A nurse is assisting in the care of a client who presents with redness, dimpling, and thickening of the skin on the right breast.
Which of the following diagnostic procedures should the nurse prepare the client for first?
Ultrasound.
Magnetic resonance imaging study.
Core needle biopsy.
Staging of invasive cancer.
The Correct Answer is A
Choice A rationale
Initial diagnostic steps for inflammatory breast cancer symptoms like redness, dimpling, and skin thickening usually involve imaging to differentiate between an abscess and a solid mass. Ultrasound is the preferred first-line tool because it is non-invasive, cost-effective, and highly effective at characterizing localized tissue changes and identifying fluid-filled versus solid lesions. It provides real-time guidance and helps the medical team determine the necessity and precise location for more invasive follow-up procedures like biopsies.
Choice B rationale
Magnetic resonance imaging is a sophisticated diagnostic tool that provides detailed cross-sectional views of breast tissue, but it is typically reserved for high-risk screening or further characterization after an initial ultrasound or mammogram. It is not the first step because it is expensive and may show false positives. While excellent for determining the extent of a known disease, it is considered a secondary imaging modality in the initial diagnostic workup of new breast symptoms.
Choice C rationale
A core needle biopsy is the definitive method for obtaining a tissue sample to confirm a diagnosis of malignancy. However, imaging must be performed first to visualize the area of concern and provide a roadmap for the needle. Skipping straight to a biopsy without prior imaging like an ultrasound is not standard practice, as the imaging helps ensure the biopsy is taken from the most suspicious and representative area of the affected breast tissue.
Choice D rationale
Staging is a process used to determine the extent of cancer spread throughout the body once a definitive diagnosis of malignancy has already been established. It involves various scans and tests to check lymph nodes and distant organs. Because the client has not yet been diagnosed with cancer, performing staging procedures would be premature. The priority is to first confirm whether the clinical signs of dimpling and redness actually represent a malignant process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"C"},"E":{"answers":"B"},"F":{"answers":"A"},"G":{"answers":"B"}}
Explanation
- Ultrasound result (Twin gestation): A multifetal pregnancy is a biophysical risk because it physically alters the pregnancy's progression, increasing the risk for preterm labor, gestational hypertension, and placental issues.
- Caffeine intake / Recreational substance use: Excessive caffeine (3 energy drinks per day) is considered a psychosocial risk factor because it pertains to maternal lifestyle choices and nutritional behaviors that can lead to low birth weight or miscarriage.
- Job (X-ray technician): Working around radiation is an environmental risk factor. Even with safety protocols, exposure to ionizing radiation represents an external hazard to the developing fetus.
- Pets (Cats): Specifically regarding the cats, there is an environmental risk of Toxoplasmosis, a parasite found in cat feces that can cause significant fetal complications if the mother is exposed while cleaning a litter box.
- Medical history (Bulimia nervosa): A history of eating disorders is a psychosocial risk factor. It affects maternal nutrition, body image, and psychological well-being, and carries a risk of relapse due to the stress of pregnancy.
- Laboratory results: The Hgb of 10 g/dL and Hct of 32% indicate anemia. This is a biophysical finding that requires medical intervention to ensure adequate oxygenation for both the mother and the twins.
Correct Answer is D
Explanation
Choice A rationale
A history of recurrent urinary tract infections is a common medical concern but is generally not a contraindication for pregnancy. While pregnancy does increase the risk of UTIs and pyelonephritis due to ureteral dilation and hormonal changes, these conditions are manageable with appropriate screening and antibiotic therapy. Careful monitoring of urine cultures throughout the gestational period allows for safe outcomes for both the parent and the fetus without necessitating the avoidance of pregnancy.
Choice B rationale
Having a negative Rh antigen, or being Rh-negative, is a hematological trait that requires specific management during pregnancy but is not a contraindication. If the fetus is Rh-positive, the parent may develop antibodies. However, this is effectively prevented by administering Rho(D) immune globulin at 28 weeks of gestation and after birth. With modern prophylactic treatments, Rh incompatibility is a well-managed aspect of prenatal care and does not prevent a person from having a healthy pregnancy.
Choice C rationale
Anxiety is a mental health condition that requires support and potentially medication, but it is not a contraindication for pregnancy. Many individuals manage anxiety successfully during pregnancy through therapy and pregnancy-safe pharmacological interventions. While maternal mental health is a priority, and stress can impact pregnancy, a diagnosis of anxiety does not preclude someone from conceiving or carrying a child, provided there is a comprehensive care plan in place with healthcare providers.
Choice D rationale
Severe kidney disease is often a significant contraindication for pregnancy because the kidneys must work 50 percent harder to filter the increased blood volume and fetal waste. Pregnant individuals with advanced renal failure face high risks of severe preeclampsia, fetal growth restriction, and preterm birth. The physiological strain of pregnancy can cause a permanent decline in maternal renal function. Therefore, preconception counseling often advises against pregnancy in cases of significantly impaired glomerular filtration rates.
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