Chapter 17 breasts
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 101 F. She has also had symptoms of the flu, 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?
ANS: Mastitis The symptoms describe mastitis, which stems from infection or stasis caused by a plugged duct. A plugged duct does not have infection present. (See Table 17-7.) Refer to Table 17-6 for descriptions of Paget's disease and mammary duct ectasia.
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 include which of the following? Select all that apply.
ANS: Nontender mass Hard, dense, and immobile Regular border Cancerous breast masses are solitary, unilateral, nontender, masses. They are solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive. Their borders are irregular and poorly delineated. They are often painless, although the person may have pain. They are most common in upper outer quadrant. A dull, heavy pain on palpation and a mass with a rubbery texture and a regular border are characteristics of benign breast disease.
The nurse is examining a 62-year-old man and notes that he has gynecomastia bilaterally. The nurse should explore his history for which related conditions? Select all that apply.
ANS: Obesity Hyperthyroidism Liver disease History of alcohol abuse Gynecomastia occurs with obesity, Cushing's syndrome, liver cirrhosis, adrenal disease, hyperthyroidism, and numerous drugs: alcohol and marijuana use, estrogen treatment for prostate cancer, antibiotics (metronidazole, isoniazid), digoxin, ACE inhibitors, diazepam, and tricyclic antidepressants.
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?
ANS: One percent of all breast cancer occurs in men. One percent of all breast cancer occurs in men. Early spread to axillary lymph nodes occurs due to minimal breast tissue.
A woman is in the family planning clinic seeking birth control information. She states that her breasts "change all month long"
ANS: Tell her that, because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common.
The nurse is conducting a class about breast self-examination (BSE). Which of these statements indicates proper BSE technique?
ANS: The best time to perform BSE is 4 to 7 days after the first day of the menstrual period. The nurse should help each woman establish a regular schedule of self-care. The best time to conduct breast self-examination is right after the menstrual period, or the fourth through seventh day of the menstrual cycle, when the breasts are the smallest and least congested. Advise the pregnant or menopausal woman who is not having menstrual periods to select a familiar date to examine her breasts each month, for example, her birth date or the day the rent is due.
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.
ANS: Where did it first appear—on the nipple, the areola, or the surrounding skin?
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:
ANS: palpate the unaffected breast first.
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:
ANS: peau d'orange. This condition is known as peau d'orange. Lymphatic obstruction produces edema, which thickens the skin and exaggerates the hair follicles. The skin has a pig-skin or orange-peel look, and this condition suggests cancer.
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:
ANS: slowly lift her arms above her head and note any retraction or lag in movement
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:
ANS: the location of most breast tumors. The upper outer quadrant is the site of most breast tumors. In the upper outer quadrant
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:
ANS: a retracted nipple. The retracted nipple looks flatter and broader, like an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. It also may occur with benign lesions such as ectasia of the ducts. The nurse should not confuse retraction with the normal long-standing type of nipple inversion, which has no broadening and is not fixed.
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. The nurse should:
ANS: consider these normal findings and proceed with the examination. Normal findings of the breast include one breast (most often the left) slightly larger than the other and the presence of Montgomery's glands across the areola.
If a patient reports a recent breast infection, then the nurse should expect to find _____ node enlargement.
ANS: ipsilateral axillary.
A patient is newly diagnosed with benign breast disease. The presence of benign breast disease:
ANS: makes it harder to examine the breasts.
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 o'clock, approximately 5 cm from the nipple. It is firm, mobile, nontender, with borders that are not well defined. The nurse's recommendation to her is:
ANS: "Because of the change in consistency of the lump, it should be further evaluated by a physician." A lump that has been present for years and is not exhibiting changes may not be serious but still should be explored. Any recent change or new lump should be evaluated. The other responses are not correct.
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:
ANS: "Decreases in hormones after menopause causes atrophy of the glandular tissue in the breast. This is a normal process of aging." The hormonal changes of menopause cause the breast glandular tissue to atrophy, making the breasts more pendulous, flattened, and sagging.
During a discussion about breast self-examination with a 30-year-old woman, which of these statements by the nurse is most appropriate?
ANS: "Examine your breasts shortly after your menstrual period each month." The best time to conduct breast self-examination is shortly after the menstrual period when the breasts are the smallest and least congested.
Which of these positions is most likely to make significant lumps more distinct during breast palpation?
ANS: Supine with arms raised over her head
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?
ANS: This finding is not unusual, but the nurse should verify that this change is not new.
A 14-year-old girl is anxious about not having reached menarche. The age:
ANS: she began to develop breasts Full development from stage 2 to stage 5 takes an average of 3 years, although the range is 1.5 to 6 years.
When a breastfeeding mother is diagnosed with a breast abscess, which of these instructions from the nurse is correct? The mother needs to:
ANS: temporarily discontinue nursing on affected breast and manually express milk and discard it. With a breast abscess, the patient must temporarily discontinue nursing on the affected breast, manually express the milk, and discard it. Nursing can continue on the unaffected side.
The nurse is discussing breast self-examination with a postmenopausal woman. The best time for postmenopausal women to perform breast self-examination is:
ANS: the same day every month. Postmenopausal women are no longer experiencing regular menstrual cycles but need to continue to perform breast self-examination on a monthly basis. Choosing the same day of the month is a helpful reminder to perform breast self-examination.
The nurse has palpated a lump in a female patient's right breast. The nurse documents this as a small, round, firm, distinct, lump located at 2 o'clock, 2 cm from the nipple. It is nontender and fixed. It is missing information about:
ANS: the size of the lump. If the nurse feels a lump or mass, he or she should note these characteristics: (1) location, (2) size—judge in centimeters in three dimensions: width length thickness, (3) shape, (4) consistency, (5) motility, (6) distinctness, (7) nipple, (8) the skin over the lump, (9) tenderness, and (10) lymphadenopathy.
The nurse is preparing to teach a woman about breast self-examination (BSE). Which statement by the nurse is correct?
ANS: "BSE on a monthly basis will help you feel familiar with your own breasts and their normal variations." The nurse should stress that a regular monthly self-examination will familiarize her with her own breasts and their normal variations. This is a positive step that will reassure her of her healthy state. While teaching, the nurse should focus on the positive aspects of breast self-examination and should avoid citing frightening mortality statistics about breast cancer. This may generate excessive fear and denial that actually obstructs a woman's self-care action.
During an interview, a patient reveals that she is pregnant. will breastfeed her baby and asks for some information about this.
ANS: "Breastfeeding provides the perfect food and antibodies for your baby."
Which of these clinical situations would the nurse consider to be outside normal limits?
ANS: A patient has had two pregnancies and she breastfed both of 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.
The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the United States, has the highest risk for development of breast cancer?
ANS: African-American
Which statement is true with regard to breast cancer in African-American women in the United States?
ANS: African-American women are more likely to die of breast cancer at any age.
A 65-year-old patient remarks that she just can't believe that her breasts sag so much.
ANS: After menopause, the glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag.
a female patient states that she has noticed a few drops of clear discharge from her right nipple.
ANS: Ask her some additional questions about the medications she is taking.
During an examination of a 7-year-old girl, the nurse notices that the girl is showing breast budding.
ANS: Assess the girl's weight and body mass index (BMI).
During an annual physical exam, a 43-year-old patient states that she doesn't perform monthly breast self-examinations (BSE).
ANS: BSEs may detect lumps that appear between mammograms.
In performing an assessment of a woman's axillary lymph system, the nurse should assess which of these nodes?
ANS: Central, lateral, pectoral, and subscapular nodes
In examining a 70-year-old male patient, he has bilateral gynecomastia. nurse's best course of action?
ANS: Explain that this condition may be the result of hormonal changes
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?
ANS: It is a normal variation and not a significant finding. A supernumerary nipple looks like a mole, but close examination reveals a tiny nipple and areola. It is not a significant finding.
During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate?
ANS: It should be determined whether the inversion is a recent change. .
A woman has just learned that she is pregnant. What are some things the nurse should teach her about her breasts?
ANS: She can expect her areolae to become larger and darker in color.
Which of the following statements is true regarding the internal structures of the breast? The breast is:
ANS: composed of fibrous, glandular, and adipose tissue.
A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer. What would be the nurse's best response?
it is most likely normal breast development.
The nurse is assisting with a self-breast examination clinic. Which of these women reflect abnormal findings during the inspection phase of breast examination?
ANS: Woman whose nipples are in different planes (deviated)
A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally asks, "Am I normal?
ANS: "I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age." Adolescent breast development usually begins between 8 and 10 years of age
During a breast health interview, a patient states that she has noticed pain in her left breast.
ANS: "I would like some more information about the pain in your left breast."
The nurse is teaching a pregnant woman about breast milk. Which is correct?
ANS: "You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy."
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?
ANS: 65 year old whose mother had breast cancer
