Ch 19 PrepU

During the examination of the breasts, a young adult client's nipples becomes erect and the areolas pucker. The nurse explains to the client that these findings indicate:

Intact tactile stimulation of the area

Which of the following is true regarding self breast examination?

A high proportion of breast masses are detected by self breast examination.

When should a woman conduct self breast examination with respect to her menses?

5 to 7 days following her menses

Assessment of a client's breasts reveals tenderness on palpation and diffuse redness. What collaborative problem is most clearly suggested by these data?

RC: Infection

The nurse is performing a breast examination. Which of the following findings are considered a common or concerning symptom?

Rash Unusual nipple discharge Breast discomfort Change in shape Edema

The nurse is examining the breasts of a woman with Paget's disease. Which of the following would the nurse expect to find?

Red, scaly, crusty areas

Montgomery glands secrete

protective lubricant

The nurse observes dimpling in an adult female client's breasts. The nurse should explain to the client that dimpling of the breast may indicate a

tumor.

During the physical examination of a client, a nurse notes that the client has tenderness of the breasts. Which question should the nurse ask the client with regard to this finding?

"Are you taking oral contraceptive pills?"

Mrs. Ash, a client in her 50s, has told the nurse during her most recent visit to the clinic that she and her circle of friends have discontinued breast self-examination (BSE) since hearing and reading that the practice is now considered ineffective. How can the nurse best respond to Mrs. Ash?

"BSE is certainly not a replacement for other screening methods, but a high proportion of breast masses are in fact detected by women themselves."

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?

"Many women have this, and it's rarely a sign of a health problem."

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."

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 glandular tissue

A client denies performing breast self-examination however practices breast awareness. What is this client focusing on when following this practice?

Appearance, feel, and shape of the breasts and nipples

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?

Arrange for a prompt referral to her primary care provider.

When examining the lymph nodes, a nurse finds an enlarged anterior axillary node. Which of the following would the nurse examine next?

Breast

After teaching a group of young women about breast self-examination, the nurse determines that the teaching was successful when the women state that they will palpate their breasts using which pattern?

Vertical strip

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?

Glandular

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

Gynecomastia

Which technique is appropriate for the nurse to use to palpate a client's breast?

Flat pads of three fingers

A nurse is teaching an older adult client about breast self-examination. The nurse includes changes in the client's breasts due to aging. Which of the following would the nurse include?

Increase in fatty tissue

A 43-year-old store clerk comes to the office upset because she has found an enlarged lymph node under her left arm. She states she found it yesterday when she was feeling pain under her arm during movement. She states the lymph node is about an inch long and is very painful. She checks her breasts monthly and gets a yearly mammogram (her last was 2 months ago); until now everything has been normal. She states she is so upset because her mother died in her 50s of breast cancer. The client does not smoke, drink, or use illegal drugs. Her father is in good health. Examination shows a tense woman appearing her stated age. Visual inspection of her left axilla reveals a tense red area with no surrounding scarring. On palpation, the examiner feels a 2-cm tender movable lymph node underlying hot skin. Other shoddy nodes are also in the area. Visualization of both breasts is normal. Palpation of her right axilla and both breasts is unremarkable. Examination of the left arm reveals a scabbed-over superficial laceration over her left hand. Upon questioning, the client remembers that she cut her hand gardening last week. What disorder of the axilla is most likely responsible for her symptoms?

Lymphadenopathy of infectious origin

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

Malignancy

A 31-year-old woman has presented to her family physician 3 weeks after giving birth to her first child. The woman complains of exquisitely tender breasts that are reddened on inspection and warm on palpation. The client has a temperature of 37.8°C orally. Which of the following diagnoses should be first suspected?

Mastitis

A 56-year-old woman comes to the clinic reporting that her left breast looks unusual. She says that for 2 months the angle of the nipple has changed direction. She does not do self-breast examinations so she doesn't know if she has a lump. She has no history of weight loss, weight gain, fever, or night sweats. Her past medical history is significant for high blood pressure. She smokes two packs of cigarettes a day and drinks three to four drinks per weekend night. Her paternal aunt died of breast cancer in her forties. Her mother is healthy, but her father died of prostate cancer. Examination shows a middle-aged woman appearing older than her stated age. Inspection of her left breast reveals a flattened nipple deviating towards the lateral side. On palpation the nipple feels thickened. Lateral to the areola is a nontender 4-cm mass. The axilla contains several fixed nodes. The right breast examination and axilla are unremarkable. What visible skin change of the breast does she have?

Nipple retraction

Which of the following assessment findings is most likely benign on breast examination?

One breast larger than the other

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?

Paget's disease

A mother brings her adolescent son into the clinic because she is concerned about his development of breast tissue. Her son denies use of any medications and is slender in appearance. What should be the nurse's next action?

Palpate for any irregular or hard masses.

The nurse instructs a client on breast self-examination techniques. Which observation indicates that teaching has been effective?

Palpates the breasts using an up and down approach

A nurse is discussing breast self-examination (BSE) with a 60-year-old woman. Which of the following should the nurse recommend?

Picking a set day of the month that the client will remember on which to perform BSE

During an instruction session on breast self-examination, the nurse would instruct a client to perform the exam at which time?

Right after the menstrual period ends

A 33-year-old female client is being seen in the clinic for changes in the right breast. The nurse performs a focused breast assessment. Findings include a small (less than 1-cm) nodule that is nontender, smooth, and movable.

Small (less than 1-cm) nodule -- Benign Nodule Nontender -- Benign Nodule Smooth -- Benign Nodule Movable -- Benign Nodule

When taking a health history for a female client, which factor should the nurse identify as placing the client at increased risk for breast cancer?

The client had her first child at age 38

Elevated sebaceous glands, known as Montgomery glands, are located in the breast's

areolas.

The nurse is caring for an adult female client when the client tells the nurse that she has had a clear discharge from her nipples for the past month. The nurse should ask the client if she has been taking

contraceptives.

While studying the breast and axillae, students learn that variations in the color of the skin and nipple are primarily influenced by

ethnic background

Benign conditions of the breast include

fibrocystic changes

Which characteristic would support the determination that a client is at high risk for breast cancer?

first degree relative with a history of either BRCA1 or BRCA2 mutation

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

having a baby before the age of 20 years.

The lymph nodes that are responsible for drainage from the arms are the

lateral lymph nodes.

After assessing the breasts of a female client, the nurse should explain to the client that most breast tumors occur in the

upper outer quadrant.