ch 17 assessment

breasts

lie anterior to the pectoralis major and serratus anterior muscles

Cooper ligaments

support the breast tissue.

areola

surrounds the nipple for a 1- to 2-cm radius

40 years of age.

the American Cancer Society recommends beginning annual mammography screening at _____________________

BRCA1 and BRCA2

women who inherit a mutation on one or both of these have a significantly increased risk of developing breast or ovarian cancer

hematoma or edema

A lump from an injury (seat belt injury, direct blow) is caused by local _____________________ and resolves shortly.

Breast Abscess

A rare complication of generalized infection (e.g., mastitis) if untreated. A pocket of pus that feels hard, looks red, and is quite tender accumulates in one local area.

Breast bud stage (2nd stage of breast development)

A small mound of breast and nipple develops; the areola widens.

increase in the size

A sudden ___________________of one breast signifies inflammation or new growth.

supernumerary nipple

An extra nipple along the embryonic "milk line" on the thorax or abdomen is a congenital finding

Deviation in Nipple Pointing

An underlying cancer causes fibrosis in the mammary ducts, which pulls the nipple angle toward it.

Fixation

Asymmetry, distortion, or decreased mobility with the elevated arm maneuver. As cancer becomes invasive, the fibrosis fixes the breast to the underlying pectoral muscles

estrogen hormones

At puberty the ________________________ stimulate breast changes

Fibroadenoma

Benign tumors; most commonly present as self-detected in late adolescence. Solitary nontender mass that is solid, firm, rubbery, and elastic.

chest radiation exposure

Between ages 10 and 30 years, _________________________ has greatest risk of breast cancer later in life.

atypical hyperplasia

Biopsy-confirmed ______________increases breast cancer risk.

carcinoma

Bloody nipple discharge that is unilateral and from a single duct requires further investigation

second

Breast cancer is the _____________ major cause of death from cancer in women

Edema (Peau d'Orange)

Lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel look

retroareolar lump

Male breast cancer is rare but usually presents with painless, firm, _________________.

perimenopause

Mammary Duct Ectasia Usually occurs in ______________________.

alcohol drinking

Many studies have associated ___________________________ with breast cancer risk in a dose-dependent measure

12 years of age

Menarche occurs in breast development stage 3 or 4, usually just after the peak of the adolescent growth spurt around _________________

Benign Breast Disease (Fibrocystic Breast Disease)

Multiple tender masses that occur with numerous symptoms and physical findings

Mature breast: (5th stage of breast development

Only the nipple protrudes; the areola is flush with the breast contour (the areola may continue as a secondary mound in some normal women).

Mammary Duct Ectasia

Pastelike matter in subareolar ducts produces sticky, purulent discharge that may be white, gray, brown, green, or bloody.

20 to 39 years of age

The American Cancer Society recommends that women _______________________ have a clinical breast examination (CBE) every 3 years

masses and abnormalities

The CBE screens for breast _______________________

retracted nipple

The ____________________ looks flatter and broader, like an underlying crater.

4th stage of breast development

The areola and nipple form a secondary mound over the breast.

menarche

The beginning of breast development precedes ______________ by about 2 years.

menstrual period

The best time to perform BSE is right after the ____________________ (day 4 to 7 of the cycle), when the breasts are the smallest and least congested

history questions

The best way to detect a person's risk for breast cancer is by asking the right_____________

3rd stage of breast development

The breast and areola enlarge; the nipple is flush with the breast surface

(1) glandular tissue (2) fibrous tissue (3) adipose tissue

The breast is composed of

Cyclic pain

___________________ is common with normal breasts, oral contraceptives, and benign breast (fibrocystic) disease.

Paget disease

___________________ starts with a small crust on the nipple apex and spreads to areola

Recreational physical activity

_____________________ at any intensity level may reduce breast cancer risk

Gynecomastia

________________________ is a benign growth of this breast tissue, making it distinguishable from the other tissues in the chest wall

Oral contraceptives

________________________ may control symptoms of benign ("fibrocystic") breast disease.

nipple

just below the center of the breast

adipose tissue

layers of subcutaneous and retromammary fat actually provide most of the bulk of the breast.

A,D,F

1. 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 is aware that characteristics of a cancerous mass include which of the following? 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

B

1. Which of the following statements is true regarding the internal structures of the breast? The breast is made up of: a. Primarily muscle with very little fibrous tissue. b. Fibrous, glandular, and adipose tissues. c. Primarily milk ducts, known as lactiferous ducts. d. Glandular tissue, which supports the breast by attaching to the chest wall.

D

10. The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? a. Your breast milk is immediately present after the delivery of your baby. b. Breast milk is rich in protein and sugars (lactose) but has very little fat. c. The colostrum, which is present right after birth, does not contain the same nutrients as breast milk. d. You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy.

D

11. A 65-year-old patient remarks that she just cannot believe that her breasts sag so much. She states it must be from a lack of exercise. What explanation should the nurse offer her? After menopause: a. Only women with large breasts experience sagging. b. Sagging is usually due to decreased muscle mass within the breast. c. A diet that is high in protein will help maintain muscle mass, which keeps the breasts from sagging. d. The glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag.

C

12. In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Which of the following describes the nurses best course of action? a. Recommend that he make an appointment with his physician for a mammogram. b. Ignore it. Benign breast enlargement in men is not unusual. c. Explain that this condition may be the result of hormonal changes, and recommend that he see his physician. d. Explain that gynecomastia in men is usually associated with prostate enlargement and recommend that he be thoroughly screened.

A

14. The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the United States, has the highest risk for developing breast cancer? a. Black b. White c. Asian d. American Indian

C

15. The nurse is preparing for a class in early detection of breast cancer. Which statement is true with regard to breast cancer in black women in the United States? a. Breast cancer is not a threat to black women. b. Black women have a lower incidence of regional or distant breast cancer than white women. c. Black women are more likely to die of breast cancer at any age. d. Breast cancer incidence in black women is higher than that of white women after age 45.

B

16. During a breast health interview, a patient states that she has noticed pain in her left breast. The nurses most appropriate response to this would be: a. Dont 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.

C

18. During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for approximately 2 weeks. In trying to find the cause of the rash, which question would be important for the nurse to ask? a. Is the rash raised and red? b. Does it appear to be cyclic? c. Where did the rash first appearon 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?

A

19. A patient is newly diagnosed with benign breast disease. The nurse recognizes which statement about benign breast disease to be true? The presence of benign breast disease: a. Makes it hard to examine the breasts. b. Frequently turns into cancer in a womans later years. c. Is easily reduced with hormone replacement therapy. d. Is usually diagnosed before a woman reaches childbearing age.

B

2. In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason for this is that the upper outer quadrant is: a. The largest quadrant of the breast. b. The location of most breast tumors. c. Where most of the suspensory ligaments attach. d. More prone to injury and calcifications than other locations in the breast.

B,D,E

2. The nurse is examining a 62-year-old man and notes that he has bilateral gynecomastia. The nurse should explore his health history for which related conditions? Select all that apply. a. Malnutrition b. Hyperthyroidism c. Type 2 diabetes mellitus d. Liver disease e. History of alcohol abuse

A

20. During an annual physical examination, a 43-year-old patient states that she does not perform monthly 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. BSEs may detect lumps that appear between mammograms. b. BSEs are unnecessary until the age of 50 years. c. She is correctmammography is a good replacement for BSE. d. She does not need to perform BSEs as long as a physician checks her breasts annually.

D

22. The nurse is reviewing risk factors for breast cancer. Which of these women have risk factors that place them at a higher risk for breast cancer? a. 37 year old who is slightly overweight b. 42 year old who has had ovarian cancer c. 45 year old who has never been pregnant d. 65 year old whose mother had breast cancer

C

23. During an examination of a woman, the nurse notices that her left breast is slightly larger than her right breast. Which of these statements is true about this finding? a. Breasts should always be symmetric. b. Asymmetry of breast size and shape is probably due to breastfeeding and is nothing to worry about. c. Asymmetry is not unusual, but the nurse should verify that this change is not new. d. Asymmetry of breast size and shape is very unusual and means she may have an inflammation or growth.

A

24. The nurse is assisting with a BSE clinic. Which of these women reflect abnormal findings during the inspection phase of breast examination? a. Woman whose nipples are in different planes (deviated). b. Woman whose left breast is slightly larger than her right. c. Nonpregnant woman whose skin is marked with linear striae. d. Pregnant woman whose breasts have a fine blue network of veins visible under the skin.

C

25. During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate? a. Normal nipple inversion is usually bilateral. b. Unilateral inversion of a nipple is always a serious sign. c. Whether the inversion is a recent change should be determined. d. Nipple inversion is not significant unless accompanied by an underlying palpable mass.

D

26. The nurse is performing a breast examination. Which of these statements best describes the correct procedure to use when screening for nipple and skin retraction during a breast examination? Have the woman: a. Bend over and touch her toes. b. Lie down on her left side and notice any retraction. c. Shift from a supine position to a standing position, and note any lag or retraction. d. Slowly lift her arms above her head, and note any retraction or lag in movement.

A

27. The nurse is palpating a female patients breasts during an examination. Which of these positions is most likely to make significant lumps more distinct during breast palpation? a. Supine with the arms raised over her head b. Sitting with the arms relaxed at her sides c. Supine with the arms relaxed at her sides d. Sitting with the arms flexed and fingertips touching her shoulders

C

3. In performing an assessment of a womans axillary lymph system, the nurse should assess which of these nodes? a. Central, axillary, lateral, and sternal b. Pectoral, lateral, anterior, and sternal c. Central, lateral, pectoral, and subscapular d. Lateral, pectoral, axillary, and suprascapular

C

30. The nurse has palpated a lump in a female patients right breast. The nurse documents this as a small, round, firm, distinct, lump located at 2 oclock, 2 cm from the nipple. It is nontender and fixed. No associated retraction of the skin or nipple, no erythema, and no axillary lymphadenopathy are observed. What information is missing from the documentation? a. Shape of the lump b. Consistency of the lump c. Size of the lump d. Whether the lump is solitary or multiple

C

31. The nurse is conducting a class on BSE. Which of these statements indicates the proper BSE technique? a. The best time to perform BSE is in the middle of the menstrual cycle. b. The woman needs to perform BSE only bimonthly unless she has fibrocystic breast tissue. c. The best time to perform a BSE is 4 to 7 days after the first day of the menstrual period. d. If she suspects that she is pregnant, then the woman should not perform a BSE until her baby is born.

C

32. The nurse is preparing to teach a woman about BSE. Which statement by the nurse is correct? a. BSE is more important than ever for you because you have never had any children. b. BSE is so important because one out of nine women will develop breast cancer in her lifetime. c. BSE on a monthly basis will help you become familiar with your own breasts and feel their normal variations. d. BSE will save your life because you are likely to find a cancerous lump between mammograms.

C

33. A 55-year-old postmenopausal woman is being seen in the clinic for her annual 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 nurses 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 and is due to the increased levels of progesterone during the aging process. c. Decreases in hormones after menopause causes atrophy of the glandular tissue in the breast and 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 changes in elasticity and size.

A

34. A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast 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 determined that it was nothing to worry about. The examination validates the presence of a mass in the right upper outer quadrant at 1 oclock, approximately 5 cm from the nipple. It is firm, mobile, and nontender, with borders that are not well defined. The nurse replies: 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 the changes in the mass each month. c. The lump is probably nothing to worry about because it has been present for years and was determined to be noncancerous 5 years ago. d. Because you are experiencing no pain and the size has not changed, you should continue to monitor the lump and return to the clinic in 3 months.

C

35. During a discussion about BSEs with a 30-year-old woman, which of these statements by the nurse is most appropriate? a. The best time to examine your breasts is during ovulation. b. Examine your breasts every month on the same day of the month. c. Examine your breasts shortly after your menstrual period each month. d. The best time to examine your breasts is immediately before menstruation.

A

36. The nurse is discussing BSEs with a postmenopausal woman. The best time for postmenopausal women to perform BSEs is: a. On the same day every month. b. Daily, during the shower or bath. c. One week after her menstrual period. d. Every year with her annual gynecologic examination.

B

37. While inspecting a patients breasts, the nurse finds that the left breast is slightly larger than the right with the bilateral presence of Montgomery glands. The nurse should: a. Palpate over the Montgomery glands, checking for drainage. b. Consider these findings as normal, and proceed with the examination. c. Ask extensive health history questions regarding the womans breast asymmetry. d. Continue with the examination, and then refer the patient for further evaluation of the Montgomery glands.

A

38. During an examination, the nurse notes a supernumerary nipple just under the patients left breast. The patient tells the nurse that she always thought it was a mole. Which statement about this finding is correct? a. This variation is normal and not a significant finding. b. This finding is significant and needs further investigation. c. A supernumerary nipple also contains glandular tissue and may leak milk during pregnancy and lactation. d. The patient is correcta supernumerary nipple is actually a mole that happens to be located under the breast.

C

39. While examining a 75-year-old woman, the nurse notices that the skin over her right breast is thickened and the hair follicles are exaggerated. This condition is known as: a. Dimpling. b. Retraction. c. Peau dorange. d. Benign breast disease.

B

4. If a patient reports a recent breast infection, then the nurse should expect to find ________ node enlargement. a. Nonspecific b. Ipsilateral axillary c. Contralateral axillary d. Inguinal and cervical

A

41. A new mother calls the clinic to report that part of her left breast is red, swollen, tender, very hot, and hard. She has a fever of 38.3 C. She also has had symptoms of influenza, such as chills, sweating, and feeling tired. The nurse notices that she has been breastfeeding for 1 month. From her description, what condition does the nurse suspect? a. Mastitis b. Paget disease c. Plugged milk duct d. Mammary duct ectasia

B

42. During a breast examination on a female patient, the nurse notices that the nipple is flat, broad, and fixed. The patient states it started doing that a few months ago. This finding suggests: a. Dimpling. b. Retracted nipple. c. Nipple inversion. d. Deviation in nipple pointing.

C

43. 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 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 cancer in men rarely spreads to the lymph nodes. c. One percent of all breast cancers occurs in men. d. Most breast masses in men are diagnosed as gynecomastia.

C

7. During a health 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? a. Immediately contact the physician to report the discharge. b. Ask her if she is possibly pregnant. c. Ask the patient some additional questions about the medications she is taking. d. Immediately obtain a sample for culture and sensitivity testing.

C

8. 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 nurses best response? The nurse should tell her that: a. Continual changes in her breasts are unusual. The breasts of nonpregnant women usually stay pretty much the same all month long. b. Breast changes in response to stress are very common and that she should assess her life for stressful events. c. Because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common. d. Breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time.

lump

A ___________________ present for many years and exhibiting no change may not be serious but still should be explored

estrogen and progesterone decreases

After menopause ovarian secretion of ______________________, which causes the breast glandular tissue to atrophy

Lateral

Along the humerus, inside the upper arm.

Pectoral

Along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold.

subscapular

Along the lateral edge of the scapula, deep in the posterior axillary fold.

Mammary Duct Ectasia

Caused by stagnation of cellular debris and secretions in the ducts, leading to obstruction, inflammation, and infection.

firmness

Decreased estrogen level causes decreased ______________

breastfeeding.

Eczema or other dermatitis rarely starts at the nipple unless it is caused by ____________________

axillary tail of spence

G

13 or 14 years of age.

Gynecomastia occurs in about one half of adolescent boys at _____________________

Central axillary nodes

High up in the middle of the axilla, over the ribs and serratus anterior muscle. These receive lymph from the other three groups of nodes.

central axillary nodes

High up in the middle of the axilla, over the ribs and serratus anterior muscle. These receive lymph from the other three groups of nodes.

Montgomery glands

In the areola are small elevated sebaceous glands, called

shrinkage

Rapid decrease in estrogen level causes actual _____________.

Hyperpigmentation

Redness and heat with inflammation. Unilateral dilated superficial veins in a nonpregnant woman.

growing neoplasms.

Retraction signs are caused by fibrosis in the breast tissue, usually caused by __________________________

mammography

Screening _________________ can discover small, potentially curable breast cancers

glandular tissue

The glandular tissue contains 15 to 20 lobes radiating from the nipple, and these are composed of lobules

8 and 9 years

The onset of breast development occurs at an average age between ________________ for African-American girls

10 years

The onset of breast development occurs at an average age between ________________ for White girls

benign breast disease

The presence of _________________________ makes the breasts harder to examine;

axillary tail of Spence

The superior lateral corner of breast tissue, and projects up and laterally into the axilla is called

Cooper ligaments

The suspensory ligaments, are fibrous connective tissue extending vertically from the skin surface to attach on chest wall muscles

Preadolescent (1st stage of breast development)

There is only a small elevated nipple.

Intraductal Papilloma

These are discrete benign tumors that arise in a single or multiple papillary duct(s). May have serous or serosanguineous discharge.

montgomery glands

These secrete a protective lipid material during lactation

Mastitis

This is uncommon; an inflammatory mass before abscess formation. Usually occurs in single quadrant.

Tyrer-Cuzick Model

This model and its associated IBIS Breast Cancer Risk Evaluation Tool incorporate both genetic and nongenetic factors into a computer program that gives a personalized risk estimate.

BRCA1 and BRCA2

We all have certain tumor suppressor genes termed _____________________

BSE

With good _____________ practice, a woman knows how her breasts normally feel and can detect any change more easily.

50 years

Women older than _____________________ have an increased risk for breast cancer

The gait model

________________ identifies risk factors, including current age, age at menarche, age at first live birth, and family history of breast cancer in first-degree relatives

Past

__________________ breast cancer increases the risk for recurrent cancer

Combined hormone therapy

___________________ after menopause increases risk of breast cancer

second and sixth ribs

breasts are located between the _____________________________, extending from the side of the sternum to the midaxillary line

Galactorrhea

excessive or inappropriate production of milk.

triple test

fibroadenoma is diagnosed by the _________________

size and shape

for General Appearance Note symmetry of _____________________

Mastalgia

occurs with trauma, inflammation, infection, and benign breast disease.

Tanner staging

the five stages of breast development follow this classic description of sexual maturity rating, or ___________________-