Deck 17: Breasts and Regional Lymphatics

Question 1

An 9-year-old girl is in the clinic for a sports physical.After some initial shyness she finally 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:
1)"Don't worry,you still have plenty of time to develop."
2)"I know just how you feel,I was a late bloomer myself.Just be patient and they will grow."
3)"You will probably get your periods before you notice any significant growth in your breasts."
4)"I understand that it is hard to feel different from your friends.Breasts usually develop between 8 and 10 years of age."

Answer 1

4
Adolescent breast development usually begins on an average between 8 and 10 years of age.The beginning of breast development precedes menarche by about 2 years.

Question 2

Which of the following statements is true regarding the internal structures of the breast?
1)The breast is mainly muscle,with very little fibrous tissue.
2)The breast is composed of fibrous,glandular,and adipose tissue.
3)The breast is composed mostly of milk ducts,known as lactiferous ducts.
4)The breast is composed of glandular tissue,which supports the breast by attaching to the chest wall.

Answer 2

2
The breast is composed of (1)glandular tissue, (2)fibrous tissue,including the suspensory ligaments,and (3)adipose tissue.

Question 3

Which cultural group has the lowest risk for development of breast cancer?
1)Black women
2)European women
3)American Indian women
4)White women in the United States

Answer 3

3
The incidence of breast cancer varies with different cultural groups.According to the American Cancer Society (2007),Asian,Hispanic,and American Indian women have a lower risk for development of breast cancer.

Question 4

A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer.She describes a unilateral enlargement of the right breast with associated tenderness.She is worried because the left breast is not enlarge d.What would be the nurse's best response?
1)Tell the mother that breast development is usually fairly symmetric and she should be examined right away.
2)Tell the mother that she should bring her daughter in right away because breast cancer is fairly common in preadolescent girls.
3)Tell the mother that,although an examination of her daughter would rule out a problem,it is most likely normal breast development.
4)Tell the mother that it is unusual for breasts that are first developing to feel tender because they haven't developed much fibrous tissue.

Question 5

A patient is newly diagnosed with benign breast disease.The nurse recognizes that which statement about benign breast disease is true? The presence of benign breast disease:
1)makes it more difficult to examine the breasts.
2)frequently turns into cancer in a woman's later years.
3)is easily reduced with hormone replacement therapy.
4)is usually diagnosed before a woman reaches childbearing age.

Question 6

A 14-year-old girl is anxious about not having reached menarche.When taking the history,the nurse should ascertain which of the following?
1)The age she began to develop breasts
2)The age her mother developed breasts
3)The age she began to develop pubic hair
4)The age she began to develop axillary hair.

Question 7

In performing an assessment of a woman's axillary lymph system,the nurse will assess the:
1)central,axillary,lateral,and sternal nodes.
2)pectoral,lateral,anterior,and sternal nodes.
3)central,lateral,pectoral,and subscapular nodes.
4)lateral,pectoral,axillary,and suprascapular nodes.

Question 8

If a patient reports a recent breast infection,the nurse would expect to find:
1)nonspecific node enlargement.
2)ipsilateral axillary node enlargement.
3)contralateral axillary node enlargement.
4)inguinal and cervical node enlargement.

Question 9

A woman has just learned that she is pregnant.What are some things the nurse should teach her about her breasts?
1)She can expect her areolae to become larger and darker in color.
2)Breasts may begin secreting milk after the fourth month of pregnancy.
3)She should inspect her breasts for visible veins and report this immediately.
4)During pregnancy,breast changes are fairly uncommon;most of the changes occur after the birth.

Question 10

The nurse is teaching a pregnant woman about breast milk.Which statement would be true?
1)Breast milk is present immediately after delivery of the baby.
2)Breast milk is rich in protein and sugars (lactose)but has very little fat.
3)Colostrum,which is a thin,watery fluid,is present on days 4 and 5 post partum (after the birth).
4)Colostrum is a fluid that contains antibodies and is usually present after the fourth month of pregnancy.

Question 11

In 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?
1)Recommend that he make an appointment with his physician for a mammogram.
2)Ignore it;it is not unusual for men to have benign breast enlargement.
3)Explain that this condition may be the result of hormonal changes and recommend that he see his physician.
4)Tell him that gynecomastia in men is usually associated with prostate enlargement and recommend that he be screened thoroughly.

Question 12

Which of the following statements is true with regard to breast cancer in black women in the United States?
1)Breast cancer is not a threat to black women.
2)Breast cancer is the leading cause of death among black women.
3)Breast cancer is the leading cause of cancer death among black women.
4)Breast cancer incidence in black women is much higher than that of white women.

Question 13

During a 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 would be important for the nurse to determine?
1)Is the rash raised and red?
2)Does it appear to be cyclic?
3)Where did it first appear-on the nipple,the areola,or the surrounding skin?
4)What was she doing when she first noticed the rash,and do her actions make it worse?

Question 14

During an examination of a 13-year-old black girl,which of the following would the nurse expect to find on the basis of Tanner's data on sexual maturity?
1)Her secondary sex characteristics will appear earlier than those of white girls her age.
2)Her secondary sex characteristics will appear to be in line with Tanner's data on sexual maturity.
3)She will be significantly slower than white girls in her development of secondary sex characteristics.
4)The development of secondary sex characteristics is inversely correlated with socioeconomic status.

Question 15

During a history interview,a female patient states that she has noticed a few drops of clear discharge from her right nipple.What should the nurse do next?
1)Contact the physician immediately to report the discharge.
2)Discontinue the interview and refer her for a mammogram.
3)Ask her some additional questions about the medications she is taking.
4)Make a note of the discharge but ask no further questions because clear discharge is often found in healthy women.

Question 16

In performing a breast examination,the nurse knows that it is especially important to examine the upper outer quadrant of the breast.The reason for this is that the upper outer quadrant is:
1)the largest quadrant of the breast.
2)the location of most breast tumors.
3)where most of the suspensory ligaments attach.
4)more prone to injury and calcifications than other locations in the breast.

Question 17

A 65-year-old patient remarks that she just can't believe that her breasts sag so much.She states it must be from lack of exercise.What explanation should the nurse offer her?
1)After menopause,only women with large breasts experience sagging.
2)After menopause,sagging is usually due to decreased muscle mass within the breast.
3)After menopause,a diet that is high in protein will help maintain muscle mass,which keeps the breasts from sagging.
4)After menopause,the glandular and fat tissue atrophies,causing breast size and elasticity to diminish,resulting in breasts that sag.

Question 18

A woman is in the family planning clinic seeking birth control information.She states that her breasts "change all month long" and that she is worried that this is unusual.What is the nurse's best response?
1)Tell her that it is unusual.The breasts of nonpregnant females usually stay pretty much the same all month long.
2)Tell her that it is very common for breasts to change in response to stress and assess her life for stressful events.
3)Tell her that,because of the changing hormones during the monthly menstrual cycle,cyclic breast changes are common.
4)Tell her that breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time.

Question 19

During a breast health interview,a patient states that she has noticed pain in her left breast.The nurse's most appropriate response to this would be:
1)"Don't worry about the pain;breast cancer is not painful."
2)"I would like some more information about the pain in your left breast."
3)"Oh,I had pain like that after my son was born;it turned out to be a blocked milk duct."
4)"Breast pain is almost always the result of benign breast disease and so let's just ignore it."

Question 20

During an annual physical exam,a 43-year-old patient states that she doesn't perform monthly breast self-examinations.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:
1)mammography may not detect all palpable lumps.
2)breast self-examination is unnecessary until the age of 50 years.
3)she is correct,mammography is a good replacement for breast self-examination.
4)she doesn't need to perform breast self-examination as long as a physician checks her breasts yearly.

Question 21

While inspecting a patient's breasts,the nurse finds that the left breast is slightly larger than the right with the presence of Montgomery's glands bilaterally and a fine venous pattern in both breasts.The nurse would:
1)palpate over the venous patterns,checking for drainage.
2)consider these normal findings and proceed with the examination.
3)ask extensive history questions regarding the woman's breast asymmetry.
4)continue with examination and then refer the patient for further evaluation of the Montgomery's glands.

Question 22

A patient states during the interview that she noticed a new lump in the shower a few days ago.It was on her left breast near her axilla.The nurse should plan to:
1)palpate the lump first .
2)palpate the unaffected breast first.
3)avoid palpating the lump because it could be a cyst,which might rupture.
4)palpate the breast with the lump first but plan to palpate the axilla last.

Question 23

Which of the following statements best describes the correct procedure to screen for nipple and/or skin retraction during a breast examination?
1)Have the woman bend over and touch her toes.
2)Have the woman lie down on her left side and note any retraction.
3)Have the woman shift from a supine position to a standing position;note any lag or retraction.
4)Have the woman slowly lift her arms above her head and note any retraction or lag in movement.

Question 24

Which of the following statements reflects the best approach to teaching a woman about breast self-examination (BSE)?
1)"BSE is more important than ever for you since you have never had any children."
2)"BSE is so important because one out of nine women will develop breast cancer in her lifetime."
3)"BSE on a monthly basis will help you feel familiar with your own breasts and their normal variations."
4)"BSE will save your life because you are likely to find a cancerous lump between mammograms."

Question 25

Which of the following women have risk factors that place them at a higher risk for breast cancer?
1)A 37-year-old who is slightly overweight
2)A 42-year-old who has had ovarian cancer
3)A 45-year-old who has never been pregnant
4)A 65-year-old whose mother had breast cancer

Question 26

When a breast-feeding mother is diagnosed with a breast abscess,which of the following instructions from the nurse is correct? The mother needs to:
1)continue to nurse on both sides to encourage milk flow.
2)discontinue nursing immediately to allow for healing.
3)temporarily discontinue nursing on affected breast and must manually express milk and discard it.
4)temporarily discontinue nursing on affected breast but can manually express milk and give it to the baby.

Question 27

Which of the following positions is most likely to make significant lumps more distinct during breast palpation?
1)Supine with arms raised over her head
2)Sitting with arms relaxed at the sides
3)Supine with arms relaxed at the sides
4)Sitting with arms flexed and fingertips touching shoulders

Question 28

A 55-year-old postmenopausal woman is being seen in the clinic for a yearly examination.She is concerned about changes in her breasts that she has noticed over the past 5 years.She states that her breasts have decreased in size and that the elasticity has changed so that her breasts seem "flat and flabby." The nurse's best reply would be:
1)"This change occurs most often because of long-term use of bras that do not provide enough support to the breast tissues."
2)"This is a normal change that occurs as women get older.It is due to the increased levels of progesterone during the aging process."
3)"Decreases in progesterone and estrogen after menopause causes atrophy of the glandular tissue in the breast.This is a normal process of aging."
4)"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 to prevent the changes in elasticity and size."

Question 29

During a discussion about breast self-examination with a 30-year-old woman,which of the following statements by the nurse is most appropriate?
1)"The best time to examine your breasts is during ovulation."
2)"Examine your breasts every month on the same day of the month."
3)"Examine your breasts shortly after your menstrual cycle each month."
4)"The best time to examine your breasts is immediately before menstruation."

Question 30

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 that characteristics of a cancerous mass would be: Select all that apply.
1)nontender mass.
2)dull,heavy pain on palpation.
3)rubbery texture and mobile.
4)hard,dense,and immobile.
5)regular border.
6)irregular,poorly delineated border.

Question 31

Which of the following women reflect abnormal findings during the inspection phase of breast examination?
1)A woman whose nipples are in different planes (deviated)
2)A woman whose left breast is slightly larger than her right
3)A nonpregnant woman whose skin is marked with linear striae
4)A pregnant woman whose breasts have a fine blue network of veins visible under the skin

Question 32

During the physical examination,the nurse notes that a female patient.has an inverted left nipple.Which statement regarding this is most accurate?
1)Normal nipple inversion is usually bilateral.
2)A unilateral inversion of a nipple is always a serious sign.
3)It should be determined whether the inversion is a recent change.
4)Nipple inversion is not significant unless accompanied by an underlying palpable mass.

Question 33

During an 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 statement about this finding is correct?
1)It is a normal variation and not a significant finding.
2)It is a significant finding and needs further investigation.
3)It also contains glandular tissue and may leak milk during pregnancy and lactation.
4)The patient is correct-it is actually a mole that happens to be located under the breast.

Question 34

A 54-year-old man comes to the clinic with a "horrible problem." He tells the nurse that he has just discovered a lump on his breast and is fearful of cancer.The nurse knows that which statement about breast cancer in males is true?
1)Breast masses in men are difficult to detect because of minimal breast tissue.
2)Breast masses in men are noticeable early because of minimal breast tissue.
3)Fewer than 1% of all breast cancer occurs in men.
4)Most breast masses in men are diagnosed as gynecomastia.

Question 35

During an examination of a woman,the nurse notices that her left breast is slightly larger than her right breast.Which of the following is true?
1)Breasts should always be symmetric.
2)This finding is probably due to breast-feeding and is nothing to worry about.
3)This finding is not unusual,but the nurse should verify that this change is not new.
4)This finding is very unusual and means she may have an inflammation or growth.

Question 36

During an interview,a patient reveals that she is pregnant.She states that she is not sure whether she will breast-feed her baby and asks for some information about this.Which of the following statements by the nurse is accurate with regard to breast-feeding?
1)Breast-fed babies tend to be more colicky.
2)Breast-feeding may reduce the risk of breast cancer.
3)Breast-fed babies eat more often than infants on formula.
4)Breast-feeding is second nature and every woman can do it.