Breast Navigator Quiz
Neoplasm can be classified as either benign or malignant. The following are characteristics of a malignant tumor except
Ability to metastasize
Infiltrates surrounding tissues
Remains encapsulated
Poorly differentiated cells
Nina, an oncology nurse navigator, is speaking to a women’s group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate:
Mammography is the most reliable method for detecting breast cancer
Breast cancer is the leading killer of women of childbearing age
Breast cancer requires a mastectomy
Men can develop breast cancer
Which of the following is NOT classified as a cancer?
Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS)
Infiltrating ductal carcinoma in situ
Infiltrating lobular carcinoma in situ
Which of the following is an unfavorable histological type of invasive breast cancer?
Tubular
Medullary
Mucinous
Infiltrating lobular carcinoma
A patient asks, “What are tumor-suppressor genes?” As part of your answer, you explain that tumor-suppressor genes code for proteins that __________ growth-promoting factors.
Enhance
Fuel
Inactivate
Duplicate
All of the following statements are true about noninvasive breast cancers except:
Noninvasive cancers stay within the milk ducts or milk lobules in the breast
Noninvasive cancers do not grow beyond the breast
Noninvasive cancers are sometimes referred to as pre-cancers
Noninvasive cancers may grow into normal breast tissue
Which of the following statements about invasive breast cancer is true?
Most breast cancers are not invasive, but are localized
Invasive breast cancer grows into normal breast tissue
Invasive breast cancer spreads only though the blood
The diagnosis of invasive breast cancer can be made with a diagnostic mammogram
Which of the following BEST describes tumor angiogenesis?
A process whereby tumor cells are able to divide despite low hemoglobin
A response to tumor hypoxia
A process whereby tumors create their own vascular network
A process whereby tumors are deprived of a vascular network
To decrease the risk of lymphedema after a sentinel lymph node biopsy or lymph node dissection, a woman should be instructed to:
Elevate the affected arm above the level of the heart at all times
Use a compression sleeve on the affected arm when taking airline trips
Exercise regularly to help move lymph fluid through the lymphatic system
Have blood pressures checked in the affected arm
Breast cancer hormone receptor assay test results may be used for
Determing the breast cancer stage
Determining whether lymph node dissection needs to be performed
Deciding on adjuvant treatment options
Deciding between breast conservation or mastectomy
Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by
Breast self-exam
Mammography
Core Needle Biopsy
Chest X-ray
The advantages of fine-needle aspiration biopsy include all of the following except:
It is inexpensive
It is rapid and painless
It has a false-negative rate of 4-10%
It can distinguish between in situ and invasive cancer
Which of the following statements about core-needle biopsy is true?
Core-needle biopsy is superior to fine-needle aspiration when no mass is palpable
It is rapid and painless, but expensive
Surgical excision is preferred over core-needle biopsy when tissue biopsy is needed
Core-needle biopsy provides cytological details for evaluation
In reading the pathology report, your patient notes a comment that says the surgical margins are negative. You explain to her that is means:
The surgery had a negative effect on the tissue
The surgeon removed all of the cancer with an extra space or margin of normal tissue around it
She will need additional surgery to remove the remaining cancer
The pathologist determined the distance between the cancer cells and normal tissue is too small
The pathology report indicates there is lymphatic or vascular invasion. You tell your patient that this means:
There was no spread of the cancer to the lymph nodes
This is a normal finding as lymph and vascular circulation is a normal route for elimination of cancer cells
Lymphatic spread is common with ductal cancer in situ
Cancer cells were found in the fluid channels of the breast and this increases the risk of cancer recurring
The pathology report indicates Ms. Green’s breast cancer is HER2/neu positive. In discussing this result with Ms. Green, you tell her all of the following except
HER2/neu genes are causing amplification or too many copies of themselves
Amplified HER2 genes cause breast cells to make too many HER2/neu receptors
Over-expressed HER@/neu receptors cause breast cells to grow and divide uncontrollably
Patients with HER2/neu-positive cancer only receive chemotherapy for treatment
Your patients has early-stage, hormone receptor-positive breast cancer. The doctor has ordered an additional genomic assay. The best explanation to your patient about the reason for this test is
Oncotype DX and MammaPrint assays help the doctor decide if adjuvant chemotherapy is indicated
Oncotype DX and MammaPrint assays predict when the cancer will come back
Oncotype DX and MammaPrint are only used in clinical trials
Oncotype DX and MammaPrint identify inherited breast cancer genes
The oncologist ordered an Oncotype DX and your patient wants to know what her Recurrence Score means. Your best explanation is
The test determines how 21 specific genes are expressed within a tumor sample
A high Recurrence Score means she will benefit from chemotherapy
Tumor size and grade and lymph node status are all that is needed to determine the risk of recurrence
A low Recurrence Score means she will benefit from chemotherapy
The TNM systems is used for staging and grading breast cancer. What does TNM stand for?
Time, Neoplasm, Mode of Growth
Tumor, Node, Metastasis
Tumor, Neoplasm, Mode of Growth
Time, Node, Metastasis
Using the TNM Staging Criteria listed, clinically stage a patient with a 4 cm tumor with 2 axillary and neck lymph nodes involved.
Stage I
Stage II
Stage III
Stage IV
How are regional lymph nodes that cannot be assessed (e.g., previously removed) designated in the TNM staging system for breast cancer?
NX
N0
N1
PN0
A stage IV breast cancer tumor is designated by which grouping of primary tumor (T), lymph node status (N), and metastasis (M)?
T4, N3, M0
T4, N2, M0
Any T, N3, M0
Any T, any N, M1
A patient is diagnosed with ductal carcinoma in situ (DCIS). Which of the following statements demonstrates her understanding of the stage of her breast cancer?
This is a stage I breast cancer
This is an late-stage breast cancer
This is a noninvasive breast cancer that is limited to the lining of the ducts of my breast
This is a small breast cancer that has only spread into the nearby fatty tissue of the breast
Betsy has recently been diagnosed with ER(-) and PR(-) breast cancer. Which of the following statements demonstrates to you that she understands her hormone receptor status in relation to treatment for her disease?
I want to be sure that the hormone therapy used has the least side effects
I am able to switch to hormone therapy if I find the side effects of chemotherapy to be disagreeable
I understand that chemotherapy is the only option for me related to my breast cancer treatment
I am scared about the side effects that I may experience receiving chemotherapy and hormonal therapy
Mrs. Carry asks you to explain the relationship among tumor size, node involvement, and prognosis. Which of the following statements is most accurate?
Smaller tumors with positive node involvement have the best prognosis
Larger tumors with negative node involvement have the best prognosis
Smaller tumors with negative node involvement have the worst prognosis
Larger tumors with positive node involvement have the worst prognosis
The most important objective of solid tumor staging is:
To provide information regarding risk factors
To identify individuals at high risk for disease recurrence
To determine performance status and eligibility for research protocols
To provide the necessary information for individual treatment planning
Neoadjuvant treatment is defined as:
Treatment that occurs after surgery
Another name for immunotherapy
Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given
A specialized type of radiation therapy
Compared with mastectomy, breast conservation surgery results in
Equivalent lymphedema incidence rates
Greater lymphedema incidence rates
Equivalent 5-year survival rates
Greater 5-year survival rates
Modified radical mastectomy may be indicated for women who have:
Bony metastasis
A large tumor
Positive lymph nodes
A family history of breast cancer
Mrs. K is a 42 year-old pre-menopausal woman with stage II breast cancer who just completed four cycles of Cytoxan/Adriamycin and is experiencing hot flashes. The navigator may assist Mrs. K. By instructing her to
Consume a high-protein diet
Begin a regular exercise program
Dress in loose-fitting clothing
Begin estrogen replacement therapy
A woman with breast cancer who received adjuvant chemotherapy is at risk for
Acute leukemia
Diabetes mellitus
Hypertension
Osteoporosis
Biphosphonates are indicated for women with breast cancer that has metastasized to the bone to
Improve anemia
Enhance bone demineralization
Prevent hypocalcemia
Reduce bone pain
Mrs. T. Will be receiving radiation after her lumpectomy. Which of the following is a common side effect of breast irradiation?
Chest pain
Dyspnea
Esophagitis
Fatigue
The removal of the entire breast, pectoralis major and minor muscles and neck lymph nodes, followed by skin grafting is a procedures called
Simple mastectomy
Modified radical mastectomy
Radiation therapy
Radical mastectomy
The following are teaching guidelines regarding radiation therapy except:
Radiation therapy is painless
To promote safety, the client is assisted in the therapy room by therapy personnel while the machine is in operation
The client may communicate all her concerns, needs, discomfort while the machine is operating
Safety precautions are necessary only during the time of actual irradiation
Which of the following statements is correct about the rate of cell growth in relation to chemotherapy?
Faster growing cells are less susceptible to chemotherapy
Non-dividing cells are more susceptible to chemotherapy
Faster growing cells are more susceptible to chemotherapy
Smaller growing cells are more susceptible to chemotherapy
A 32 year-old woman meets with her navigator for the first time since undergoing a left mastectomy. When asked how she is doing, the woman states that her appetite is still not good, she is not getting much sleep because she doesn’t go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following interventions should the navigator explore first to support the client’s current needs?
Call the physician to discuss allowing the client to return to work earlier
Suggest that the client learn relaxation techniques to help with insomnia
Perform a nutritional assessment to assess for anorexia
Ask open-ended questions about sexuality issues related to her mastectomy
A 56 year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls you to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is most likely responsible for her symptoms?
Hiatal hernia
Stomatitis
Radiation enteritis
Esophagitis
The navigator is providing follow-up instruction for a postmenopausal patient with breast cancer about the expected outcomes of her cancer treatment. The nurse evaluates that teaching has been effective when the patient says
After cancer has not recurred for 5 years, it is considered cured
I will need to have follow-up exams for many years after I have treatment
Cancer is considered cured if the entire tumor is surgically removed
There is no cure for any type of cancer; I am hopeless
Jenny, who has advanced breast cancer, is prescribed tamoxifen. When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
Vision changes
Hearing loss
Headache
Anorexia
The timing for breast reconstruction is based upon:
Age younger than 60 years
Patient's desire
Postoperative radiation
The schedules of the plastic and oncologic surgeons
Susan is to receive doxorubicin and trastuzumab for treatment of her metastatic breast cancer. What test will she need prior to her first treatment?
Serum calcium level
MUGA scan
CT of the lungs
MRI of the brain
The most common and lethal side effect of chemotherapy is
Myelosuppression
Respiratory distress
Increased liver function tests
Electrolyte imbalance from nausea, vomiting, and diarrhea
Which of the following postoperative situations requires immediate intervention?
A smooth suture line with no sign of swelling
Hematoma formation beneath a skin flap
Bleeding the size of a quarter on a dressing
Clearing of airway secretions by coughing
Which is not a common side effect of opioids?
Sedation
Constipation
Increased motility
Respiratory depression
Which of the following is a known risk factor for breast cancer because of the increased exposure to estrogen and/or progesterone?
Early first-term pregnancy
Lactation
Physical activity
Late menopause
Which of the following racial and ethnic groups have the highest breast cancer mortality rates?
African Americans
American Indians
Asian and Pacific Islanders
Hispanics
A 34 year-old female client is requesting information about mammograms and breast cancer. She isn’t considered at high risk for breast cancer. What should the nurse tell this patient?
She should have had a baseline mammogram before age 30
She should eat a low-fat diet to further decrease her risk of breast cancer
She should perform breast self-exam during the first 5 days of each menstrual cycle
When she begins having yearly mammograms, breast self-exams will no longer be necessary
What is the most significant risk factor for the development of breast cancer?
Sex
Age
Age at menarche
Age of first pregnancy
Which of the following is an appropriate response to a patient regarding established breast cancer risk factors?
Age at first live birth less than 30 is a breast cancer risk factor
Menopause starting at the age of 50 is a breast cancer risk factor
Menarche starting after the age of 14 is a breast cancer risk factor
Menarche starting before the age of 12 is a breast cancer risk factor
Susan, age 40, has a strong family history of breast cancer and is also positive for the BRCA1 gene. She is considering undergoing a bilateral oophorectomy to reduce her risk of breast cancer. Your most appropriate response to her would be
A bilateral oophorectomy does not reduce your risk of breast cancer
A bilateral oophorectomy will reduce your risk of breast cancer by 50%
A bilateral oophorectomy will reduce your risk of breast cancer by 10%
A bilateral oophorectomy will increase your risk of breast cancer by 10%
Mary has a family history of breast cancer and would like to have genetic testing to learn if she is at high risk. However, she is concerned that her employer may find out if the results are positive and it would affect her employment and insurance. Your best response to Mary is
You do not have to worry because the government passed the Genetic Information and Nondiscrimination Act (GINA) of 2008, which protects patients with cancer
GINA prohibits employers from requesting or requiring genetic testing, unless it is for a wellness program
GINA prohibits health insurers from requesting genetic testing and refusing coverage for disability or long-term care insurance
GINA prohibits employers from using a person’s genetic information to influence firing or promotion decisions; however, employers can collect genetic information for wellness programs
All of the following are characteristics of breast cancer in males except:
Men are found to be significantly younger at diagnosis than women
Men are more likely to have larger tumors at diagnosis than women
Men are more likely to have nodal involvement at diagnosis than women
Men are more likely to have estrogen receptor-positive (ER+) tumors at diagnosis than women
Which of the following statements best describes the significance of the BRCA1 gene?
It is an inherited gene that identifies women who are ensured of having breast cancer during their premenopausal years
It is an inherited gene mutation that identifies families at significant risk for breast cancer and ovarian cancer
It is an inherited gene mutation that identifies women likely to have breast cancer in their postmenopausal years
It is an inherited gene that is present in more than 90% of women with breast cancer
Which of the following is a less common clinical manifestation in the diagnostic assessment of early-stage breast cancer?
Breast pain
Skin dimpling
Nipple inversion
Bloody nipple discharge
The classic symptoms that define breast cancer include the following except:
"pink peel” skin
Solitary, irregularly shaped mass
Firm, nontender, nonmobile mass
Abnormal discharge from the nipple
During a routine physical examination, a firm mass is palpated in the right breast of a 35 year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease?
History of early menarche
Changes in mass size during menstrual cycle
History of anovulatory cycles
Increased vascularity of the breast
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