Deck 18: Breasts and Regional Lymphatic System

Question 1

During examination,the nurse notices that a woman's left breast is slightly larger than her right breast.Which of the following is true?

A)Breasts should always be symmetrical.
B)This probably resulted from breastfeeding and is nothing to worry about.
C)This finding is not unusual,but the nurse should verify that this change is not new.
D)This finding is very unusual and means that the woman may have an inflammation or growth.

Answer 1

This finding is not unusual,but the nurse should verify that this change is not new.

Question 2

During physical examination,a 45-year-old woman states that she has had a crusty,itchy rash on her breast for about 2 weeks.In trying to find the cause of the rash,which of the following questions would be important for the nurse to ask?

A)Is the rash raised and red?
B)Does the rash appear cyclically?
C)Where did it first appear-on the nipple,the areola,or the surrounding skin?
D)What was she doing when she first noticed the rash,and do her actions make it worse?

Answer 2

Where did it first appear-on the nipple,the areola,or the surrounding skin?

Question 3

During assessment of a woman's axillary lymph system,the nurse will assess the:

A)central,axillary,lateral,and sternal nodes.
B)pectoral,lateral,anterior,and sternal nodes.
C)central,lateral,pectoral,and subscapular nodes.
D)lateral,pectoral,axillary,and suprascapular nodes.

Answer 3

central,lateral,pectoral,and subscapular nodes.

Question 4

While examining a 70-year-old male patient,the nurse notices that he has bilateral gynecomastia.Which of the following describes the nurse's best course of action?

A)Recommend that he make an appointment with his physician for a mammogram.
B)Ignore it;it is not unusual for men to have benign breast enlargement.
C)Explain that this condition may be the result of hormonal changes,and recommend that he consult his physician.
D)Tell him that gynecomastia in men is usually associated with prostate enlargement,and recommend that he undergo thorough screening.

Question 5

A patient contacts the clinic and tells the nurse that she is worried that her 10-year-old daughter may have breast cancer.She describes a unilateral enlargement of the right breast with associated tenderness.Which of the following would be the nurse's best response?

A)Tell the mother that breast development is usually fairly symmetrical,so the daughter should be examined right away.
B)Tell the mother that she should bring her daughter in right away because breast cancer is fairly common in preadolescent girls.
C)Tell the mother that a clinical examination of her daughter would help rule out her suspicions,but it is most likely that the condition is due to normal breast development.
D)Tell the mother that it is unusual for newly developing breasts to feel tender because at this stage they would not have developed much fibrous tissue.

Question 6

During history-taking,a female patient reports that she has noticed a few drops of clear discharge from her right nipple.What should the nurse do next?

A)Immediately report this to the physician.
B)Discontinue the interview,and refer the patient for a mammogram.
C)Question the patient about medications she is taking.
D)Make a note about the discharge,but ask no further questions because clear discharge is often found in healthy women.

Question 7

During breast examination,it is especially important for the nurse to examine the upper outer quadrant of the breast because it is:

A)the largest quadrant of the breast.
B)the area where most breast tumours occur.
C)where most of the suspensory ligaments are attached.
D)more prone to injury and calcifications than are other areas in the breast.

Question 8

Which of the following statements about the internal structures of the breast is true?

A)The breast is mainly muscle,with very little fibrous tissue.
B)The breast is composed of fibrous,glandular,and adipose tissues.
C)The breast is composed mostly of milk ducts,known as lactiferous ducts.
D)The breast is composed of glandular tissue,which supports the breast by being attached to the chest wall.

Question 9

Which of the following women has risk factors that place her at a higher risk for breast cancer?

A)A 37-year-old who is slightly overweight
B)A 42-year-old who had a diagnosis of ovarian cancer
C)A 45-year-old who has never been pregnant
D)A 65-year-old whose mother had breast cancer

Question 10

During assessment,a patient reveals that she is pregnant.She states that she is not sure whether she will breastfeed her baby and asks for some information on breastfeeding.Which of the following statements about breastfeeding is accurate?

A)Breastfed babies tend to be more colicky.
B)Breastfeeding may reduce the risk of ear infections.
C)Breastfed babies feed more frequently than do infants on formula.
D)Breastfeeding is natural to women,and every woman can do it.

Question 11

A patient is newly diagnosed with benign breast disease.Which of the following statements about benign breast disease is true? The presence of benign breast disease:

A)makes it more difficult to examine the breasts.
B)frequently turns into cancer in a woman's later years.
C)is easily resolved with hormone replacement therapy.
D)is usually diagnosed before a woman reaches the childbearing age.

Question 12

If a patient reports a recent infection in the breast,the nurse would expect to find:

A)nonspecific node enlargement.
B)ipsilateral axillary node enlargement.
C)contralateral axillary node enlargement.
D)inguinal and cervical node enlargement.

Question 13

A woman is in the family planning clinic to obtain birth control information.She states that her breasts "change all through the month" and that she is worried that this may be unusual.Which of the following would be the nurse's best response?

A)Tell her that it is unusual.Breasts of nonpregnant females usually remain unchanged throughout the month.
B)Tell her that it is very common for breasts to change in response to stress and assess her life for stressful events.
C)Tell her that because of hormonal changes during the monthly menstrual cycle,cyclical breast changes are common.
D)Tell her that breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time.

Question 14

A 14-year-old girl is anxious about not having reached menarche yet.When taking a history,which of the following should the nurse ascertain?

A)The age she began to develop breasts
B)The age her mother developed breasts
C)The age she began to develop pubic hair
D)The age she began to develop axillary hair

Question 15

The nurse is teaching a pregnant woman about breast milk.Which of the following statements would be true?

A)Breast milk is secreted immediately after delivery of the baby.
B)Breast milk is rich in protein and sugars (lactose)but has very little fat.
C)Colostrum,a thin,watery fluid,is present on days 4 and 5 postpartum (after the birth).
D)Colostrum is a fluid that contains antibodies and is usually present after the fourth month of pregnancy.

Question 16

A 65-year-old patient remarks that she just cannot believe that her breasts sag so much.She thinks it could be due to lack of exercise.What explanation should the nurse offer her?

A)Only women with large breasts experience sagging after menopause.
B)Sagging of breasts after menopause is usually due to decreasing muscle mass within the breast.
C)After menopause,a high-protein diet will help maintain muscle mass,which would prevent sagging of breasts.
D)After menopause,the glandular and fat tissues atrophy,causing breast size and elasticity to decrease,resulting in sagging.

Question 17

During the annual physical examination,a 43-year-old patient states that she does not perform breast self-examinations (BSEs).She tells the nurse that she believes that mammograms "do a much better job than I ever could to find a lump." The nurse should explain to her that:

A)mammography may detect a lump that is not palpable,but it is important to get to know your own breasts.
B)BSE is unnecessary until the age of 50 years.
C)she is correct,mammography is a good replacement for BSE.
D)she does not need to perform BSE as long as a physician examines her breasts yearly.

Question 18

A 9-year-old girl is in the clinic for a sports physical assessment.Getting over her initial shyness,she asks,"Am I normal? I don't seem to need a bra yet,but I have some friends who do.What if I never get breasts?" The nurse's best response would be:

A)"Don't worry,you still have plenty of time to develop."
B)"I know just how you feel;I was a late bloomer myself.Just be patient;they will develop."
C)"You will probably get your periods before you notice any significant development of your breasts."
D)"I understand that it is hard when you feel different from your friends.Breasts usually develop between 8 and 10 years of age."

Question 19

A woman has just learned that she is pregnant.What are some things the nurse should teach the woman about breasts?

A)She can expect the areolae to become larger and darker in colour.
B)Breasts may begin secreting milk after the fourth month of pregnancy.
C)Breasts should be inspected for visible veins,which should be reported immediately if present.
D)Breast changes are fairly uncommon during pregnancy;most of the changes occur after delivery.

Question 20

During a breast health interview,a patient states that she occasionally experiences pain in her left breast.The nurse's most appropriate response to this would be:

A)"Don't worry about the pain;breast cancer is not painful."
B)"I would like some more information about the pain in your left breast."
C)"Oh,I had pain like that after my son was born;it turned out to be a blocked milk duct."
D)"Breast pain is almost always the result of benign breast disease,so let's just ignore it."

Question 21

The nurse is discussing mammography with a postmenopausal 64-year-old woman.How often does the nurse recommend that the patient have a mammography exam?

A)Annually
B)Every 2 to 3 years
C)Every 5 years
D)Mammography is not recommended after 60 years of age.

Question 22

While examining a 75-year-old woman,the nurse notes that the skin over her right breast is thickened and the hair follicles appear exaggerated.This condition is known as:

A)dimpling.
B)retraction.
C)peau d'orange.
D)benign breast disease.

Question 23

During physical examination,the nurse notes that a female patient has an inverted left nipple.Which of the following statements about inverted nipples is most accurate?

A)Normal nipple inversion is usually bilateral.
B)Unilateral nipple inversion is always a serious sign.
C)It should be determined whether the inversion is a recent change.
D)Nipple inversion is not significant unless accompanied by an underlying palpable mass.

Question 24

While examining a patient's breasts,the nurse finds the left breast slightly larger than the right and the presence of Montgomery's glands bilaterally.The nurse would:

A)palpate over the venous patterns,checking for drainage.
B)consider these normal findings and proceed with the examination.
C)ask extensive history questions regarding the woman's breast asymmetry.
D)continue with the examination and then refer the patient for further evaluation of the Montgomery's glands.

Question 25

During breast examination,which of the following is the correct procedure to screen for nipple or skin retraction?

A)Have the woman bend and touch her toes with the tips of her fingers.
B)Have the woman lie down on her left side,and note any retraction.
C)Have the woman change from a supine position to a standing position,and note any lag or retraction.
D)Have the woman slowly lift her arms above her head,and note any retraction or lag in movement.

Question 26

The nurse is conducting a class about breast health.Which of the following statements is true?

A)The best time to perform BSE is in the middle of the menstrual cycle.
B)The woman needs to do BSE every month.
C)Breast volume is smallest from day 4 to 7 of your menstrual cycle and is a good time to get to know your breast structure.
D)If she suspects that she is pregnant,the woman should not perform BSE until her baby is born.

Question 27

Which of the following clinical situations would the nurse consider as being outside normal limits?

A)A patient has had one pregnancy.She states that she believes she may be entering menopause.Her breast examination reveals breasts that are soft and sag slightly.
B)A patient has never been pregnant.Her breast examination reveals large,pendulous breasts that have a firm,transverse ridge along the lower quadrant in both breasts.
C)A patient has never been pregnant.She reports that she should begin her period tomorrow.Her breast examination reveals breast tissue that is nodular and somewhat engorged.She states that the examination was slightly painful.
D)A patient has had two pregnancies,and she breastfed both her children.Her youngest child is now 10 years old.Her breast examination reveals breast tissue that is somewhat soft,and she has a small amount of thick yellow discharge from both nipples.

Question 28

During breast examination,the nurse notes that the woman's nipple is flat,broad,and fixed.The patient states that this "started happening a few months ago." This finding suggests:

A)dimpling.
B)a retracted nipple.
C)nipple inversion.
D)deviation in nipple pointing.

Question 29

Which assessment finding regarding the shape of a breast lump would indicate that the woman may have breast cancer?

A)Circular
B)Elongated
C)Star-shaped
D)Lobular

Question 30

A patient states during the assessment that she noticed a new lump in her left breast near her axilla while in the shower a few days ago.The nurse should plan to:

A)palpate the lump first.
B)palpate the unaffected breast first.
C)avoid palpating the lump because it could be a cyst,which might rupture.
D)palpate the breast with the lump first and the axilla last.

Question 31

A 54-year-old man comes to the clinic with a "horrible problem." He tells the nurse that he has just discovered a lump in his breast and is fearful of cancer.Which statement about breast cancer in men is true?

A)Breast masses in men are difficult to detect because of minimal breast tissue.
B)Breast masses in men are less noticeable because of minimal breast tissue.
C)Fewer than 1% of all breast cancers occur in men.
D)Most breast masses in men are diagnosed as gynecomastia.

Question 32

Which of the following statements reflects the best approach to teaching a woman about BSE?

A)"BSE is more important for you,since you have never had any children."
B)"BSE is very important because one out of nine women will develop breast cancer."
C)"Monthly BSE is no longer routinely recommended for women who have a low to average risk for developing breast cancer."
D)"BSE will save your life because there is a likelihood of finding a cancerous lump between mammograms."

Question 33

A 43-year-old woman is at the clinic for a routine examination.She reports that she has had a lump in her right breast for years.Recently,it has begun to change in consistency and is becoming harder.She reports that 5 years ago her physician evaluated the lump and had determined that it "was nothing to worry about." The examination validates the presence of a mass in the right upper outer quadrant at 1 o'clock,approximately 5 cm from the nipple.It is firm,mobile,and nontender,with borders that are not well defined.The nurse's recommendation to her is:

A)"Because of the change in consistency of the lump,it should be further evaluated by a physician."
B)"The changes could be related to your menstrual cycles.Keep track of changes in the mass each month."
C)"This is probably nothing to worry about because it has been present for years and has been determined to be noncancerous by your physician."
D)"Because you are experiencing no pain and the size has not changed,continue to monitor the lump and return to the clinic in 3 months."

Question 34

Which of the following is an abnormal finding during the inspection phase of breast examination?

A)Nipples in different planes (deviated)
B)The left breast slightly larger than the right
C)Skin of a nonpregnant woman marked with linear striae
D)Breasts of a pregnant woman having a fine blue network of veins visible under the skin

Question 35

A 55-year-old postmenopausal woman is being seen in the clinic for her annual physical examination.She is concerned about the changes she has noticed in her breasts in the past 5 years.She states that her breasts have decreased in size and that the elasticity has decreased so much that her breasts seem "flat and flabby." The nurse's best reply would be:

A)"This change occurs most often because of long-term use of bras that do not provide enough support to the breast tissues."
B)"This is a normal change that occurs as women get older.It is due to the increased levels of progesterone during the aging process."
C)"Decreases in progesterone and estrogen after menopause cause atrophy of the glandular tissue in the breast.This is a normal process of aging."
D)"Postural changes in the spine make it appear that your breasts have changed in shape.Exercises to strengthen the muscles of the upper back and chest wall will help prevent the decreases in elasticity and size."

Question 36

During breast palpation,which of the following positions is most likely to clearly delineate significant lumps?

A)Supine,with arms raised over her head
B)Sitting,with arms relaxed at the sides
C)Supine,with arms relaxed at the sides
D)Sitting,with arms flexed and fingertips touching shoulders

Question 37

While palpating,the nurse has found a lump in a female patient's right breast.The nurse documents this as a small,round,firm,distinct lump located at the 2:00 position,2 cm from the nipple.It is nontender and fixed.There is no associated retraction of skin or nipple,no erythema,and no axillary lymphadenopathy.This entry is missing information about:

A)the shape of the lump.
B)the lump's consistency.
C)the exact size of the lump.
D)whether the lump is solitary or multiple.

Question 38

During examination,the nurse notes a supernumerary nipple just under the patient's left breast.The patient tells the nurse that she always thought it was a mole.Which of the following statements about this finding is correct?

A)It is a normal variation and not a significant finding.
B)It is a significant finding and requires further investigation.
C)It also contains glandular tissue and may leak milk during pregnancy and lactation.
D)The patient is correct;it is actually a mole that happens to be located under the breast.

Question 39

A breastfeeding mother is diagnosed with a breast abscess.Which of the following instructions from the nurse is correct? The mother needs to:

A)continue to nurse on both sides to encourage milk flow.
B)discontinue nursing immediately to allow for healing.
C)temporarily discontinue nursing on the affected breast,manually express the milk,and discard it.
D)temporarily discontinue nursing on the affected breast but can manually express the milk and give it to the baby.

Question 40

A new mother,who has been breastfeeding for 1 month,calls the clinic to report that an area of her left breast is red,swollen,tender,very hot,and hard.She has a fever of 38.3°C.She has also had symptoms of flu,such as chills,sweating,and tiredness.From this description,what condition does the nurse suspect?

A)Mastitis
B)Paget's disease
C)Plugged milk duct
D)Mammary duct ectasia

Question 41

The nurse is assessing the breasts of a 68-year-old woman and discovers a mass in the upper outer quadrant of the left breast.When assessing this mass,the nurse keeps in mind certain characteristics of a cancerous mass.(Select all that apply. )

A)Nontender mass
B)Dull,heavy pain on palpation
C)Rubbery texture and mobile
D)Hard,dense,and immobile
E)Regular border
F)Irregular,poorly delineated border