are implicated in the development of gynecomastia.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-5

Question 20

Type: MCSA

A new mother reports that her infant sons breasts are enlarged and tender. How can the nurse best respond?

1. Bring him to the clinic immediately; we need to examine him more closely.

2. This sometimes happens in babies whose gender is not clear.

3. Occasionally a baby is born with a cyst or tumor, but they generally disappear by the time the baby is a month old.

4. Babies of both genders often have breast enlargement, which will go away in a month or so.

Correct Answer: 4

Rationale 1: This is not an emergent situation. There is no need to bring the baby to the clinic immediately.

Rationale 2: This enlargement has nothing to do with gender.

Rationale 3: This tissue enlargement is not likely due to a cyst or tumor.

Rationale 4: Gynecomastia related to the newborn period resolves within the first month of life.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-5

Question 21

Type: MCMA

A patient is undergoing diagnostic testing for a breast mass. Initial reports suggest that the mass is benign, but definitive results are not yet available. Which nursing diagnoses would the nurse consider when planning this patients care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fear

2. Decisional Conflicts

3. Altered Tissue Perfusion: Peripheral

4. Disturbed Body Image

5. Deficient Knowledge

Correct Answer: 1,2,4,5

Rationale 1: This patient may have fear associated with the unknown diagnosis. The nurse should assess for fear at each encounter.

Rationale 2: Many treatment options are available to a patient with a breast mass. Decisional conflicts are common. The nurse should provide sufficient information so that the patient can make an informed decision about treatment.

Rationale 3: This scenario does not specify which tests have been done, so there is not enough information to diagnose altered tissue perfusion.

Rationale 4: Disturbance of body image is a common problem when patients have a breast disorder. This disturbance is not dependent on treatment options and can be present even if no procedures are done.

Rationale 5: The patient is likely to need education about treatment options, results, and procedures. This is a time of high anxiety, and the nurse should assess for the retention of information and reinforce as needed.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 44-4

Question 22

Type: MCSA

A patient has the nursing diagnosis Disturbed Body Image related to surgical excision of a benign breast mass. Which patient statement would the nurse evaluate as indicating that the goal of acceptance of body image has been achieved?

1. The scar is not as red as I thought it would be.

2. I hope I can still wear a bikini top.

3. I havent shown the scar to my husband yet.

4. I think my shirts fit differently since my surgery.

Correct Answer: 1

Rationale 1: Discussing the color of the scar is a small step toward acceptance of its presence. This indicates movement toward achievement of the goal.

Rationale 2: This statement reflects grieving for the past body rather than accepting the body change.

Rationale 3: Reluctance to show the scar to the husband may indicate that the patient has not yet accepted the change to her body.

Rationale 4: It would be unlikely that excisional biopsy would make enough of a difference in breast contours to affect the fit of the womans shirts. This statement may indicate that the patient is looking for changes in her body. It does not indicate acceptance.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-6

Question 23

Type: MCMA

A breastfeeding mother reports that one of her nipples is cracked and sore. She is concerned about developing infection in her breast. Which instruction should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Express breast milk and rub it into your nipples after feeding is completed.

2. Purchase some evening primrose oil and treat your nipples with it twice each day.

3. Avoid feeding on that breast until the nipple heals.

4. You can use water-soluble lanolin on your nipple to sooth and heal it.

5. Coat your nipples with petroleum jelly prior to feedings.

Correct Answer: 1,4

Rationale 1: Breast milk will moisten and protect the nipples.

Rationale 2: Evening primrose oil is suggested for mastalgia but is not indicated for preventing mastitis.

Rationale 3: The breast should be emptied of milk routinely. Avoidance of feeding on that side is not indicated.

Rationale 4: Water-soluble lanolin is useful for soothing and healing cracked and sore nipples.

Rationale 5: Petroleum jelly is not water soluble and should not be used on the nipples.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-2

Question 24

Type: MCSA

During a community information session about breast cancer a participant says, You hear about so many women with breast cancer now. Why is it so much more common? Which nursing statement is indicated?

1. We believe that the hormone additives in milk and meat have made breast cancer more common.

2. Since we revised the recommendations for the use of hormones during menopause, the rates of breast cancer have actually decreased.

3. Our surveillance, detection, and treatment options are better now, so deaths due to breast cancer are fewer.

4. So many more women smoke cigarettes now that breast cancer rates are going up.

5. In the United States we have a higher percentage of Hispanic women, who are at highest risk of developing breast cancer.

Correct Answer: 2,3

Rationale 1: It is not true that breast cancer is more common.

Rationale 2: There has been a decrease in the incidence of breast cancer since 2002, particularly among women over 50. This decrease correlates with the decrease in the use of hormone replacement therapy.

Rationale 3: For women under age 50, deaths from breast cancer have decreased due to better surveillance, detection, and treatment options.

Rationale 4: Smoking has not been shown to be a strong risk factor for the development of breast cancer.

Rationale 5: The cultural group with the highest incidence of breast cancer is Caucasian women.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-5

Question 25

Type: FIB

The nurse has provided education to a woman who wishes to use exercise as a way to reduce her breast cancer risk. The nurse would evaluate that teaching has been effective when the woman says, I am going to start walking for ________ minutes every day.

Standard Text:

Correct Answer: 60

Rationale : Hormonal changes that occur when the woman walks for 1 hour each day seem to be protective against development of breast cancer.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-6

Question 26

Type: MCMA

A male patient has been diagnosed with breast cancer. The patient says, How did this happen? I though breast cancer only occurred in women. The nurse would consider which assessment findings as risk factors for this mans condition?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The man is 5 ft. 10 inches tall and weighs 245 pounds.

2. The patient has periodic exacerbations of severe hepatitis C.

3. The patient drinks three or four beers each day after work.

4. The patient works as an over-the-road trucker and is away from home for several days each week.

5. The patient had his spleen removed secondary to an automobile accident when he was a teenager.

Correct Answer: 1,2,3

Rationale 1: Obesity is a risk factor for development of breast cancer in men. This patient should weigh 170 to 180 pounds.

Rationale 2: Liver damage affects the livers ability to regulate estrogen levels, thereby increasing the risk for gynecomastia and breast cancer.

Rationale 3: Excessive alcohol use (over two drinks each day) increases the risk for breast cancer in men.

Rationale 4: There is no indication that occupation alone is a risk factor for development of breast cancer in men.

Rationale 5: Splenectomy is not a risk factor for development of breast cancer in men.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 44-3

Question 27

Type: MCSA

A patient is admitted for Pagets disease of the breast. The nurse completing admission assessment would expect which finding?

1. A mass in the upper outer quadrant of the patients breast

2. A thickened area of tissue in the axilla

3. Redness of the entire breast

4. A chronic rash on the nipple that is crusty in appearance

Correct Answer: 4

Rationale 1: Pagets disease does not manifest as a mass.

Rationale 2: Pagets disease does not manifest as a thickening of tissue.

Rationale 3: Pagets disease does not manifest as generalized redness of breast tissue.

Rationale 4: Pagets disease presents with a chronic, crusting rash of the nipple.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 44-1

Question 28

Type: FIB

A patients genetic studies reveal she is positive for both BRCA1 and BRCA2 mutations. The nurse prepares to care for a patient whose lifetime risk of developing breast cancer is _______%.

Standard Text:

Correct Answer: 80

Rationale : Mutation of both BRCA1 and BRCA2 increases the lifetime risk of developing breast cancer to 80%.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 44-2

Question 29

Type: MCSA

A woman presents to the clinic with a breast mass. The nurse reviewing this patients history identifies which finding as indicating the highest risk of the mass being malignant?

1. The patients father died of breast cancer.

2. The woman is Native American.

3. The womans children were born when she was 22 and 27.

4. The woman is vegetarian.

Correct Answer: 1

Rationale 1: Breast cancer in a male relative increases a womans risk of having breast cancer.

Rationale 2: Native American women have a lower risk for development of breast cancer than do Caucasian women.

Rationale 3: Not having children or having children after age 30 increases the risk.

Rationale 4: The risk of breast cancer is not higher among vegetarian women.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 44-2

Question 30

Type: MCMA

A patient had a mastectomy with axillary node dissection and was told she has stage IV breast cancer. The nurse would expect surveillance of which body systems as the most likely areas for metastasis?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Bone

2. Liver

3. Brain

4. Lung

5. Uterus

Correct Answer: 1,2,3,4

Rationale 1: Breast cancer often metastasizes to the bone.

Rationale 2: The liver is a common site of metastasis from breast cancer.

Rationale 3: Brain metastasis is common with breast cancer.

Rationale 4: Lung metastasis is common with breast cancer.

Rationale 5: The uterus is not a common site for metastasis from breast cancer.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 44-3

Question 31

Type: MCSA

The surgeon tells a family that the goal for their mothers surgery is a clean lumpectomy. How would the nurse interpret this statement for the family?

1. It is hoped that their mother will have a short anesthesia time and a quick surgery.

2. The goal is that only one lump is found in the breast.

3. It is hoped that the lump can be removed intact with noncancerous margins.

4. The goal is that the patient will lose a minimal amount of blood.

Correct Answer: 3

Rationale 1: A speedy surgery is not the goal.

Rationale 2: Studies to find masses should be completed prior to the surgical procedure.

Rationale 3: In a clean lumpectomy, the lump is removed with a margin of normal or clean tissue all around it.

Rationale 4: Clean lumpectomy does not refer to the amount of blood lost.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-6

Question 32

Type: MCSA

A woman has undergone fine needle biopsy of a breast lump. Which statement would the nurse evaluate as indicating that the patient understands discharge teaching?

1. Even if this lump was cancer, it is all gone now.

2. I will massage my breast twice daily for the next week.

3. I can go back to work today if I wish.

4. There is no risk of infection with this procedure.

Correct Answer: 3

Rationale 1: Fine needle biopsy samples only a few cells; it does not remove the lump.

Rationale 2: There is no indication that massage of the breast is beneficial.

Rationale 3: The patient should be able to return to normal activities after discharge.

Rationale 4: The skin has been perforated for this procedure, so there is a risk of infection.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 44-3

Question 33

Type: MCSA

A patient diagnosed with breast cancer wishes to have reconstruction surgery as soon as possible. Which information should the nurse reinforce?

1. Breast reconstruction works better if it is done as a separate surgery after you have recovered from mastectomy.

2. Breast reconstruction has to wait until after chemotherapy is completed.

3. The timing of reconstruction is your personal choice.

4. You should wait until we are certain your cancer does not recur.

Correct Answer: 3

Rationale 1: There is no information that supports the need to wait until after recovery from the mastectomy.

Rationale 2: Immediate breast reconstruction would not delay chemotherapy.

Rationale 3: Reconstruction is usually performed at the time of the patients preference.

Rationale 4: Reconstruction does not prevent detection of recurrent disease.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 44-2

Question 34

Type: MCSA

A patient who had breast augmentation surgery last year presents to the clinic and says, My right breast is so hard all over. The nurse would assess for development of which likely condition?

1. Infection

2. Hemorrhage into the implant

3. Capsule contracture

4. Breast cancer

Correct Answer: 3

Rationale 1: Infection may cause the condition that results in hardening of tissue, but it is not the most likely disorder present.

Rationale 2: Hemorrhaging into the implant is not a likely condition.

Rationale 3: Formation of scar tissue around the implant can cause the pocket to become smaller. This causes the breast tissue to feel hard. This is the most likely cause of the patients complaint.

Rationale 4: The patient with augmentation can develop breast cancer, but this is not the most likely condition causing this patients complaint.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 44-1

Question 35

Type: MCSA

A 21-year-old woman comes to the clinic seeking information about breast reduction surgery. What information should the nurse provide?

1. The scars from reduction surgery are minimal and difficult to see.

2. This surgery may make it impossible to breastfeed children.

3. Most women are not satisfied with the results of the procedure.

4. The surgery can be done only under very specific circumstances.

Correct Answer: 2

Rationale 1: Scars from this type of surgery can be long but are in areas where they are partial camouflaged.

Rationale 2: Depending on the extent of the surgery, the woman may not be able to breastfeed.

Rationale 3: Women tend to be extremely satisfied with the results because of the increased comfort and improved appearance.

Rationale 4: The considerations for the appropriateness of this surgery are no greater than for other types of surgery.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 44-5

 

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