Chapter 52: Assessment and Management of Patients with Breast Disorders

A 45-year-old client comes into the health clinic for an annual checkup. The client mentions to the nurse that they have noticed dimpling of the right breast that has occurred over the past few months. What assessment would be most appropriate for the

nurse to make?

A. Inspect the client's breasts for signs of infection.

B. Palpate the area for a breast mass.

C. Assess the client's knowledge of breast cancer.

D. Assure the client that this is likely an age-related change.

B. Palpate the area for a breast mass.

Feedback:

It would be most important for the nurse to palpate the breast to determine the presence of a mass and to refer the patient to her primary care provider. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage, giving the skin an orange-peel appearance (peau dorange), a classic sign of advanced breast cancer. Evaluation of milk production is required in lactating women. There is no indication of lactation in the scenario. The patients knowledge of breast cancer is relevant, but is not a time-dependent priority. This finding is not an age-related

change.

The nurse leading an educational session is describing self-examination of the breast. The nurse tells the women's group to raise their arms and inspect their breasts in a mirror. A member of the women's group asks the nurse why raising the arms is necessary. What is the nurse's best response?

A. "It helps to spread out the fat that makes up your breast."

B. "It allows you to simultaneously assess for pain."

C. "It will help to observe for dimpling more closely."

D. "This is what breast cancer experts recommend."

C. "It will help to observe for dimpling more closely."

Feedback:

The primary reason for raising the arms is to detect any dimpling. To elicit skin dimpling or retraction that may otherwise go undetected, the examiner instructs the patient to raise both arms overhead. Citing American Cancer Society recommendations does not address the womans question. The purpose of raising the arms is not to elicit pain or to redistribute adipose tissue.

A client aged 48 years comes to the clinic because they have discovered a lump in the breast. After diagnostic testing, the client receives a diagnosis of breast cancer. The client asks the nurse when the teenage daughters should begin mammography. What is the nurse's best advice?

A. Age 28

B. Age 35

C. Age 38

D. Age 48

C. Age 38

Feedback:

A general guideline is to begin screening 5 to 10 years earlier than the age at which the youngest family member developed breast cancer, but not before age 25 years. In

families with a history of breast cancer, a downward shift in age of diagnosis of about 10 years is seen. Because their mother developed breast cancer at age 48 years, the

daughters should begin mammography at age 38 to 43 years

A client scheduled for a simple mastectomy in 1 week is having preoperative education provided by the clinic nurse. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period?

A. Limit intake of green leafy vegetables.

B. Increase water intake to 8 glasses per day.

C. Stop taking aspirin.

D. Have nothing by mouth for 6 hours before surgery.

C. Stop taking aspirin.

Feedback:

The nurse should instruct the patient to stop taking aspirin due to its anticoagulant effect. Limiting green leafy vegetables will decrease vitamin K and marginally increase bleeding. Increasing fluid intake or being NPO before surgery will have no effect on bleeding.

The nurse is caring for a 52-year-old client whose aunt and mother died of breast cancer. The client states, "My doctor and I talked about tamoxifen to help prevent breast cancer. Do you think it will work?" What would be the nurse's best response?

A. "Yes, it's known to have a slight protective effect."

B. "Yes, but studies also show an increased risk of osteoporosis."

C. "You won't need to worry about getting cancer as long as you take tamoxifen."

D. "Tamoxifen is known to be a highly effective protective measure."

D. "Tamoxifen is known to be a highly effective protective measure."

Feedback:

Tamoxifen has been shown to be a highly effective chemopreventive agent. However, it cannot reduce the risk of cancer by 100%. It also acts to prevent osteoporosis.

A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention?

A) More aggressive chemotherapy

B) Left mastectomy

C) Radiation therapy

D) Bilateral mastectomy

D) Bilateral mastectomy

Feedback:

Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the patient's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.

During a recent visit to the clinic, a client presents with erythema of the nipple and areola on the right breast. The client states this started several weeks ago and they were fearful of what would be found. The nurse should promptly refer the client to the primary provider because the client's signs and symptoms are suggestive of what health problem?

A. Peau d'orange

B. Nipple inversion

C. Paget disease

D. Acute mastitis

C. Paget disease

Feedback:

Paget's disease presents with erythema of the nipple and areola. Peau dorange, which is associated with breast cancer, is caused by interference with lymphatic drainage, but does not cause these specific signs. Nipple inversion is considered normal if long-standing; if it is associated with fibrosis and is a recent development, malignancy is suspected. Acute mastitis is associated with lactation, but it may occur

at any age.

A client who came to the clinic after finding a mass in the breast is scheduled for a diagnostic breast biopsy. During the nurse's admission assessment, the nurse observes that the client is distracted and tense. What is the nurse's best action?

A. Acknowledge the fear the client is likely experiencing.

B. Describe the support groups that exist in the community.

C. Assess the client's stress management skills.

D. Document a nursing diagnosis of ineffective coping.

A. Acknowledge the fear the client is likely experiencing.

Feedback:

In the breast cancer diagnostic phase it is appropriate to acknowledge the patients feelings of fear, concern, and apprehension. This must precede interventions such as

referrals, if appropriate. Assessment of stress management skills made be necessary, but the nurse should begin by acknowledging the patients feelings. Fear is not necessarily indicative of ineffective coping.

A client has been referred to the breast clinic after the most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment?

A. Lumpectomy and radiation

B. Partial mastectomy and radiation

C. Partial mastectomy and chemotherapy

D. Total mastectomy and chemotherapy

A. Lumpectomy and radiation

Feedback:

Treatment for breast cancer depends on the disease stage and type, the patient's age and menopausal status, and the disfiguring effects of the surgery. For this patient, lumpectomy is the most likely option because the nodule is well-defined. The patient usually undergoes radiation therapy afterward. Because a lumpectomy is possible,

mastectomy would not be the treatment of choice.

A 23-year-old client comes to the free clinic stating, "I think I have a lump in my breast. Do I have cancer?" The nurse instructs the client that a diagnosis of breast cancer is confirmed by what method?

A. Supervised breast self-examination

B. Mammography

C. Fine-needle aspiration

D. Serial chest x-rays

C. Fine-needle aspiration

Feedback:

Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis, although falsenegative and falsepositive findings are

possibilities. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early, but is not diagnostic of cancer. Mammography is used to detect tumors that are too small to palpate. Chest x-rays

can be used to pinpoint rib metastasis. Neither test is considered diagnostic of breast cancer, however.

A 42-year-old client tells the nurse that they have found a painless lump in the right breast during a monthly self-examination. The client notes being afraid of having cancer. Which assessment finding would most strongly suggest that this client's lump is cancerous?

A. Eversion of the right nipple and mobile mass

B. A nonmobile mass with irregular edges

C. A mobile mass that is soft and easily delineated

D. Nonpalpable right axillary lymph nodes

B. A nonmobile mass with irregular edges

Feedback:

Breast cancer tumors are typically fixed, hard, and poorly delineated with irregular edges. A mobile mass that is soft and easily delineated is most commonly a fluid- filled benigncyst. Axillary lymph nodes may or may not be palpable on initial detection of a cancerous mass. Nipple retraction, not eversion, may be a sign of cancer.

A client in their 30s has two young children and has just had a modified radical mastectomy with immediate reconstruction. The client shares with the nurse being somewhat worried about the future, but the client appears to be adjusting well overall to the diagnosis and surgery. What nursing intervention is most appropriate to support this client's coping?

A. Encourage the client's spouse or partner to be supportive while the client recovers.

B. Encourage the client to proceed with the next phase of treatment.

C. Recommend that the client remain optimistic for the sake of their children.

D. Arrange a referral to a community-based support program.

D. Arrange a referral to a community-based support program.

Feedback:

The patient is not exhibiting clear signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had

similar experiences. The nurse may educate the patients spouse or partner to listen for concerns, but the nurse should not tell the patients spouse what to do. The

patient must consult with her physician and make her own decisions about further treatment. The patient needs to express her sadness, frustration, and fear. She cannot

be expected to be optimistic at all times.

The nurse is caring for a client who has just had a radical mastectomy and axillary node dissection. When providing client education regarding rehabilitation, what should the nurse recommend?

A. Avoid exercise of the arm for the next 2 months.

B. Keep cuticles clipped neatly.

C. Avoid lifting objects heavier than 10 pounds (4.5 kg).

D. Use a sling until healing is complete.

C. Avoid lifting objects heavier than 10 pounds (4.5 kg).

Feedback:

Following an axillary dissection, the patient should avoid lifting objects greater than 5 to 10 pounds, cutting the cuticles, and undergoing venipuncture on the affected

side. Exercises of the hand and arm are encouraged and the use of a sling is not necessary.

A breastfeeding client is reporting pain in the left breast and describes the breast as feeling "doughy." The client is diagnosed with acute mastitis and placed on antibiotics. What comfort measure should the nurse recommend?

A. Apply cold compresses as prescribed.

B. Avoid wearing a bra until the infection clears.

C. Avoid washing the breasts.

D. Perform gentle massage to stimulate neutrophil migration.

A. Apply cold compresses as prescribed.

Feedback:

Treatment of mastitis consists of antibiotics and local application of cold compresses to relieve discomfort. A broad-spectrum antibiotic agent may be prescribed for 7 to 10 days. The patient should wear a snug bra and perform

personal hygiene carefully. Massage is not recommended.

When planning discharge teaching with a client who has undergone a total mastectomy with axillary dissection, the nurse knows to instruct the client that they should report what sign or symptom to the health care provider immediately?

A. Fatigue

B. Temperature greater than 36.9°C (98.5°F)

C. Sudden cessation of output from the drainage device

D. Gradual decline in output from the drain

C. Sudden cessation of output from the drainage device

Feedback:

The patient should report sudden cessation of output from the drainage device, which could indicate an occlusion. A gradual decline in output is expected. A temperature of 100.4F or greater should also be reported to rule out postoperative infection, but a temperature of 98.5F is not problematic. Fatigue is expected during the recovery period.

A client newly diagnosed with breast cancer states that the health care provider suspects regional lymph node involvement and told the client that there are signs of metastatic disease. The nurse learns that the client has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis?

A. The client is not a surgical candidate.

B. The client's breast cancer is considered highly treatable.

C. There is a 10% chance that the client's cancer will self-resolve.

D. The client has a 15% chance of 5-year survival.

D. The client has a 15% chance of 5-year survival.

Feedback:

The 5-year survival rate is approximately 15% for stage IV breast cancer. Surgery is still a likely treatment, but the disease would not be considered to be highly treatable. Self-resolution of the disease is not a possibility.

The nurse is performing a comprehensive health history of a client who is in their 50s. The nurse should identify what risk factor that may increase this client's risk for breast cancer?

A. The client breastfed each of their children.

B. The client gave birth to their first child at age 38.

C. The client experienced perimenopausal symptoms starting at age 46.

D. The client experienced menarche at age 13.

B. The client gave birth to their first child at age 38.

Feedback:

Late age at first pregnancy is a risk factor for breast cancer. None of the other listed aspects of the patients health history is considered to be a risk factor for breast cancer.

A nurse is examining a client who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this client's diagnosis?

A. The client will be scheduled for radiation therapy.

B. The client might be referred for a biopsy.

C. The client's breast mass is considered an age-related change.

D. The client's diagnosis is likely related to use of oral contraceptives.

B. The client might be referred for a biopsy.

Feedback:

Fibroadenomas are firm, round, movable, benign tumors. These masses are nontender and are sometimes removed for biopsy and definitive diagnosis. They are not considered to be an age-related change, even though they are benign. Radiation therapy is unnecessary and fibroadenomas do not result from oral contraceptive use.

19. The nurse is reviewing the physicians notes from the patient who has just left the clinic. The nurse learns that the physician suspects a malignant breast tumor. On palpation, the mass most likely had what characteristic?

A) Nontenderness

B) A size of 5 mm

C) Softness and a regular shape

D) Mobility

A) Nontenderness

Feedback:

Generally, the lesions are nontender, fixed rather than mobile, and hard with irregular borders. Small size is not suggestive of malignancy.

20. A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram?

A) It does not use radiation.

B) Radiation levels are safe as long as mammograms are performed only once per year.

C) The negative effects of radiation do not accumulate until late in life.

D) Radiation from a mammogram is equivalent to an hour of sunlight.

D) Radiation from a mammogram is equivalent to an hour of sunlight.

Feedback:

The radiation exposure of mammogram is equivalent to about 1 hour of exposure to sunlight. Consequently, the benefits of mammography far outweigh any risks associated with the procedure. Negative consequences are insignificant, and do not accumulate later in life.

21. For which of the following population groups would an annual clinical breast examination be recommended?

A) Women over age 21

B) Women over age 25

C) Women over age 40

D) All post-pubescent females with a family history of breast cancer

C) Women over age 40

Feedback:

Annual clinical breast examination is recommended for women aged 40 years and older. Younger women may have examinations less frequently.

A 42-year-old man has come to the clinic for an annual physical. The nurse notes in the client's history that his father was treated for breast cancer. What should the nurse provide to the client before he leaves the clinic?

A. A referral for a mammogram

B. Instructions about breast self-examination (BSE)

C. A referral to a surgeon

D. A referral to a support group

B. Instructions about breast self-examination (BSE)

Feedback:

Instructions about BSE should be provided to men if they have a family history of breast cancer, because they may have an increased risk of male breast cancer. It is not within the scope of the practice of a nurse to refer a patient for a mammogram or to a surgeon; these actions are not necessary or recommended. In the absence of symptoms or a diagnosis, referral to a support group is unnecessary.

The nurse is teaching breast self-examination (BSE) to a group of women. The nurse should recommend that the women perform BSE:

A. at the time of menses.

B. at any convenient time, regardless of cycles.

C. weekly.

D. between days 5 and 7 after menses.

D. between days 5 and 7 after menses.

Feedback:

BSE is best performed after menses, on day 5 to day 7, counting the first day of menses as day 1. Monthly performance is recommended.

A nurse is teaching a group of women about the potential benefits of breast self-examination (BSE). The nurse should teach the women that effective BSE is dependent on what factor?

A. Women's knowledge of how their breasts normally look and feel

B. The rapport that exists between the client and the primary care provider

C. Synchronizing women's routines around BSE with the performance of mammograms

D. Women's knowledge of the pathophysiology of breast cancer

A. Women's knowledge of how their breasts normally look and feel

Feedback:

Current practice emphasizes the importance of breast self-awareness, which is a womans attentiveness to the normal appearance and feel of her breasts. BSE does not need to be synchronized with the performance of mammograms. Rapport between the patient and the care provider is beneficial, but does not necessarily determine the effectiveness of BSE. The woman does not need to understand the pathophysiology of breast cancer to perform BSE effectively.

25. A 60-year-old man presents at the clinic complaining that his breasts are tender and enlarging. The patient is subsequently diagnosed with gynecomastia. The patient should be assessed for the possibility of what causative factor?

A) Age-related physiologic changes

B) Medication adverse effects

C) Poor nutrition

D) Fluid overload

B) Medication adverse effects

Feedback:

Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to the use of certain medications. It is unrelated to fluid overload or nutrition and is not considered an age-related change.

A client is considering breast reduction mammoplasty. When weighing the potential risks and benefits of this surgical procedure, the nurse should confirm that the client is aware of what potential consequence?

A. Chronic breast pain

B. Unclear mammography results

C. Increased risk of breast cancer

D. Decreased nipple sensation

D. Decreased nipple sensation

Feedback:

During the preoperative consultation, the patient should be informed of a possibility that sensory changes of the nipple (e.g., numbness) may occur. There is no consequent increase in breast cancer risk and it does not affect future mammography results. Chronic pain is not an expected complication.

A client is to undergo an ultrasound-guided core biopsy. The client tells the nurse that a friend of theirs had a stereotactic core biopsy. The client wants to understand the differences between the two procedures. What would be the nurse's best response?

A. "An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation."

B. "An ultrasound-guided core biopsy is a little more expensive, but it doesn't use radiation and it is faster."

C. "An ultrasound-guided core biopsy is a little more expensive, and it also uses radiation but it is faster."

D. "An ultrasound-guided core biopsy takes more time, and it also uses radiation, but it is less expensive."

A. "An ultrasound-guided core biopsy is faster, less expensive, and does not use radiation."

Feedback:

Ultrasound-guided core biopsy does not use radiation and is also faster and less expensive than stereotactic core biopsy.

A client at high risk for breast cancer is scheduled for an incisional biopsy in the outpatient surgery department. When the nurse is providing preoperative education, the client asks why an incisional biopsy is being done instead of just removing the mass. What would be the nurse's best response?

A. "An incisional biopsy is performed because it's known to be less painful and more accurate than other forms of testing."

B. "An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment."

C. "An incisional biopsy is performed to assess the potential for recovery from a mastectomy."

D. "An incisional biopsy is performed on clients who are younger than the age of 40 and who are otherwise healthy."

B. "An incisional biopsy is performed to confirm a diagnosis and so that special studies can be done that will help determine the best treatment."

Feedback:

Incisional biopsy surgically removes a portion of a mass. This is performed to confirm a diagnosis and to conduct special studies that will aid in determining treatment. Incisional biopsies cannot always remove the whole mass, nor is it

always beneficial to the patient to do so. The procedure is not chosen because of the potential for pain, the possibility of recovery from mastectomy, or the patient's age.

A client is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in the left breast. What are the criteria for discharging this client home? Select all that apply.

A. Client must understand when they can begin ambulating.

B. Client must have someone to accompany them home.

C. Client must understand activity restrictions.

D. Client must understand care of the biopsy site.

E. Client must understand when they can safely remove the urinary catheter.

B. Client must have someone to accompany them home.

C. Client must understand activity restrictions.

D. Client must understand care of the biopsy site.

Feedback:

Prior to discharge from the ambulatory surgical center or the office, the patient must be able to tolerate fluids, ambulate, and void. The patient must have somebody to accompany her home and would not be discharged with urinary catheter in place.

A client has just been told they need to have an incisional biopsy of a right breast mass. During preoperative teaching, how could the nurse best assess this client for specific educational, physical, or psychosocial needs the client might have?

A. By encouraging the client to verbalize questions and concerns

B. By discussing the possible findings of the biopsy

C. By discussing possible treatment options if the diagnosis is cancer

D. By reviewing the client's medical history

A. By encouraging the client to verbalize questions and concerns

Feedback:

During the preoperative visit, the nurse assesses the patient for any specific educational, physical, or psychosocial needs that she may have. This can be accomplished by encouraging her to verbalize her fears, concerns, and questions. Reviewing her medical history may be beneficial, but it is not the best way to ascertain her needs. Discussing possible findings of the biopsy and possible treatment options is the responsibility of the treating physician.

A client has just returned to the postsurgical unit from postanesthetic recovery after breast surgery for removal of a malignancy. What is the most likely major nursing diagnosis to include in this client's immediate plan of care?

A. Acute pain related to tissue manipulation and incision

B. Ineffective coping related to surgery

C. Risk for trauma related to postsurgical injury

D. Chronic sorrow related to change in body image

A. Acute pain related to tissue manipulation and incision

Feedback:

Although many patients experience minimal pain, it is still important to assess for this postsurgical complication. Sorrow and ineffective coping are possible, but neither is likely to be evident in the immediate postoperative period. There is minimal risk of trauma.

32. A 52-year-old woman has just been told she has breast cancer and is scheduled for a modified mastectomy the following week. The nurse caring for this patient knows that she is anxious and fearful about the upcoming procedure and the newly diagnosed malignancy. How can the nurse most likely alleviate this patients fears?

A) Provide written material on the procedure that has been scheduled for the

patient.

B) Provide the patient with relevant information about expected recovery.

C) Give the patient current information on breast cancer survival rates.

D) Offer the patient alternative treatment options.

B) Provide the patient with relevant information about expected recovery.

Feedback:

Providing the patient with realistic expectations about the healing process and expected recovery can help alleviate fears. Offering the patient alternative treatment options is not within the nurses normal scope of practice. Addressing survival rates may or may not be beneficial for the patient. Written material is rarely sufficient to meet patients needs.

A nurse is explaining that each breast contains 12 to 20 cone-shaped lobes. The nurse should explain that each lobe consists of what elements?

A. Modified tendons and ligaments

B. Connective tissue and smooth muscle

C. Lobules and ducts

D. Endocrine glands and sebaceous glands

C. Lobules and ducts

Feedback:

Each breast contains 12 to 20 cone-shaped lobes, which are made up of glandular elements (lobules and ducts) and separated by fat and fibrous tissue that binds the lobes together. These breast lobes do not consist of tendons, ligaments, endocrine glands, or smooth muscle.

A nurse has assessed that a client is not yet willing to view the mastectomy site. How should the nurse best assist the client in developing a positive body image?

A. Ask the client to describe the current appearance of the breast.

B. Help the client to understand that many women have gone through the same unpleasant experience.

C. Explain to the client that their body image does not have to depend on their physical appearance.

D. Provide the client with encouragement in an empathic and thoughtful manner.

D. Provide the client with encouragement in an empathic and thoughtful manner.

Feedback:

Gentle encouragement can help the patient progress toward accepting the change in her appearance. The nurse should not downplay the significance of physical appearance. Explaining that others have had similar experiences may or may not benefit the patient. Asking the patient to describe the appearance of her breast is likely to exacerbate the womans reluctance to do so.

A client has had a total mastectomy with immediate reconstruction. The client asks the nurse when they can take a shower. What should the nurse respond?

A. "Not until the drain is removed"

B. "On the second postoperative day"

C. "Now, if you wash gently with soap and water"

D. "Seven days after your surgery"

A. "Not until the drain is removed"

Feedback:

If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed.

A client has been discharged home after a total mastectomy without reconstruction. The client lives alone and has a home health referral. When the home care nurse performs the first scheduled visit on this client, what should the nurse assess? Select all that apply.

A. Adherence to the exercise plan

B. Overall psychological functioning

C. Integrity of surgical drains

D. Understanding of cancer

E. Use of the breast prosthesis

A. Adherence to the exercise plan

B. Overall psychological functioning

C. Integrity of surgical drains

Feedback:

Patients who have difficulty managing their postoperative care at home may benefit from a home health care referral. The home care nurse assesses the patients incision and surgical drain(s), adequacy of pain management, adherence to the exercise plan, and overall physical and psychological functioning. It is unnecessary to assess the patients understanding of cancer at this stage of recovery. Prostheses may be considered later in the recovery process.

A client has just been diagnosed with breast cancer and the nurse is performing a client interview. In assessing this client's ability to cope with this diagnosis, what would be an appropriate question for the nurse to ask?

A. "What is your level of education?"

B. "Are you feeling all right these days?"

C. "Is there someone you trust to help you make treatment choices?"

D. "Are you concerned about receiving this diagnosis?"

C. "Is there someone you trust to help you make treatment choices?"

Feedback:

A trusted ally to assist in making treatment choices is beneficial to the patients coping ability. It is condescending and inappropriate to ask if the patient is feeling alright these days or is concerned about the diagnosis. The patients education level is irrelevant.

A client has been diagnosed with stage II breast cancer. The client tells the nurse that the health care provider has recommended breast conservation surgery followed by radiation. The client's husband has done some online research and is asking why his wife does not have a modified radical mastectomy "to be sure all the cancer is gone." The nurse knows that breast conservation surgery was recommended for which reason?

A. "Modified radical mastectomies are very hard on a client, both physically and emotionally, and they really aren't necessary anymore."

B. "According to current guidelines, having a modified radical mastectomy is no longer seen as beneficial."

C. "Modified radical mastectomies have a poor survival rate because of the risk of cancer recurrence."

D. "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy."

D. "According to current guidelines, breast conservation combined with radiation is as effective as a modified radical mastectomy."

Feedback:

Breast conservation along with radiation therapy in stage I and stage II breast cancer results in a survival rate equal to that of modified radical mastectomy. Mastectomies are still necessary in many cases, but are not associated with

particular risk of recurrence.

A client who has had a lumpectomy calls the clinic to talk to the nurse. The client tells the nurse that they have developed a tender area on the breast that is red and warm and looks like someone "drew a line with a red marker." What would the nurse suspect is the client's problem?

A. Mondor disease

B. Deep vein thrombosis (DVT) of the breast

C. Recurrent malignancy

D. An area of fat necrosis

A. Mondor disease

Feedback:

Superficial thrombophlebitis of the breast (Mondor disease) is an uncommon condition that is usually associated with pregnancy, trauma, or breast surgery. Pain and redness occur as a result of a superficial thrombophlebitis in the vein that drains the outer part of the breast. The mass is usually linear, tender, and erythematous. Fat necrosis is a condition of the breast that is often associated with a history of trauma. The scenario described does not indicate a recurrent malignancy. DVTs of the breast do not occur.

A client calls the clinic and tells the nurse they have had bloody drainage from the right nipple. The nurse makes an appointment for this client, expecting the health care provider or practitioner to order what diagnostic test on this client?

A. Breast ultrasound

B. Radiography

C. Positron emission tomography (PET)

D. Galactography

D. Galactography

Feedback:

Galactography is a diagnostic procedure that involves injection of less than 1 mL of radiopaque material through a cannula inserted into the ductal opening on the areola,

which is followed by mammography. It is performed to evaluate an abnormality within the duct when the patient has bloody nipple discharge on expression, spontaneous nipple discharge, or a solitary dilated duct noted on mammography. X-ray, PET, and ultrasound are not typically used for this purpose.