Ch 20: breat+lymphatic

A nurse is discussing breast self-examination (BSE) with a 60-year-old woman. Which of the following should the nurse recommend? Performing BSE annually, on the client's birthday Picking a set day of the month that the client will remember on which to perform BSE Performing BSE as soon as menstruation ceases each month Discontinuing the practice, as it is no longer needed after menopause

Picking a set day of the month that the client will remember on which to perform BSE Older clients and others who no longer menstruate may find it helpful to pick a set day of the month for BSE, a date that they will remember each month such as the day of the month they were born. Although BSE is not required, the nurse should not encourage the client to discontinue it if she is already performing it. It is unlikely that the client is still menstruating at her age. The BSE, if performed, should be done monthly, not annually.

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? Alcohol intake in excess of three drinks a day Prescribed medications such as antipsychotic agents Recent surgeries or trauma Environmental exposure to chemicals

Prescribed medications such as antipsychotic agents 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.

During the physical examination of a client's breast, which finding should the nurse recognize as a possible indication of a malignant tumor? Retraction of nipples Well-defined lump Stretch marks on breast Tenderness of breast

Retraction of nipples Retracted nipples are indicative of a malignant tumor. A malignant tumor has fibrous strands attached to the breast tissue and the fascia of the muscles. As the muscle contracts, it draws the breast tissue and skin with it, causing dimpling or retraction. Lumps are ill-defined and non-tender in breast cancer. Linear stretch marks may be seen during and after pregnancy or with significant weight gain or loss. A generalized increase in nodularity and tenderness may be a normal finding associated with the menstrual cycle or hormonal medications.

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

Retraction of the left nipple 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 examines a client diagnosed with fibroadenoma. Which characteristic of the lump should the nurse expect to find in the client? Tender, mobile, well-defined Irregular, hard, not well-defined Round, firm, well-defined Round, elastic, not well-defined

Round, firm, well-defined The nurse should expect to find a round, firm, and well-defined mass in a client with fibroadenoma. Fibroadenomas are lobular, ovoid, or round. They are firm, well-defined, seldom tender, and usually singular and mobile. An irregular, hard, not well-defined mass is characteristic of a cancerous tumor. Fibroadenomas are round and well-defined but not elastic. A tender, mobile, well-defined mass characterizes benign breast disease.

When palpating the female breast for masses, the nurse distinguishes which of the following characteristics as a potentially cancerous mass? Single, tender, well-delineated nodule Multiple soft, nontender nodules Multiple round, mobile nodules Single, firm, fixed nodule

Single, firm, fixed nodule Any mass that is firm, fixed, poorly circumscribed, and qualitatively different from surrounding tissue strongly suggests cancer.

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. For each finding, click to specify if the finding indicates a malignant nodule or benign nodule. Finding: Small (less than 1-cm) Nontender Smooth Movable

Small (less than 1-cm) - benign Nontender - benign Smooth -benign Movable -benign Benign nodules are small (less than 1 cm), nontender, smooth, and movable. Malignant nodules are usually larger than 1 cm, hard, and fixed.

A client is concerned about a dark skin lesion on her anterolateral abdomen. The lesion has not changed, nor is there any discharge or bleeding. On examination there is a medium brown circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly pigmented, and is about 7 mm in diameter. What is this lesion? Supernumerary nipple Dysplastic nevus Melanoma Dermatofibroma

Supernumerary nipple This represents a supernumerary nipple. These occur along the "milk line" and do not exhibit features of more concerning lesions.

Which is true of women who have had a unilateral mastectomy? Women with breast reconstruction over their mastectomy site no longer require examination. Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer. They no longer require breast examination. They should be examined carefully along the surgical scar for masses.

They should be examined carefully along the surgical scar for masses. A woman who has had breast cancer remains at high risk for recurrence, especially in the contralateral breast. The mastectomy site should be carefully examined for local recurrence as well. Lymphedema or swelling of the ipsilateral arm following mastectomy is common and does not usually indicate recurrence. Women with breast reconstruction must also undergo careful examination.

A client has had a recent mastectomy and visits the clinic for postoperative evaluation. The client tells the nurse that she has been depressed and feels as if she is less of a woman. The most appropriate nursing diagnosis for this client is fear of additional breast cancer related to the presence of risk factors. PC: hematoma after mastectomy. ineffective individual coping related to mastectomy. disturbed body image related to mastectomy.

disturbed body image related to mastectomy. When interviewing clients—especially females—about the breasts, keep in mind that this topic may evoke a wide spectrum of emotions from the client. Explore your own feelings regarding body image, fear of breast cancer, and the influence of the breasts on self-esteem. Disturbed body image is the most appropriate nursing diagnosis.

The size and shape of the breasts in females are related to the amount of glandular tissue. fibrous tissue. fatty tissue. lactiferous ducts.

fatty tissue. Fatty tissue is the third component of the breast. The glandular tissue is embedded in the fatty tissue. This subcutaneous and retromammary fat provides most of the substance to the breast, determining the size and shape of the breasts.

Benign conditions of the breast include Paget disease fibrocystic changes precancerous lesions ductal carcinoma

fibrocystic changes Cysts (due to BBD) are common lumps that are usually elliptical or round, soft, and mobile. Size may vary, and they often occur in multiple numbers, usually in both breasts, and frequently in the upper outer quadrants.

Benign conditions of the breast include fibrocystic changes precancerous lesions ductal carcinoma Paget disease

fibrocystic changes Cysts (due to BBD) are common lumps that are usually elliptical or round, soft, and mobile. Size may vary, and they often occur in multiple numbers, usually in both breasts, and frequently in the upper outer quadrants.

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 extremely dense breast tissue history of atypical ductal hyperplasia history of lobular hyperplasia

first degree relative with a history of either BRCA1 or BRCA2 mutation A known first-degree relative, including a father or brother, with BRCA1 or BRCA2 mutation is considered a high risk factor for the development of breast cancer. The remaining options are associated with a moderate risk.

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. hard and nontender irregular in shape rubbery and mobile well-demarcated borders fixed to underlying tissues

hard and nontender irregular in shape fixed to underlying tissues 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.

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. consumption of a high-fat diet. a family history of breast cancer. late menopause.

having a baby before the age of 20 years. 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.

At puberty, the female breasts enlarge in response to estrogen and aldosterone. lactogen. progesterone. prolactin.

progesterone The male and female breasts are similar until puberty, when female breast tissue enlarges in response to the hormones estrogen and progesterone, which are released from the ovaries.

The client reports to the nurse that she is concerned she has cancer as she has been experiencing clear discharge from her breasts. What is the best response of the nurse? "You must be experiencing stress." "Do you have a history of breast cancer in your family?" "Do you take any medications?" "You are most likely pregnant."

"Do you take any medications?" Some medications such as steroids, calcium channel blockers, oral contraceptives. or tranquilizers may also cause nipple discharge. Stress, family history and early pregnancy do not cause clear discharge.

During a breast cancer screening, the nurse assesses a client for factors affected by the circulation of hormones by asking which question? "Do you have any first-degree relatives with breast cancer?" "Have you ever breastfed a baby?" "Have you ever been diagnosed with atypical hyperplasia?" "Have you ever been told you have high-density breast tissue?"

"Have you ever been told you have high-density breast tissue?" The question that focuses on assessing for factors affected by the circulation of hormones is related to having high-density breast tissue. None of the other options assess this factor.

A nurse is inspecting a client's breasts. The nurse notices that one breast is larger than the other. Which action should the nurse take next? Ask the client whether the larger breast has increased in size recently Inform the physician immediately Record the finding and proceed with the examination Ask the client whether she has any family history of breast cancer

Ask the client whether the larger breast has increased in size recently Breasts can be a variety of sizes and are somewhat round and pendulous. One breast may normally be larger than the other. However, a recent increase in the size of one breast may indicate inflammation or an abnormal growth; it thus would be best for the nurse to inquire about any recent changes in breast size. There is no need to inform the physician immediately. Inquiring about the client's family history of breast cancer should have occurred earlier, during the interview.

The nurse instructs the client to lean forward so she can inspect the breasts. What might this position reveal that is not visible in another position? Retraction of the nipple and areola Asymmetry of the breast or nipple Mammary duct ectasia Posttraumatic fat necrosis

Asymmetry of the breast or nipple This position may reveal an asymmetry of the breast or nipple not otherwise visible.

A 63-year-old nurse comes to the office upset because she has found an enlarged lymph node under her right arm. She states she found it last week while taking a shower. She isn't sure if she has any breast lumps because she doesn't know how to do self-breast examinations. She states her last mammogram was 5 years ago and it was normal. Her past medical history is significant for high blood pressure and chronic obstructive pulmonary disease. She quit smoking 2 years ago after a 55-pack a year history. She denies any illegal drugs and drinks alcohol rarely. Her mother died of a heart attack and her father died of a stroke. She has no children. Examination shows an older woman appearing her stated age. Visual inspection of her right axilla reveals nothing unusual. Palpation reveals a 2-cm hard fixed lymph node. She denies any tenderness. Visualization of both breasts is normal. Palpation of her left axilla and breast is unremarkable. On palpation of the right breast, the nurse detects a nontender 1-cm lump in the tail of Spence. What disorder of the axilla is most likely responsible for her symptoms? Hidradenitis suppurativa Lymphadenopathy of infectious origin Breast cancer

Breast cancer Metastatic lymph nodes tend to be hard, nontender, and fixed, often to the rib cage. Although the client has no family history of breast cancer, she is at a slightly increased risk because she never had children.

A 72-year-old retired saleswoman comes to the office with a bloody discharge from her left breast for 3 months. She denies any trauma to her breast. Her past medical history includes high blood pressure and abdominal surgery for colon cancer. Her aunt died of ovarian cancer and her father died of colon cancer. Her mother died of a stroke. The client denies tobacco, alcohol, or drug use. She is a widow and has three healthy children. On examination her breasts are symmetrical with no skin changes. The nurse can express bloody discharge from the client's left nipple. No discrete masses are palpable, but her left axilla has a hard 1-cm fixed node. The remainder or her heart, lung, abdominal, and pelvic examinations are unremarkable. What is the most likely cause of nipple discharge in her circumstance? Breast cancer Galactorrhea Benign breast abnormality

Breast cancer Nipple discharge in breast cancer is usually unilateral and can be clear or bloody. Although a breast mass is not palpated, in this case a fixed lymph node is palpated. Other forms of breast cancer can present as a chronic rash on the breast.

The nurse is examining the breast of a clinic client and palpates a lump. What would the nurse be sure to document about this lump? Select all that apply. Erythema Distinctness Pallor Mobility Consistency

Distinctness Mobility Consistency If a lump is palpated, the nurse documents the location, size, shape, consistency, mobility, tenderness, and distinctness. Additionally, the nurse notes the skin over the lump, the nipple, and any lymphadenopathy. The nurse would not note erythema or pallor of the lump, because these are notations about the skin over the lump.

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

Engage in regular, strenuous physical activity Have children before 30 years of age Breast-feed if possible 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.

While interviewing a 23-year-old client, a nurse discusses the need for a clinical breast examination (CBE). How often should this client be receiving a CBE? Every year Twice a year Every 5 years Every 3 years

Every 3 years The ACS recommends a clinical breast examination (CBE) by a health care professional every 3 years for women ages 20 to 39 and every year for women age 40 and older.

During the breast examination of a client, the nurse notes firm but rubbery lesions in both breasts. The client comments that the lesions become tender just before menses. The nurse understands that these symptoms are most likely due to which breast condition? Paget's disease Fibrocystic lesions Fibroadenoma Metastatic disease

Fibrocystic lesions Fibrocystic lesions are benign and firm but rubbery lesions that tend to be bilateral and may become tender just before menses. Paget's 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.

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

Flat pads of three fingers 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.

When assessing the breast and lymphatics of the axillae, where would the nurse locate the central axillary nodes? Inside the lateral axillary fold Along the lateral edge of the scapulae Inside the upper arm High in the axillae at the top of the ribs

High in the axillae at the top of the ribs The central axillary (midaxillary) nodes are palpable high up in the axillae at the top of the ribs. These nodes receive lymph from the lateral, posterior, and anterior axillary nodes. The anterior axillary (pectoral) nodes are located inside the lateral axillary fold along the pectoralis major muscle. The lateral axillary (brachial) nodes are located inside the upper arm along the humerus. The posterior axillary (subscapular) nodes lie inside the posterior axillary fold along the lateral edge of the scapulae.

The nurse notes that a client's left breast feels significantly warmer than the right breast. What should the nurse consider is occurring with this client? Extramammary duct location Fibrocystic breast disease Inflammation Breast cancer

Inflammation Heat in the breasts of a client who has not given birth or lactating indicates inflammation. This finding is not associated with breast cancer or fibrocystic breast disease. Extramammary ducts are visible and not associated with warmer skin temperature over the breast.

When examining the breasts of a client, the nurse finds a collection of fatty tissue that appears as a lump. The nurse knows that this is which of the following conditions? Fibroadenoma Carcinoma Lipoma Milk cyst

Lipoma Lipomas are a collection of fatty tissue that may also appear as a lump. Milk cysts are sacs filled with milk. Fibroadenomas are usually 1-5 cm, round or oval, mobile, firm, solid, elastic, nontender, single or multiple benign masses found in one or both breasts. Malignant tumors, or carcinomas, are most often found in the upper outer quadrant of the breast. They are usually unilateral, with irregular, poorly delineated borders. They are hard and nontender and fixed to underlying tissues.

A nurse is assessing a 60-year-old woman's risk for breast cancer. Which of the following factors would tend to increase her risk for developing this disease? Select all that apply. Birth of first child at age 25 Menses at age 11 Menopause at age 58 Having given birth to five children

Menses at age 11 Menopause at age 58 Early menses (before age 13) or delayed menopause (after age 52) increases the risk for 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. Having given birth to five children would not increase the client's risk.

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? Peau d'orange sign Paget's disease Nipple retraction

Nipple retraction retracted nipple is flattened or pulled inward or toward the medial, lateral, anterior, or posterior side of the breast. The surrounding skin can be thickened. This is a relatively late finding in breast cancer.

A nurse is examining the breasts of a 75-year-old woman. Which of the following are normal findings in the breasts of an older adult? Select all that apply. Nipples that are less erectile on stimulation Smaller, flatter nipples Pendulous breasts Spontaneous discharge Peau d'orange skin

Nipples that are less erectile on stimulation Smaller, flatter nipples Pendulous breasts The older client often has more pendulous, less firm, and saggy breasts and smaller, flatter nipples that are less erectile on stimulation. Peau d'orange skin, associated with carcinoma, and spontaneous discharge are not normal findings in the breasts of older adults and should be referred for further evaluation.

What is considered a modifiable risk factor for breast cancer? Age Obesity Genetics Asthma

Obesity It is important for women to be aware of their specific risk factors for breast cancer. A modifiable risk factor for breast cancer is obesity. Asthma is not correlated with breast cancer. Genetics and age are not modifiable risk factors.

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

One breast larger than the other 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 Hyperpigmentation Paget disease Peau d'orange

Paget disease 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? Paget disease Fibrocystic lesions Metastatic disease Fibroadenoma

Paget disease 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 Paget's disease Nipple retraction

Paget's disease

When performing a breast assessment on a clinic client, the nurse practitioner notes scaly lesions that begin at the nipple and move toward a lump behind the nipple well. The NP would know that further assessment for what would be necessary? Mastalgia Paget's disease Lipoma Fibroadenoma

Paget's disease Paget's disease produces scaly lesions that begin at the nipple and progress to a lump behind the nipple well. Severe pain (mastalgia) is more likely to result from trauma or infection. Single breast masses can indicate benign conditions (e.g., cysts, fibroadenoma, fat necrosis, lipoma) or more serious conditions (e.g., cancer).

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? Nipple retraction Peau d'orange sign Paget's disease

Paget's disease 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 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? Recommend continued observation for the next 1-2 years. Advise the mother that these hormonal changes are normal. Provide dietary teaching. Palpate for any irregular or hard masses.

Palpate for any irregular or hard masses. Gynecomastia (firm, glandular tissue in the breasts) in males may occur when there is an imbalance of estrogen and androgen. An ulcer or hard, irregular mass suggests cancer and should be palpated for upon initial assessment. Gynecomastia also occurs with use of anabolic steroids, diseases, and as an adverse effect of some medications; however this boy denies any medication use. Gynecomastia also occurs in overweight or obese males; however this client is slender; therefore dietary teaching is not the next, best action. These hormonal changes can be expected; but first the nurse should assess for a serious condition such as cancer by palpating for hard or irregular masses. Uncomplicated gynecomastia does tend to resolve with time; but the nurse must assess for signs of abnormalities such as cancer first.

A nurse is examining the breasts of a woman who has had a mastectomy. Which of the following should the nurse do? Refer the client to a physician if any white scar tissue is observed Palpate the scar for redness, lesions, lumps, swelling, or tenderness Palpate the affected breast but avoid the scar Visually inspect but not palpate the affected breast

Palpate the scar for redness, lesions, lumps, swelling, or tenderness If the client has had a mastectomy or lumpectomy, it is still important to perform a thorough examination. Palpate the scar and any remaining breast or axillary tissue for redness, lesions, lumps, swelling, or tenderness. White scar tissue in a client who underwent a mastectomy or lumpectomy is a normal finding and need not be referred.

The nurse instructs a client on breast self-examination techniques. Which observation indicates that teaching has been effective? Feels the breasts with a warm wet washcloth Lays prone on a firm surface Palpates the breasts using an up and down approach Stands with arms extended to the sides of the body

Palpates the breasts using an up and down approach When performing a breast self-examination, the client should be supine with the arm of the breast being examined under the head. The breasts should be palpated with the fingertips. The arms should be placed on the hips or extended above the head. One approach to palpate the breasts is to use an up and down approach.

When considering malignancy, what signs/symptom determined through assessment of the breast requires additional assessment? (Select all that apply.) Peau d'orange Pain Erythema Hyperpigmentation Unilateral vascular appearance

Peau d'orange Hyperpigmentation Unilateral vascular appearance Redness (erythema) and heat can indicate infection or inflammation. Hyperpigmentation can signify cancer. A unilateral vascular appearance could indicate increased blood flow to a malignancy (produced by dilated superficial veins). Peau d'orange appearance is caused by breast edema from blocked lymph drainage and indicates advanced cancer. Pain is associated with trauma or possibly infection.

Which of the following are the four major axillary node groups? Pectoral, subscapular, lateral, central Pectoral, epitrochlear, subscapular, supraclavicular Central, medial, posterior, infraclavicular Infraclavicular, epitrochlear, lateral, pectoral

Pectoral, subscapular, lateral, central The four groups of lymph nodes consist of the central nodes, which are palpable, and the pectoral, subscapular, and lateral nodes, which are seldom palpable.

When would be the best time during the month for a post-menopausal woman to perform self-breast examination? First two weeks of month Last two weeks of month First day of each month A convenient day of each month

A convenient day of each month With the cessation of menses, hormonal changes no longer affect the breasts. For this reason, clients can choose a convenient day of each month to perform SBEs. With this information, none of the other options present the best time.

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. BSE is usually performed monthly after the period.

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 genetic deviation. fibrocystic breast. fibroadenoma. tumor.

tumor. Dimpling or retraction is usually caused by a malignant tumor that has fibrous strands attached to the breast tissue and the fascia of the muscles. As the muscle contracts, it draws the breast tissue and skin with it, causing dimpling or retraction.

area of the breast where most tumors occur?

upper outer quadrant The upper outer quadrant is the area most targeted by breast cancer.

After assessing the breasts of a female client, the nurse should explain to the client that most breast tumors occur in the lower outer quadrant. upper inner quadrant. lower inner quadrant. upper outer quadrant.

upper outer quadrant. 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.

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? "How much do you drink or smoke?" "Have you ever noticed a lump in your breast?" "Are you taking oral contraceptive pills?" "Does anyone in your family have breast cancer?"

"Are you taking oral contraceptive pills?" The nurse should question the client on the use of oral contraceptives as they can cause breast tenderness due to hormonal effect. Questioning the client about family history, past history, and habits such as drinking and smoking are not related to finding tenderness of the breasts.

Which question(s) should the nurse include when counseling a client about minimizing modifiable risk factors for breast cancer? Select all that apply. "Do you engage in some form of regular exercise?" "Are you aware that alcohol use increases the risk of breast cancer?" "At what age did you have your first baby?" "When did you first begin having menstrual periods?" "What type of hormone replacement therapy (HRT) are you taking?"

"Do you engage in some form of regular exercise?" "Are you aware that alcohol use increases the risk of breast cancer?" "What type of hormone replacement therapy (HRT) are you taking?" Modifiable factors include alcohol use, postmenopausal obesity and physical inactivity, and use of estrogen-progesterone combination HRT. The remaining options are considered nonmodifiable risk factors.

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 Immediately before the menstrual period begins On the 14th day of the menstrual period Three days after the menstrual period begins

Right after the menstrual period ends The best time for breast self-examination is right after menstruation or between the fourth and seventh day of the cycle is regular.

The nurse observes an orange peel appearance, or peau d'orange, of the areolae of a client's breasts. The nurse should explain to the client that this is most likely due to radiation therapy. fibrocystic breast disease. fibroadenomas. blocked lymphatic drainage.

blocked lymphatic drainage. A pigskin-like or orange-peel (peau d'orange) appearance results from edema, which is seen in metastatic breast disease. The edema is caused by blocked lymphatic drainage.

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."

A client asks why the nurse touches the area near the arm pit when conducting a breast examination. What should the nurse respond to this client? "The mammary ducts are in this region." "I'm checking the integrity of your fibrous tissue." "The upper outer quadrant of the breast extends into the axillae." "This is where most of the fatty breast tissue is located."

"The upper outer quadrant of the breast extends into the axillae." The upper outer quadrant extends into the axillary area and is referred to as the tail of Spence. This is the location for most breast tumors. The mammary ducts are located closer to the glandular tissue. The fibrous tissue provides support for the glandular tissue. Fatty tissue provides most of the substance of the breast.

A 58-year-old client asks the nurse how often they should have a mammogram. According to the USPSTF Guidelines, what is the best response by the nurse? "Women 55 and older should have it done yearly." "It should be done every 5 years." "It is no longer recommended after 50 years of age." "Women 55 and older should have it done every 2 years."

"Women 55 and older should have it done yearly." The USPSTF Guidelines recommend women 55 and older have a mammogram every year, not every 2 years. After the age of 75, there is no noted benefit. It should done more often than every 5 years.

A 23-year-old computer programmer comes to the office for an annual examination. She has recently become sexually active and wants to start oral contraception. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt; she scrubs her skin nightly with soap and water, but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes and her father has high blood pressure. The client denies tobacco but drinks four to five drinks on Friday and Saturday nights. She denies any illegal drug use. Examination shows a mildly obese woman breathing comfortably. Her vital signs are unremarkable. Inspection of the axillae reveals dark velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have? Peau d'orange Hidradenitis suppurativa Acanthosis nigricans

Acanthosis nigricans Acanthosis nigricans can be associated with an internal malignancy, but in most cases it is a benign dermatological condition associated with polycystic ovarian syndrome, a syndrome consisting of acne, hirsutism, obesity, irregular periods, infertility, ovarian cysts, and early onset type 2 diabetes. It is also known to correlate with insulin resistance.

When assessing the breasts, the client asks why is it important to lift her arms over her head. What is the basis for the nurse's response? Adds tension to suspensory ligaments Accentuates signs of unilateral nipple inversion Minimize dimpling and retraction Deemphasizes suspensory ligament retraction

Adds tension to suspensory ligaments Lifting the arms over the head adds tension to the suspensory ligaments and accentuates any dimpling or retraction. Lifting of the arms does not accentuate signs of unilateral nipple inversion, nor does it de-emphasize suspensory ligament retraction. Lifting the arms would maximize dimpling and retraction if it were present.

The nurse reviews factors related to which of the following areas to assess a client's risk of breast cancer? Lifestyle, occupation, exposure to hazardous chemicals Family history, age, occupation Exposure to hazardous chemicals, lifestyle, reproductive history Age, family history, reproductive history

Age, family history, reproductive history While numerous risk factors have been identified for breast cancer, age, family history, and reproductive history are among the most significant.

A client denies performing breast self-examination however practices breast awareness. What is this client focusing on when following this practice? Frequency of discharge from the nipples Appearance, feel, and shape of the breasts and nipples Size of the chest and bra Amount of discomfort that occurs with menstruation

Appearance, feel, and shape of the breasts and nipples Because breast self-examination has been met with controversy, an alternative called breast self-awareness may be practiced. This is the act of becoming familiar with the appearance, feel, and shape of one's breasts and nipples. Breast self-awareness does not focus on the size of the chest and bra or the amount of breast discomfort with menstruation. Discharge from the nipples should be reported to the health care provider for evaluation.

The nurse notes that a client has fibrocystic breasts. What should the nurse expect when assessing this client? Select all that apply. Breast pain Areas of thickening Enlarged axillae nodes Green nipple discharge Changes in breast lumps

Breast pain Areas of thickening Green nipple discharge Changes in breast lumps Breast pain is common in fibrocystic breasts. Additional findings include areas of thickening, green nipple discharge, and changes in breast lumps. Enlarged axillae nodes are not associated with fibrocystic breasts.

A 48-year-old woman has presented to her primary care provider concerned about the recent detection of a mass in her left breast. The mass is tender on palpation, and the nurse notes that it is round, well-delineated, and mobile. There is no evidence of nipple retraction on inspection. Which of the following breast masses would the nurse first suspect? Breast cancer Cyst Paget's disease Fibroadenoma

Cyst Cysts are typically tender, mobile, and well-delineated and usually occur in women age 30-50. Retraction signs are normally absent.

A nurse examines a client diagnosed with fibroadenoma. Which characteristic of the lump should the nurse expect to find in the client? Round, firm, well-defined Irregular, hard, not well-defined Round, elastic, not well-defined Tender, mobile, well-defined

Round, firm, well-defined The nurse should expect to find a round, firm, and well-defined mass in a client with fibroadenoma. Fibroadenomas are lobular, ovoid, or round. They are firm, well-defined, seldom tender, and usually singular and mobile. An irregular, hard, not well-defined mass is characteristic of a cancerous tumor. Fibroadenomas are round and well-defined but not elastic. A tender, mobile, well-defined mass characterizes benign breast disease.

How should a nurse instruct a client to perform a breast self-examination to most effectively cover the entire breast? Rub the finger pads across the breast in a horizontal motion Raise the arm straight up and over the head so that the underarm tissue is exposed In a circular pattern beginning at the nipple and moving outward Up-and-down pattern starting at the underarm and moving across the breast

Up-and-down pattern starting at the underarm and moving across the breast There is some evidence that the up-and-down pattern, also referred to as the vertical pattern, is the best method to most effectively cover the breast tissue. It is important to teach the client that breast tissue covers the entire upper chest, thus the exam should be performed from the underarm and move across the breast to the middle of the chest bone (sternum). Hands should go up and down the breast until the client feels the ribs and up to the neck area.

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? Wedge Vertical strip Circular Clockwise

Vertical strip Evidence suggests that the up-and-down pattern, called the vertical strip pattern, is the most effective pattern to use when palpating because it promotes examination of the entire breast. A nurse palpating a client's breasts can use a circular or clockwise pattern, wedged pattern, or the vertical strip pattern.

What pattern of palpation is currently the best validated technique for detecting breast masses? Circular pattern Wedge pattern Vertical strip pattern Supra to infra pattern

Vertical strip pattern Although a circular or wedge pattern can be used, the vertical strip pattern is currently the best validated technique for detecting breast masses.

The nurse is assessing a 50-year-old client's breasts and observes a spontaneous discharge of fluid from the left nipple. The nurse should refer the client for a cytology examination. determine whether the client wears a supportive bra. document this as a normal finding. ask the client if she has had retracted nipples.

refer the client for a cytology examination. Any type of spontaneous discharge should be referred for cytologic study and further evaluation.

The nurse is preparing to examine the breasts of a female client who had a left radical mastectomy 3 years ago. When examining the client, the nurse observes redness at the scar area. The nurse should explain to the client that this may be indicative of poor lymphatic drainage. additional tumors. metastasis to the right breast. an infectious process.

an infectious process. Redness and inflammation of the scar area may indicate infection.

Elevated sebaceous glands, known as Montgomery glands, are located in the breast's nipples. hair follicles. lactiferous ducts. areolas.

areolas The areola surrounds the nipple (generally 1 to 2 cm radius) and contains elevated sebaceous glands (Montgomery glands) that secrete a protective lipid substance during lactation.

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. insulin. antibiotics. nonsteroidal anti-inflammatory drugs.

contraceptives. Discharge may be seen in endocrine disorders and with certain medications (i.e., antihypertensives, tricyclic antidepressants, and estrogen).

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 depression. ulcers. inflammation. infection.

depression 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.

The nurse is concerned that a client has undiagnosed cancer of the breast. What assessment finding is most likely related to this clinical determination? retracted nipples areola larger on the right breast larger left breast dimpling of the breast

dimpling of the breast Dimpling could indicate an underlying lesion that causes the tissue to pucker with movement. Uneven breast size is not an indication of breast cancer. Retracted nipples do not indicate breast cancer unless it is a new finding and occurs in one breast. Uneven areola size is not an indication of breast cancer.

The functional part of the breast that allows for milk production consists of tissue termed adipose. lactiferous. fibrous. glandular.

glandular. Glandular tissue constitutes the functional part of the breast, allowing for milk production. Glandular tissue is arranged in 15 to 20 lobes that radiate in a circular fashion from the nipple. Each lobe contains several lobules in which the secreting alveoli (acini cells) are embedded in grape-like clusters.

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. rubbery and mobile hard and nontender fixed to underlying tissues well-demarcated borders irregular in shape

hard and nontender fixed to underlying tissues irregular in shape 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 lymph nodes that are responsible for drainage from the arms are the central lymph nodes. lateral lymph nodes. anterior lymph nodes. posterior lymph nodes.

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