ch 18: breasts and axillae

unilateral areola tenderness

A

bilateral venous patterns

N

The client should lean _ so the breasts can fall forward.

forward

swollen breast tissue in a newborn may be caused by _

hyperestrogen

supernumerary nipple third nipple

A

thick breast skin

A

breast growth my be _

asymmetrical

in the female fatty tissue will replace _ tissue at menopause

glandular

a 14 year old girl is having an annual physical. she appears quite embarrassed during the physical examination and shyly ask the nurse if it is normal for one her breast to be larger than the other. the nurses best response should be :

" breast development may not be the same on both sides; this is quite normal"

The nurse is planning a focused breast/axillae interview and wants to begin with a general health question. Which question would fit this criterion? Hint: Focused Interview Questions a. "Has your mother or sister had breast cancer?" b. "Are you still menstruating?" c. "Have you had any breast trauma?" d. "Have you ever had a mammogram?"

"Are you still menstruating?" General health questions for the breast/axillae focused interview include a description of the breasts, changes in the breasts with menstruation, and date of the last menstrual period. Family history of breast cancer is included in questions related to illness or infection. A history of breast trauma is included in questions related to symptoms. Mammogram history is included in questions related to behaviors.

A client asks the nurse, "Why do I need to examine my underarms when I perform breast self-examination?" The most appropriate response by the nurse is: Hint: Anatomy and Physiology Review a. "This is the hardest area to feel for changes." b. "Breast tissue extends into the axilla." c. "This is the least likely area for breast cancer to occur." d. "It is easier to detect abnormalities in this area than in the breast tissue."

"Breast tissue extends into the axilla." Breast tissue extends superiolaterally into the axilla as the axillary tail or Tail of Spence. The axilla is not the hardest area to feel for changes. The upper outer quadrant and Tail of Spence are the more common places for breast cancer to occur in women. It is not easier to detect abnormalities in the Tail of Spence.

A teenage girl is upset because her breasts are not the same size. How should the nurse respond to this girl's concerns? Hint: Developmental Considerations, Infants and Children a. "Your breasts really appear equal in size." b. "Don't worry; most girls have breasts that are slightly unequal in size." c. "It is normal for breast tissue development to be unequal during puberty. It will even out as you get older." d. "Did your mother experience the same thing when she was your age?"

"It is normal for breast tissue development to be unequal during puberty. It will even out as you get older." Growth of the breasts is not steady or symmetrical. Reassure girls that the rate of breast tissue growth depends on changing hormone levels and is uniquely individual. Stating that the breasts look equal to the examiner is not appropriate in this situation. Telling the client not to worry is not a therapeutic communication technique. Asking whether the adolescent's mother experienced the same development is not appropriate as it is common and normal for asymmetry to be present during breast development.

A young adult female client asks what she can do to reduce her risk for breast cancer. Which statements should the nurse include in responding to this client's question and concern? Select all that apply. a. "Regular exercise can help to decrease your risk for breast cancer." b. "You should begin to have yearly mammograms between the ages of 40 and 50." c. "Try to keep your weight within a normal range." d. "If you choose to breastfeed, you should limit it to less than 3 months." e. "You should not have any breast enhancement surgery."

"Regular exercise can help to decrease your risk for breast cancer." "Try to keep your weight within a normal range." Physical activity in the form of exercise has been found to decrease a woman's risk for breast cancer. Obesity has been linked with breast cancer; thus, maintaining a healthy weight can reduce a woman's risk for breast cancer. Mammography is used for early detection of breast cancer, not prevention. Breastfeeding (especially 1½-2 years) has been shown to decrease a woman's risk for breast cancer; therefore, a woman should be encouraged and supported, not limited. Breast enhancement surgery does not increase a woman's risk for breast cancer; however, implants can make reading mammograms more difficult to interpret.

A 32-week-pregnant client is upset and is concerned about breast disease because she has been experiencing a thick, yellowish discharge coming from her breasts. How should the nurse respond to this client? Hint: Questions for the Pregnant Female a. "This is normal toward the end of pregnancy and is called colostrum." b. "I am referring you for a mammogram." c. "I will let your provider know about this right away." d. "Do you have a history of breast infections?"

"This is normal toward the end of pregnancy and is called colostrum." A thick yellowish discharge called colostrum may be expressed from the breasts in the final weeks of pregnancy. A mammogram is not indicated in this situation since this is a normal finding. The healthcare provider does not need to be notified since this is a normal finding. The discharge is not indicative of an infection.

a 19 yo female college student just finished reading an article in a fashion magazine on breast ca. it really upset her bc her aunt died from breast ca 2 years ago. the student decides that it is time for her to start thinking about performing breast self examinations (BSE). unsure of what to do she consults a nurse. the nurse includes which of the following statements regarding (BSE)?

"it is best to perform BSE about 5 days after your menstrual period" Rationale: The nurse should teach the client to perform a BSE at the same time each month, usually 5 days after the onset of menses, when there is less hormonal influence on tissues

The nurse is palpating the breasts of an adult female. Normal findings include: Select all that apply. Hint: Techniques and Findings, Palpation of the Breast a. smooth, elastic breast tissue b. unilateral nipple discharge c. peau d'orange d. thickening of the skin e. wrinkled skin over areola

* smooth, elastic breast tissue * wrinkled skin over areola The breasts should feel smooth, elastic, and symmetrical. The skin of the areola is darker and wrinkled. Unilateral nipple discharge is not a normal finding, and the nurse should refer the client to her healthcare provider for further evaluation. Peau d'orange, orange peel skin, occurs in advanced stages of cancer from blocked lymphatic drainage. Thickening of the skin is abnormal and suggests underlying carcinoma.

Each breast has _ to _ lobes of glandular tissue.

15, 20

each breast lobe is composed of _ to _ lobules

20, 40

explain to the female client that at least _ positions will be used during the assessment of the breasts

3

a school nurse is teaching a group of young girls about puberty. the nurse explains that breast tissue will begin to enlarge during puberty between the ages of :

9 and 13 Rationale: Breast tissue starts to enlarge in females with the onset of puberty, usually between the ages of 9 and 13.

Breast tissue starts to change at the onset of puberty between the ages of _ and _.

9, 13

RED, scaly areolae

A

dimpling

A

galactorrhea excessive or inappropriate production of milk.

A

gynecomastia

A

inverted nipples for two weeks

A

nipple discharge

A

peau d'orange a pitted or dimpled appearance of the skin, especially as characteristic of some cases of breast cancer or due to cellulite.

A

which statement by the nurse best explains changes in breast tissue during menopause? the breast tissue experiences :

relaxation of the suspensory ligaments

What is the nurse assessing when performing a breast assessment on a client and palpating along the inner aspect of the humerus? a. Central axillary nodes b. Subscapular nodes c. Pectoral nodes d. Brachial (lateral axillary) nodes

Brachial (lateral axillary) nodes Lymph nodes drain lymph from the breast and axillae and return it to the bloodstream. The lateral axillary (brachial) nodes are included in the breast assessment and are located along the inner aspect of the humerus. The central axillary nodes are located high in the axilla. The subscapular nodes are located along the inner aspect of the latissimus dorsi muscle. The pectoral nodes lie inside the pectoral fold in the axilla.

breasts fall freely and evenly when sitting or standing

N

firm pectoral muscles

N

nonpalpable axillary lymph nodes

N

oval areolae

N

pendulous breasts

N

presence of axillary hair

N

slight asymmetry of breasts

N

smooth skin over the breast

N

uninterrupted breast contour

N

which of the following would the nurse document as an abnormal assessment finding during the menstrual cycle?

NIPPLE DISCHARGE Rationale: Breast pain, or mastalgia, is most often associated with the menstrual cycle. In some cases, however, referred pain from cardiac, pulmonary, and gastrointestinal causes must be ruled out. Discharge is not commonly associated with the menstrual cycle.

The nurse is inspecting the breasts of a female client. Which finding should trigger a prompt referral to the woman's healthcare provider? Hint: Techniques and Normal Findings, Inspection of the Breast a. Left breast is slightly larger than her right b. Skin is marked with linear striae c. Faint, healed scarring bilaterally d. Nipples are pointing in different directions

Nipples are pointing in different directions Nipples should point in the same direction outward and slightly upward. A change in the direction of point of the nipple is suggestive of an abnormality. It is normal for a woman to have one breast slightly larger than the other unless this is a recent change. The presence of striae (stretch marks) is also considered within normal limits. Well-healed bilateral scarring should trigger additional questions if the nurse has not asked about breast surgery but should not trigger an immediate referral.

spence glands are _ glands that produce oils to lubricate and _ the _ and nipple

sebaceous, moisturize, areola

When performing a breast examination, the nurse notes the presence of Montgomery's tubercles, soft tissue bilaterally, palpable infraclavicular lymph nodes, and slight tenderness to deep palpation bilaterally. Which of the findings does the nurse consider a deviation from normal? Hint: Techniques and Normal Findings a. The presence of Montgomery's tubercles b. Soft tissue bilaterally c. Slight tenderness to deep palpation d. Palpable infraclavicular lymph nodes

Palpable infraclavicular lymph nodes Normal lymph nodes should not be palpable. The presence of Montgomery's tubercles, which are tiny sebaceous glands on the areolae, is normal. The tissue of the breast should be soft. Tenderness to deep palpation is not as concerning as palpable lymph nodes in the breast assessment.

The nurse notes the presence of gynecomastia in a teenage boy. The nurse understands: Hint: Palpation of the Male Breast, Abnormalities of the Male Breast a. This condition is abnormal if it is of recent onset. b. The client may be at increased risk for the development of breast cancer. c. This is an abnormal finding for a client at this age. d. This is a temporary condition in puberty.

This is a temporary condition in puberty. Gynecomastia (breast enlargement in males) is a normal, temporary condition seen in up to 30% of males at puberty. Gynecomastia is also seen after birth due to circulating maternal hormones and in elderly males. The presence of gynecomastia is considered normal in adolescent males. Men are not at increased risk of developing breast cancer if they have had gynecomastia. This is a normal finding for a male of this age.

During a breast assessment, the nurse notes an inverted right nipple. The nurse knows that this is: Hint: Techniques and Normal Findings, Inspection of the Breast a. always indicative of a slow-growing tumor b. a significant finding if it is recent c. a normal finding in most women d. usually found on lactating mothers

a significant finding if it is recent Recent inversion of a nipple, a change in the direction of the nipple, or retraction of the nipple is suggestive of malignancy. Recent nipple inversion is suggestive of malignancy but not always indicative of a slow-growing tumor. This is not a normal finding in most women nor expected during pregnancy.

The nurse is preparing to examine the breasts of a male client and plans to: Select all that apply. Hint: Inspection of the Male Breast a. position the client in the sitting position for inspection of the breasts b. position the client in the supine position for palpation of the breasts c. palpate the lymph nodes in the axillary region d. palpate extensively in the Tail of Spence area since this is where most breast cancers occur in males e. ask about a family history of testicular cancer since testicular and breast cancer are related conditions

a, b, c

When gathering breast history information on a client, the client states that she has noticed a few drops of clear discharge from her nipples over the past few months. The nurse should: Hint: Focused Interview Questions, Questions Related to Symptoms a. notify the health-care provider b. document the presence of the discharge c. ask additional history questions about the discharge and medications she is currently taking d. refer the client for a mammogram

ask additional history questions about the discharge and medications she is currently taking Nipple discharge from medications is usually clear. This discharge is bilateral. Unilateral nipple discharge would be of more concern and perhaps be caused by an intraductal papilloma or cancer. More information needs to be obtained before determining whether to notify the healthcare provider. The nurse would document the presence of the discharge; however, more information needs to be obtained regarding the discharge. Referral for a mammogram is not indicated at this time.

a male newborn has milky white discharge from the nipples. what is the nurses best action?

assure the parents this will resolve in a couple of weeks Rationale: Because of circulating maternal estrogen and prolactin, male and female infants may have a milky white discharge from their nipples that is commonly called "witch's milk." This condition will resolve within 1 to 2 weeks after birth when maternal hormone levels decrease. This is not a sign of infection that necessitates notifying the healthcare provider.

the nurse knows that the incidence of breast ca in the female is highest in the ?

axillary tail Rationale: The incidence of breast cancers is highest in the upper outer quadrant, including the axillary tail of Spence. Masses in the tail must be distinguished from enlarged lymph nodes

women with very small, very large, or asymmetrical breasts are at higher risk for _ disturbance

body image or self esteem

many women avoid doing _ bc their culture has prohibited looking at or touching oneself

breast self exams

when palpating one breast, the nurse should _ the breast that is not being examined

cover

during pregnancy the nipples and areolae become _ in color and _ in size

darker, increase

the nurse notes speckled raised areas on the areolas of a female client. what is the nurses best action?

document sebaceous glands Rationale: The surface of the areola is speckled with tiny sebaceous glands know as Montgomery's glands. The healthcare provider does not need to be notified of an expected finding. The nurse should not attempt to squeeze the glands and no treatment is necessary.

research has suggested that a high fat diet may _ a females risk of developing breast cancer

increase

a male client refuses a breast exam by the nurse . what is the nurses first action?

inform the client that breast ca can occur in males as well as in females Rationale: The first action of the nurse in this situation is to inform and educate the client so he can make a truly informed decision about his healthcare. Breast cancer can occur in males. A mammogram may be required after a physical assessment if fixed nodules or suspicious nodules are present.

Blood is supplied to the breasts by the _ and lateral _ arteries and _ branches of the posterior intercostal arteries.

internal, thoracic, cutaneous

acini cells produce milk that is emptied into the _ and carried to the _

lactiferous ducts, nipples

asian and hispanic women have the _ rates of breasts cancer

lowest

adolescent male "breast buds" usually disappear within _ of onset

one year

the finger _ of the first _ should be used in a slightly _ motion during palpation of the breast

pads, three fingers, rotary,

inspection of the breasts can be done with the clients hands _ at the level of the wrist

pressed together

Increased levels of _ and estrogen cause changes in fat deposits, _ , and pigmentation of the breasts

progesterone, ductile maturity,

A young adult female with benign breast disease says she has increased breast pain and tenderness with menses. In response to this client's concerns, the nurse should: Hint: Abnormal Findings, Benign Breast Disease a. discuss the relationship of benign breast disease to breast cancer b. explain that a breast biopsy may be indicated c. tell the client that this condition will soon go away d. recommend an over-the-counter analgesic and reducing salt intake

recommend an over-the-counter analgesic and reducing salt intake Decreasing salt intake and taking a mild analgesic may help with the breast pain. There is no direct link between benign breast disease and the incidence of cancer. The discomfort associated with this disease is cyclical, occurring in the days prior to menstruation, and does not indicate that a biopsy is needed. The condition occurs during the woman's reproductive years, typically during the 20s. Telling the woman that the condition will soon go away is not correct.

The nurse is inspecting the breasts of a female client. Which position will accentuate the presence of dimpling? The nurse asks the client to: Hint: Techniques and Normal Findings, Inspection of the Breast a. sit with arms relaxed at the sides b. lean forward with arms in front of the client c. sit with arms raised over the head d. lie on her back with arms elevated

sit with arms raised over the head Dimpling of the skin over a mass is usually a visible sign of breast cancer. Dimpling is accentuated with the client's arms raised over the head, which tightens the pectoral muscles. Sitting with arms relaxed at the sides gives the examiner a general impression of the breasts. Leaning forward with arms in front of the client demonstrates whether the breasts fall freely from the chest wall. Lying flat or supine with the arm extended over the head is the position for palpation of the breast.

the nipples become _ and _ in the older adult

smaller, flatter

The nipple should be compressed between the _ and _.

thumb, forefinger

The towel or pillow should be placed _ the _ breast.

under , examined

if a female client has pendulous breasts, the nurse should place one hand _ the breast to support it while the other hand is _ (Pendulous breasts are breasts that do not have an upright and/or round appearance, and are, instead, longer and more cylindrical shaped.)

under, palpating

the client should be sitting _ at the beginning of a breast assessment

upright

there are a _ of patterns that covers the breasts

variety

infants may produce a thin discharge from the breasts known as _ . this secretion will subside as the maternal _ decreases

witch's milk, hormones

a nurse is working in a health and wellness center on a university campus. she was asked by a sorority to give a presentation during breast ca awareness month. in the presentation the nurse decides to include which of the following guidelines form the american ca society?

women in their 20's have an option to perform a monthly BSE