NUR 3065 PrepU Chapter 17

The nurse is beginning the inspection of a young adult client's breasts. The client states, "My left breast has always been a bit bigger than the right." How should the nurse best respond to the client's statement? "That's very normal, and it usually resolves over time as you get older." "If you lose some weight, the size disparity will likely decrease." "I'll make sure to refer to the doctor to get this assessed further." "Many women have this, and it's rarely a sign of a health problem."

"Many women have this, and it's rarely a sign of a health problem." Explanation: Slight breast asymmetry very rarely signals a health problem unless it represents a sudden change. Referral is unnecessary, and it will not usually resolve with age or weight loss.

Nurse G. is conducting a teaching session on breast self-examination to a group of women at a health fair sponsored by the local community center. Which of the following instructions is most accurate? "It's best not to do BSE in the shower because you need a mirror and a place to lie down in order to do it correctly." "Remember that doing BSE regularly is not a replacement for regularly-scheduled mammograms or clinical examinations." "If you detect a lump that is larger than a grape, you should follow up with your doctor." "The best time to do BSE is at the midpoint of your menstrual cycle."

"Remember that doing BSE regularly is not a replacement for regularly-scheduled mammograms or clinical examinations." Explanation: BSE should be coupled with mammography and clinical examination on a schedule congruent with current guidelines and the client's risk factors. It should be performed 5 to 7 days after the beginning of the woman's period and all lumps or changes should be followed up. A standing position in the shower is appropriate for palpation.

A client has been found to have a breast lump and an ultrasound has been ordered. The client voices concerns to the nurse she is afraid of the painful testing she is going to endure. How should the nurse best respond? "This noninvasive test uses high frequency waves to determine if the mass is solid or cystic." "This test consists of two x-rays and is totally noninvasive." "This noninvasive test uses a magnetic field and radio waves to stage breast cancer." "A very small needle will be inserted into the sit and it is over very quickly."

"This noninvasive test uses high frequency waves to determine if the mass is solid or cystic." Explanation: An ultrasound is a noninvasive test that uses sound waves. An MRI uses a magnetic field and mammography uses x-ray. A fine needle biopsy is an invasive procedure.

A 49-year-old cook comes to the office for consultation. She recently found out that her 44-year-old sister with premenopausal breast cancer is positive for the BRCA1 gene. The client has been doing research on the Internet and she saw that her chance of having also inherited the BRCA1 gene is 50%. She is interested in knowing what her risk of developing breast cancer would be if she were positive for the gene. She denies any lumps in her breasts and has had normal mammograms. She has had no weight loss, fever, or night sweats. Her mother is healthy and her father has prostate cancer. Two of her paternal aunts died of breast cancer. She is married. She denies tobacco and illegal drugs and rarely drinks alcohol. Her breast and axilla examination are unremarkable. At her age what is her risk of getting breast cancer if she has the BRCA1 gene? 16% 80% 50%

50% Explanation: At the age of 49, the risk of breast cancer for someone with the BRCA1 gene is 50%.

Which of the following is true regarding self breast examination? It is recommended unanimously by organizations making screening recommendations. It has been shown to reduce mortality from breast cancer. The undue fear caused by finding a mass justifies omitting instruction in self breast examination. A high proportion of breast masses are detected by self breast examination.

A high proportion of breast masses are detected by self breast examination. Explanation: Although self breast examination has not been shown to reduce mortality and is not recommended by all groups making screening recommendations, many choose to teach women a systematic method in which to examine their breasts. A high proportion of breast masses are detected by self breast examination.

During a prenatal class, a participant says that she was told that her breasts are not large enough to breastfeed. When responding to this client, the nurse should understand that the functional capacity of the breast is primarily determined by which variable? Amount of fatty tissue Amount of glandular tissue Breast size and weight Depth of the subcutaneous fat layer

Amount of glandular tissue Explanation: The glandular tissue constitutes the functional part of the breast allowing for milk production. The amount of glandular tissue determines functional capacity of the breast, not the breast size, amount of fatty tissue, or subcutaneous fat layer.

When palpating a female client's axillae, which finding would the nurse document as normal? Nodes are fixed. Node size is 1.2 cm. Nodes are hard. Nodes are discrete.

Nodes are discrete. Explanation: Normal findings would include no palpable nodes or one to two small (less than 1 cm), discrete, nontender, non-movable nodes. A size greater than 1 cm is enlarged, possibly indicating infection. Large nodes that are hard and fixed may indicate an underlying malignancy.

A client has presented for care to the clinic, stating, "I'm pretty sure that I feel a new lump in my breast." After confirming the presence of a lump, what action should the nurse take next? Facilitate a referral to an oncologist if more lumps emerge in the coming weeks. Arrange for the client to be brought to the hospital emergency department immediately. Arrange for a prompt referral to her primary care provider. Tell the client to monitor the lump for the next three weeks and seek care if it increases in size.

Arrange for a prompt referral to her primary care provider. Explanation: Any lumps should be assessed further, and the client should be referred to a physician. It would be inappropriate to take a "wait and see" approach without a referral. Admission to the emergency department is not necessary.

The nurse has completed the assessment of a client's breast and lymphatic system. The nurse has ended the assessment by offering to teach the client how to perform breast self-examination (BSE). The client states, "That's alright. I already know how to do that." What should the nurse do next? Ask the client to demonstrate BSE. Encourage the client to perform BSE as often as possible. Encourage the client to promote BSE to her peers. Reiterate the correct technique for BSE.

Ask the client to demonstrate BSE. Explanation: At the conclusion of the breast assessment, the nurse should ask the client to demonstrate how she performs BSE if she chooses to receive feedback on her technique and method. BSE should be performed regularly, but not as often as possible. It is not necessary to enlist the client in promoting BSE to her peers, although this may be appropriate. Return demonstration should precede repeated teaching.

Screening measures for breast cancer include all of the following except: Mammography Clinical breast examination Breast self-examination Breast x-rays

Breast x-rays Explanation: There are significant roles in breast cancer screening for BSE, mammography, and clinical examination. The low-density character of the breasts makes radiography less sensitive.

While examining a client's breasts, a nurse notices milky discharge from the nipple. The client explains that she recently had a baby and is currently breastfeeding. The nurse understands that which type of tissue in the breast is responsible for allowing milk production? Fatty Glandular Lymphatic Fibrous

Glandular Explanation: Glandular tissue constitutes the functional part of the breast, allowing for milk production. The fibrous tissue provides support for the glandular tissue largely by way of bands called Cooper's ligaments (suspensory ligaments). Fatty tissue provides most of the substance to the breast and thus determines the size and shape of the breasts. Lymphatic tissue, which forms lymph nodes, is responsible for draining lymph from the body.

Which technique is appropriate for the nurse to use to palpate a client's breast? Palm and fingers of one hand Palms of both the hands Tips of four fingers Flat pads of three fingers

Flat pads of three fingers Explanation: The nurse should use the flat pads of three fingers to palpate the breast of the client for accurate assessment. The tips of four fingers, palms of both hands, or palm and fingers of one hand are not used for assessing the breasts as they may not give accurate results on examination.

What can the nurse recommend to a young female client who is seeking to reduce her risk for breast cancer? Select all that apply. Engage in regular, strenuous physical activity Breast-feed if possible Have children before 30 years of age Regularly consume alcohol (two to five drinks daily) Increase the intake of fat in the diet

Engage in regular, strenuous physical activity Have children before 30 years of age Breast-feed if possible Explanation: Strenuous exercise, pregnancy before 30 years of age, and breast-feeding are factors that help to reduce the risk for breast cancer. Intake of a high fat diet and consumption of alcohol (especially 2-5 or more drinks daily) are both possible risk factors for the development of breast cancer.

A male client has a history of an endocrine system problem. When assessing this client's breasts, the nurse notices a smooth, firm movable disc of tissue in one breast. The nurse interprets this finding as suggesting which of the following? Gynecomastia Infection Obesity Breast cancer

Gynecomastia Explanation: Gynecomastia is a smooth, firm movable disc of glandular tissue that may be seen in one breast in males during puberty for a temporary time. However, it also may be seen in hormonal imbalances, drug abuse, cirrhosis, leukemia, and thyrotoxicosis. Soft fatty enlargement is seen with obesity. An irregular shaped hard nodule would occur with breast cancer. Infection would be indicated by redness, tenderness, and warmth of the breast tissue.

The nurse is assessing a 15 year old male and finds soft, fatty enlargement of breast tissue. The nurse would document this as what? Fibroadenoma Cysts Breast abscess Gynecomastia

Gynecomastia Explanation: Gynecomastia is breast enlargement. Cysts are lumps that may be found in the breasts. Abscesses are an infection. Fibroadenoma is a well-defined , usually single or multiple, nontender, firm or rubbery, round or lobular mass that is freely movable.

A nurse is providing client education to a group of prepubescent girls at a local elementary school. What would the nurse be most likely to include in the presentation? Information about the lymphatic system Information about lactation Information about breast cancer screening Information about the stages of breast development

Information about the stages of breast development Explanation: During puberty, girls begin to develop breasts (usually between 8½ and 10 years of age).

During the physical examination of a female client the nurse notes the client's axillary lymph nodes are enlarged, hard, and fixed. The nurse recognizes these findings are consistent with what disease process? Lactation Infection Malignancy Inflammation

Malignancy Explanation: Enlarged, hard, and fixed axillary lymph nodes indicate malignancy. Infection may cause swelling of the lymph nodes but does make them hard and fixed. Lactation does not cause a change in lymph nodes. Inflammation does not cause the lymph nodes to harden and get fixed.

The client is complaining of breast pain and the nurse finds a lump upon further assessment. The nurse suspects this could be what? Breast cancer Paget disease Mammary duct ectasia Infection

Mammary duct ectasia Explanation: Mammary duct ectasia or painful mammary ducts should be suspected when a lump or thickening is palpable. Paget disease is characterized by scaly lesions that begin at the nipple and progress to a lump behind the nipple. Infection usually involves redness and pain. Breast cancer is usually painless.

Which of the following assessment findings is most likely benign on breast examination? One breast larger than the other Dimpling of the skin resembling that of an orange One nipple inverted One breast with dimple when the client leans forward

One breast larger than the other Explanation: Asymmetry in size of the breasts is a common benign finding. The others are concerning for underlying malignancy.

During a breast assessment the nurse finds scaly lesions at the nipple with a lump behind the nipple. The nurse suspects what? Erythema Paget disease Peau d'orange Hyperpigmentation

Paget disease Explanation: A rash or ulceration may occur in Paget disease. Peau d'orange has an orange peel appearance and is caused by breast edema from blocked lymph drainage and indicates advanced cancer. Erythema is redness and hyperpigmentation is a darker area.

During the breast examination of a client, the nurse notes red, scaly, and crusty areas over the areola. The nurse understands that this appearance of the skin is due to what type of breast condition? Fibroadenoma Paget disease Metastatic disease Fibrocystic lesions

Paget disease Explanation: Paget disease causes red, scaly, and crusty areas over the areola. A pigskin-like or orange-peel appearance is found in metastatic disease of the breast. It results from edema caused by blocked lymphatic drainage. A fibroadenoma is a round, firm, and well-defined mass, is seldom tender, and is usually singular and mobile. Fibrocystic lesions are benign and firm but rubbery lesions that tend to be bilateral and may become tender just before menses.

A 44-year-old woman comes to the clinic complaining of severe dry skin in the area over her right nipple. She denies any trauma to the area. She noticed the skin change during a self-breast examination 2 months ago. She also admits that she had felt a lump under the nipple but kept putting off making an appointment. She does admit to 6 months of fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism. She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug use. Examination shows a middle-aged woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-like crust around her nipple. Underneath a nontender 2-cm mass is palpable. The axilla contains only soft moveable nodes. The left breast examination and axilla are unremarkable. What visible skin change of the breast does she have? Peau d'orange sign Nipple retraction Paget's disease

Paget's disease Explanation: This uncommon form of breast cancer starts as an eczema-like scaly skin change around the areola. The lesion may weep, crust, or erode. It can be associated with an underlying mass, but the skin change can also be found alone. Any eczema-like area around the nipple that does not respond to topical treatment needs to be evaluated for breast cancer.

A woman reports a sudden, spontaneous nipple discharge. Which of the following would be most appropriate for the nurse to do? Note the woman's overall skin tone. Prepare a specimen for cytologic study. Observe the breast for eversion of the nipples. Ask the woman how long the discharge has been present.

Prepare a specimen for cytologic study. Explanation: Any type of spontaneous discharge should be referred for cytologic study and further evaluation. Observing for eversion, asking about the length of time for the discharge and noting the overall skin tone would be inappropriate in this situation.

A nonpregnant female presents to the health care facility and reports new onset of breast discharge. The nurse assesses the discharge to be milky in appearance without breast tenderness or masses. What additional data should the nurse obtain from this client? Recent surgeries or trauma Environmental exposure to chemicals Alcohol intake in excess of three drinks a day Prescribed medications such as antipsychotic agents

Prescribed medications such as antipsychotic agents Explanation: A persistent milk secretion (galactorrhea) from the breasts in a nonpregnant, nonlactating woman can be caused by the intake of hormones, contraceptives, and some antipsychotic agents, such as haloperidol (Haldol). Recent surgeries or trauma and exposure to chemicals are not known to cause persistent milk discharge. Excessive alcohol intake is a risk factor for the development of breast cancer.

Assessment of a client's breasts reveals tenderness on palpation and diffuse redness. What collaborative problem is most clearly suggested by these data? RC: Hematoma RC: Breast cancer RC: Benign breast disease RC: Infection

RC: Infection Explanation: Redness is associated with breast inflammation, a finding that is also suggested by tenderness. Cancer and hematoma are not normally associated with redness and tenderness.

The nurse is assessing the breasts of a Caucasian woman who has just been diagnosed with Paget disease. What would the nurse expect to find? Nipple retraction Orange-peel skin Red and scaling on the areola Dark pink areola

Red and scaling on the areola Explanation: Red, scaly crusty areas are indicative of Paget's disease. Orange peel skin and nipple retraction are associated with cancer. A dark pink areola is a normal finding.

When inspecting the nipples, which of the following findings is unexpected? Supernumerary nipples Downward point of the nipples Retraction of the left nipple Long-standing inversion

Retraction of the left nipple Explanation: Longstanding nipple inversion and supernumerary nipples do not constitute threats to health. A downward point of the nipples, provided symmetry exists, is not necessarily pathological, while retraction can indicate underlying cancer.

A nurse teaches a group of young women about how to properly perform a self breast examination. How should the nurse explain the best time to perform the exam? Immediately before the menstrual cycle starts Right after the menstrual flow stops On the 14th day of the menstrual cycle On the third day after the menstrual cycle begins

Right after the menstrual flow stops Explanation: The best time for a woman to perform a self breast examination is right after menstrual flow ceases or between the fourth and seventh days of the cycle if the cycle is regular.

The nurse is assessing an adult client's areolas and nipples. What assessment finding would most clearly warrant referral? Small Montgomery tubercles are present on the areolas. The client's areola puckers upon palpation. Supernumerary nipples are present. The client's nipple has recently become inverted.

The client's nipple has recently become inverted. Explanation: A recently retracted nipple that was previously everted suggests malignancy. Each of the other listed findings is considered to be normal.

The lateral lymph nodes are located along the upper humerus and drain most of the arm. False True

True Explanation: The lateral nodes drain most of the arms, and the central nodes receive drainage from the anterior, posterior, and lateral lymph nodes. A small proportion of the lymph also flows into the infraclavicular or supraclavicular lymph nodes or deeper into nodes within the chest or abdomen.

A nurse is examining the breasts of a client. In which quadrant should the nurse most expect to find a tumor? Lower outer quadrant Upper outer quadrant Upper inner quadrant Lower inner quadrant

Upper outer quadrant Explanation: The upper outer quadrant, which extends into the axillary area, is referred to as the tail of Spence. Most breast tumors occur in this quadrant.

The nurse is assessing an adult male client when the nurse observes gynecomastia in the client. The nurse should ask the client if he is taking any medications for inflammation. ulcers. infection. depression.

depression. Explanation: Gynecomastia, a smooth, firm, movable disc of glandular tissue, may be seen in one breast in males during puberty, usually temporary. However, it may also be seen in hormonal imbalances, drug abuse, cirrhosis, leukemia, and thyrotoxicosis. Irregularly shaped, hard nodules occur in breast cancer.

A nurse palpates the breasts of a client for masses during the physical examination. The nurse knows that if a tumor if malignant, which characteristics will be present? Select all that apply. well-demarcated borders fixed to underlying tissues irregular in shape rubbery and mobile hard and nontender

hard and nontender fixed to underlying tissues irregular in shape Explanation: Malignant tumors are hard and nontender and fixed to underlying tissues. They are usually unilateral with irregular poorly delineated borders. Multiple rubbery mobile nodules with well-demarcated borders are found in benign breast disease.

The nurse has discussed the risks for breast cancer with a group of high school seniors. The nurse determines that one of the students needs further instructions when the student says that one risk factor is late menopause. a family history of breast cancer. having a baby before the age of 20 years. consumption of a high-fat diet.

having a baby before the age of 20 years. Explanation: Having a baby before 20 years of age does not increase the risk of breast cancer. The risk of breast cancer is greater for women who have never given birth or for those who had their first child after age 30. A family history of breast cancer, consumption of a high-fat diet, and late menopause are all factors that increase the risk of breast cancer.

The lymph nodes that are responsible for drainage from the arms are the lateral lymph nodes. posterior lymph nodes. central lymph nodes. anterior lymph nodes.

lateral lymph nodes. Explanation: The lateral nodes drain most of the arms.

What instruction should the nurse provide to a client to assess for dimpling or retraction of breast tissue? bend both arms at the elbows extend the arms out to the side shrug the shoulders raise arms over the head

raise arms over the head Explanation: To bring out dimpling or retraction that may otherwise be invisible, ask the client to raise the arms over the head. Shrugging the shoulders, bending the arms at the elbows, and extending the arms out to the side are not actions to bring out breast dimpling or retractions.

The nurse plans to instruct an adult female client with regular menstrual cycles, who is not taking oral contraceptives, about breast self-examination. The nurse should plan to instruct the client to perform breast self-examination: midway between the cycles. during menstruation. right after menstruation. on the same day every month.

right after menstruation. Explanation: BSE is usually performed monthly after the period.