HA: Chapter 16 - Breasts and Axillae

A nurse becomes suspicious that a patient may have breast cancer based on which abnormal finding? a. An irregularly shaped hard mass in one breast b. Bilateral, small, nontender nodes close to the surface c. Multiple rubbery-feeling lumps with well-defined borders d. A mobile, firm lump located in the upper outer quadrant of the left breast

ANS: A Malignant masses are solitary, irregularly shaped, unilateral, nontender, and immobile. Malignant masses are unilateral. Malignant masses have irregular, poorly defined borders. Breast cancer often occurs in the upper outer quadrant, but is immobile.

4. Based on the history, a nurse determines that the patient with which finding requires further assessment? a. Occasional discharge from nipples b. Supernumerary nipples along the milk line c. Rash in the axillae associated with change in deodorant d. Mild breast swelling that fluctuates with the menstrual cycle

ANS: A Nipple discharge is usually an abnormal finding. A specimen of the discharge should be collected. Supernumerary nipples along the milk line are a normal finding in some women. A rash in the axillae associated with change in deodorant can be solved by changing deodorant and treating the rash. Mild breast swelling that fluctuates with the menstrual cycle is consistent with fibrocystic breast disease.

13. During a breast examination of a male patient, the nurse recognizes which finding as normal? a. Bilateral nontender flat breasts with symmetric nipple and areolar areas b. A fibrous layer of subcutaneous breast tissue that is thicker than in women c. Breast tenderness on the dominant side but not on the other side d. Bilateral symmetry of breasts with absence of hair in the areolar areas

ANS: A Option A is a description of a normal finding. Options B to C are not normal findings.

A nurse is performing a breast examination of a patient who complains of pain in both breasts that occurs around the time of her menstrual period. The nurse expects which findings during the breast examination? a. Masses in the breasts that are round, soft, mobile, and well-delineated b. Masses in the breasts that are round, firm, mobile, and well-delineated c. Masses in the breasts that are irregular, hard, and fixed d. Breast tissue that is red, edematous, tender, and warm to the touch

ANS: A Option A is consistent with fibrocystic breast disease. The findings are almost the same as fibroadenoma (except for consistency of the masses), but the nurse must correlate the history (occurs during the menses) with the findings for fibrocystic disease. Option B is consistent with fibroadenoma. Option C is consistent with breast cancer. Option D is consistent with mastitis.

10. A nurse performing a breast examination on a female patient places the patient in a supine position, places a pillow under the right shoulder, and asks the patient to place her right lower arm above her head. What is the reason for this position? a. Flatten the breast tissue evenly over the chest wall. b. Help the patient to relax and feel more comfortable. c. Reveal lumps deep in the breast more easily. d. Expose any drainage from the nipples.

ANS: A This is the reason for the position. Flattening the breast tissue, not relaxation, is the reason. Lumps are detected by palpation rather than inspection. Drainage is revealed by palpation of the nipples.

1. Which lifestyle behaviors do nurses ask about to identify patients with risk factors for breast cancer? (Select all that apply.) a. Obesity after age 50 b. Smoking more than 1 pack of cigarettes a day c. Never having given birth to a viable infant d. Drinking two to five alcoholic beverages a day e. Estrogen replacement therapy for more than 5 years f. High blood pressure for more than 3 years

ANS: A, C, D, E Obesity after age 50, never having given birth to a viable infant (nulliparity), drinking two to five alcoholic beverages a day, and estrogen replacement therapy for more than 5 years are all risk factors for breast cancer. Although smoking and high blood pressure are risk factors for many disorders, they are not risk factors for breast cancer.

Which statement by a 40-year-old man would be most indicative of possible breast cancer? a. "I had embarrassing breast enlargement when I was a teenager." b. "I think I felt a hard spot in my left breast, but it does not hurt." c. "My right breast has always been a little smaller than the left." d. "My father's breasts got larger after he was older."

ANS: B A breast malignancy usually manifests in one breast as a hard, painless, irregular nodule, often fixed. Option A describes gynecomastia. One larger breast is not indicative of breast cancer and may be a normal variation. This report mentioned in option D is not indicative of breast cancer.

The nurse would give immediate attention to the patient who presents with which complaint? a. Bilateral breast swelling b. Unilateral nipple discharge c. A breast lump that changes during the menstrual cycle d. Unequal breast size

ANS: B A breast malignancy usually manifests in one breast, and a serosanguineous or clear nipple discharge may be present. Bilateral breast swelling is frequently related to fibrocystic breast disease. A breast lump that changes during the menstrual cycle is frequently related to fibrocystic breast disease. Unequal breast size that does not include a mass in one breast is not an immediate concern.

2. In reviewing the charts of several patients in the clinic, a nurse recognizes which patient as being at highest risk of breast cancer? a. A woman who had her first child at age 26 b. A woman who reached menopause at age 58 c. A woman who breastfed all four of her children d. A woman who states that she reached menarche at age 14

ANS: B A woman who reached menopause at age 58. A long menstrual history (menopause after age 50) increases risk. A woman who had her first child at age 26 has a low risk. A woman who breastfed all four of her children has a low risk. A woman who states that she reached menarche at age 14 has a low risk because the menarche was after 12 years of age.

A patient had a left radical mastectomy last year. The nurse assesses for painless and nonpitting swelling of the arm on that side. Which complication of a mastectomy is the nurse assessing for? a. Infection b. Lymphedema c. Inflammation d. Lymphoma

ANS: B Lymphedema is a localized accumulation of lymph fluid in the interstitial spaces caused by removal of the lymph nodes. Localized signs of infection include redness, heat, and pain; there can also be edema, which, when associated with infection, is pitting. Localized signs of inflammation include redness, heat, and pain; there can also be edema, which, when associated with inflammation, is pitting. The sign of lymphoma is an enlarged lymph node rather than generalized swelling.

16. In a presentation on breast cancer risk factors, a nurse would be accurate in making which statement? a. "Women who breastfeed their children are at increased risk of breast cancer." b. "Women who are more than 30% overweight are at increased risk of breast cancer." c. "African-American women have the highest risk of breast cancer." d. "Women who have children before age 30 are at increased risk of breast cancer."

ANS: B Obesity especially after age 50 or increased weight gain as an adult increases breast cancer risk. Breastfeeding is not a risk factor for breast cancer. White women have the highest incidence of breast cancer. First full-term pregnancy after age 30 increases risk.

7. What is the purpose of asking a female to lean forward during the breast examination? a. To accentuate the Montgomery glands b. To observe for symmetry of the suspensory ligaments c. To compare nipple symmetry d. To identify any breast masses in the subcutaneous tissues

ANS: B Observing these ligaments can be accomplished with the patient leaning forward. Montgomery glands are located within the areolar surface and would be difficult to inspect when the patient leans forward. Nipple symmetry is better evaluated with the patient sitting up or lying supine. Palpation is a better way to identify a breast mass in subcutaneous tissue.

What technique does a nurse use when performing a breast examination on a patient who has had a mastectomy? a. Excludes palpation of the axillary area where there was lymph node dissection b. Inspects and palpates both the operative and the nonoperative sides c. Avoids palpating the scar to prevent causing the patient any discomfort d. Palpates only the muscle tissue on the affected side

ANS: B Women who have had a mastectomy require the same breast assessment as all other women. Axilla is still palpated after node dissection. The scar tissue should not be tender and the technique of palpation on the operative side should be the same as the nonoperative side. Women who have had a mastectomy require the same breast assessment as all other women.

1. In teaching a patient about breast self-examination, why does the nurse emphasize palpation of the axillary areas? a. Because deep muscles in that area can mask changes b. Because some patients avoid this area because of tenderness c. Because most lymph draining from the breast flows through this area d. Because supporting ligaments in this area may present as tissue changes

ANS: C Because most lymph draining from the breast flows through this area. More than 75% of lymph drainage from the breast flows outward toward the axillary lymph node. Because deep muscles in that area can mask changes. This answer is incorrect. Palpating the axilla for enlarged lymph nodes is very important. Because some patients avoid this area because of tenderness. This answer is incorrect. Palpating the axilla for enlarged lymph nodes is very important. Because supporting ligaments in this area may present as tissue changes. This answer is incorrect. Palpating the axilla for enlarged lymph nodes is very important.

9. When examining the lymph nodes of an adult female patient, the nurse recognizes which finding as normal? a. Visible superficial nodes b. Palpable supraclavicular nodes c. Nonpalpable lymph nodes in the axilla d. Enlarged, fixed nodes in the neck

ANS: C Lymph nodes are not normally palpable. Lymph nodes are not normally palpable or visible. Enlarged supraclavicular nodes often indicate a malignancy.

In assessing a patient with lymphedema after a mastectomy, the nurse expects which finding? a. Fragile, thin, pale skin covering the area of lymphedema b. Several brownish-red discolorations in the center of the affected arm c. Unilateral nonpitting edema of the affected arm d. Pitting edema of affected arm

ANS: C Lymphedema is a localized accumulation of lymph fluid in the interstitial spaces caused by removal of the lymph nodes. Option A is an incorrect description of lymphedema. Option B is more consistent with a description of chronic venous insufficiency than lymphedema. The fluid accumulation in lymphedema usually is not enough to cause pitting.

21. The nurse notices dimpling of the skin surrounding a palpable mass in the right breast of a female patient. What is the most appropriate action for the nurse to take next? a. Record this as an expected finding. b. Palpate the area of dimpling for pain. c. Palpate the borders of the area of dimpling for irregularity. d. Tell the patient that dimpling indicates the mass is benign.

ANS: C Malignant breast masses are irregular and poorly delineated. As the mass grows, there may be breast asymmetry, discoloration (erythema or ecchymosis), unilateral vein prominence, peau d'orange, ulceration, dimpling, puckering, or retraction of the skin. Option A is not normal. Malignant breast masses are not tender. Dimpling may indicate a malignant mass rather than a benign mass.

In assessing the breast of a male patient, the nurse places him in which position? a. Standing with hands over the head b. Supine with the hand on the side being examined placed behind the head c. Sitting with arms at the side d. Bending forward 45 degrees at the waist

ANS: C Sitting with arms at the side is the appropriate position for the male breast examination. Standing with hands over the head is part of the examination for female patients. Supine with the hand on the side being examined placed behind the head is part of the examination for female patients. Bending forward 45 degrees at the waist is part of the examination for female patients.

During a breast examination of a healthy female, the nurse recognizes which finding as normal? a. Asymmetrical venous pattern b. Unequal nipple size c. Supernumerary nipples along the milk line d. Pink discharge from one nipple when manipulated

ANS: C Supernumerary nipples are considered a normal variation, although they are uncommon. The venous patterns should be bilaterally similar. Nipple size should be symmetric. Nipple discharge is usually considered an abnormal finding.

6. A patient comes to the clinic complaining of a new onset of nipple discharge. After inspection of the breast and discharge, what action of the nurse has the highest priority? a. Palpating both breasts comparing amount of discharge b. Asking the patient about breast pain c. Asking the patient to raise her arms and comparing the movement of the breasts d. Obtaining a specimen of the discharge for cytology

ANS: D If a patient has nipple discharge, a specimen should be collected for cytologic examination to detect malignant cells. Getting a specimen is more important than palpating breasts at this time. Asking the patient about breast pain is not a priority action at this time. Asking the patient to raise her arms and comparing the movement of the breasts is not a priority action at this time.

What instructions does the nurse give a female patient when she is learning to perform breast self-examination? a. Press the pads of the fingers firmly to compress breast tissue against the rib cage. b. Lie in front of a mirror and observe for dimpling of the skin. c. Lift the fingers from the chest wall during palpation to better define the breast tissue. d. Apply gentle pressure while moving the fingers in a pattern across the breast.

ANS: D Option D is the appropriate technique. Gentle rather than firm pressure is used. A patient stands in front of a mirror to inspect symmetry; she does not lie in front of a mirror. The fingers should not be lifted from the breast to prevent breaking the continuity of palpation.

8. Which technique does a nurse use to palpate the patient's axillary lymph nodes? a. With the patient sitting, the nurse places fingers of both hands deep into the axilla, one hand on either side, and firmly pushes the axillary tissue toward the center to feel for enlarged nodes. b. With the patient lying supine with arms at the sides, the nurse uses the tips of the fingers of one hand to palpate the axilla moving from the posterior to the anterior aspect of the axilla to feel for enlarged nodes. c. With the patient lying supine with the hand behind the head of the side being assessed, the nurse uses the pads of fingers of one hand to systematically palpate the axilla using small circular motions to feel for enlarged nodes. d. With the patient sitting, the nurse places fingers of one hand deep into the axilla and firmly slides the fingers along the patient's middle, anterior, and posterior of the axilla to feel for enlarged nodes.

ANS: D Option D is the correct technique. Options A to C are incorrect techniques.

3. While giving a presentation about breast health, a nurse informs patients about which recommendation? a. Women in their 30s should have annual clinical breast examinations. b. Women at high risk of breast cancer should have semiannual mammograms. c. Women who are postmenopausal require clinical breast examination every 5 years. d. A screening mammogram is recommended for all women beginning at age 50 years.

ANS: D Option D is the recommendation of the U.S. Preventive Services Task Force. Clinical breast examinations are recommended as part of a periodic health examination at least every 3 years for average-risk, asymptomatic women in their 20s and 30s, and annually for asymptomatic women age 40 and older. Having semiannual mammograms is more often than necessary. Clinical breast examinations are recommended as part of a periodic health examination at least every 3 years for average-risk, asymptomatic women in their 20s and 30s, and annually for asymptomatic women age 40 and older.

17. A patient comes to the clinic because she found a mass in her left breast that is present during and after her menstrual periods. On palpation the nurse finds a mass in the left breast that is round, rubbery, mobile, and nontender. This finding is consistent with which breast disorder? a. Fibrocystic breast disease b. Invasive breast cancer c. Mastitis d. Fibroadenoma

ANS: D These findings are consistent with fibroadenoma. Findings of this disorder affect both breasts and produce tenderness that subsides between menstrual periods. Masses of breast cancer are irregular, hard, and fixed. Mastitis is an inflammation of the entire breast that produces tissue that is red, edematous, tender, and warm to the touch.