333 Exam 4 - Chpt. 16 - Breasts and Axillae

mammary ridge

"Milk line" which extends from each axilla to the groin.

peau d'orange

"Orange peel" appearance caused by edema from blocked lymphatic drainage in advanced cancer.

1

A 14 year old is having an annual physical. She appears embarrassed during the exam and shyly asks the nurse if it is normal for one of her breasts to be larger than the other. The nurse's response should be: 1. "breast development may not be the same on both sides; this is quite normal." 2. "we will schedule you for a breast ultrasound." 3. "let's find out if your mother's breasts are the same way." 4. "do you have a history of breast cancer in your family?"

2

A 19 year old college student comes to the student health center because she discovered a small, non-tender, firm, rubbery lump in her right breast. What is the most common cause of breast lumps in women her age? 1. breast cancer. 2. fibroadenoma. 3. ductal ectasia. 4. breast abscess.

2

A 19 year old female college student just finished reading an article on breast cancer. It really upset her, because her aunt died of breast cancer 2 years ago. The student decides that it is time for her to start thinking about performing BSE. Unsure of what to do, she contacts the nurse at the college health service. The nurse includes which of the following statements regarding the BSE: 1. "it's best to perform the BSE about 5 days prior to your menstrual period." 2. "it's best to perform the BSE about 5 days after your menstrual period." 3. "it's best to perform the BSE during your menstrual period." 4. "we don't have to worry about BSE at our age."

1

A 58 y/o man seeks treatment for "recent breast enlargement." On examination the nurse notes bilateral enlargement of the breasts. Which question asked by the nurse is most appropriate based on this finding? 1. "what medications are you currently taking?" 2. "have you recently been lifting weights?" 3. "did your mother have large breasts?" 4. "have you ever had cancer?"

4

A 58 y/o woman has found a small lump in her breast. Which data from her history are risk factors for breast cancer? 1. her husband's mother died from breast cancer at age 43. 2. she drinks a glass of wine each night with dinner. 3. menarche occurred at age 14; menopause occurred at age 46. 4. she underwent radiation treatment for hodgkin's disease at age 17.

areola

A circular pigmented field of wrinkled skin containing the nipple.

2

A female client visits a nurse midwife for a 2-month postpartum visit. The client is breastfeeding and states she has not performed a breast self exam (BSE) since before the baby was born. The nurse midwife instructs the client that BSE's: 1. are not advised while breastfeeding. 2. should be performed after a completed breastfeeding. 3. should be performed prior to the first feed of the day. 4. can be done anytime while breastfeeding because menstruation is ceased.

1

A nurse is working in a health and wellness center on a university campus. She was asked by a sorority to give a presentation during Breast Cancer Awareness month. In the presentation, the nurse decides to include which of the following guidelines from the American Cancer Society? 1. women in their 20's have an option to perform a monthly SBE. 2. a breast exam should be performed by a healthcare provider every 5 years after the age of 25. 3. all females should have a baseline mammography at age 50. 4. all females over age 40 should perform a BSE once per week.

breast

A personal history of ovarian, endometrial, or colon cancer increases the risk of _____ cancer.

2

A school nurse is teaching a group of young girls about puberty. The nurse explains that breast tissue will begin to enlarge during puberty between the ages of: 1. 7 and 10. 2. 9 and 13. 3. 12 and 16. 4. 14 and 18.

normal (inframammary ridge - do not mistake for breast mass)

Normal/Abnormal: A firm, transverse ridge along the lower edge of the breast.

normal (may be more pronounced in obese or pregnant women)

Normal/Abnormal: bilateral venous patterns.

normal

Normal/Abnormal: breasts fall freely and evenly when sitting or standing.

abnormal (could indicate malignancy)

Normal/Abnormal: dimpling.

normal

Normal/Abnormal: firm pectoral muscles.

abnormal (lactation not associated with childbearing or breastfeeding)

Normal/Abnormal: galactorrhea.

abnormal (benign temporary breast enlargement in one or both breasts in males resulting from medications or low testosterone levels)

Normal/Abnormal: gynecomastia.

abnormal

Normal/Abnormal: inverted nipples for two weeks.

abnormal (normal during pregnancy and lactation only)

Normal/Abnormal: nipple discharge.

normal

Normal/Abnormal: non-palpable axillary lymph nodes.

normal

Normal/Abnormal: oval areolae.

abnormal ("orange peel" appearance caused by edema from blocked lymphatic drainage in advanced cancer)

Normal/Abnormal: peau d'orange.

normal (hanging down loosely, swinging freely)

Normal/Abnormal: pendulous breasts.

normal

Normal/Abnormal: presence of axillary hair.

abnormal

Normal/Abnormal: red scaly areolae.

normal

Normal/Abnormal: slight asymmetry of breasts.

normal

Normal/Abnormal: smooth skin over the breasts.

normal (third nipple; uncommon; looks like a mole)

Normal/Abnormal: supernumerary nipple that rises along the milk line.

abnormal

Normal/Abnormal: thick breast skin.

abnormal

Normal/Abnormal: unilateral areolar tenderness.

normal

Normal/Abnormal: uninterrupted breast contour.

mirror

Observe breast in front of a _______.

four

Observe breasts in _____ positions.

finger pads

Palpation of the breasts should be done with _____ _____.

2, 6, 1, 4, 3, 5, 9, 7, 8, 10

Put the following in the order that the nurse should teach a female client - 1. Compare breasts for symmetry, dimpling, shape, and lumps. 2. Observe breast in front of a mirror. 3. Many women palpate their breasts while they shower. 4. Examine the nipples for discharge and recent retractions. 5. Palpation of the breasts should be done with the finger pads. 6. Observe breasts in four positions. 7. Instruct the client to palpate from the periphery of the breasts to the nipple. 8. Compress the nipple with the thumb and forefinger. 9. A technique for palpation of the breasts is concentric circles. 10. Instruct the client not to forget the axillary tail.

increase

Research has suggested that high-fat diet may ______ a female's risk for developing breast cancer.

cooper's ligaments

Subcutaneous fibrous tissue and multiple fibrous bands that support the breasts. These suspensory ligaments extend from the connective tissue layer and run through the breast, attaching to the underlying muscle fascia.

hyperestrogenism

Swollen breast tissue in a newborn may be caused by _______.

true

T/F: Acini cells produce milk that is emptied into the lactiferous ducts and carried to the nipple.

false (blood is supplied by the internal and lateral thoracic arteries and cutaneous branches of the posterior intercostal arteries)

T/F: Blood is supplied to the breasts by the Montgomery gland.

true

T/F: Breast growth may be asymmetrical.

false (begins ages 9-13)

T/F: Breast tissue starts to change at the onset of puberty between the ages of 14-16.

false (increased progesterone and estrogen levels cause changes)

T/F: Decreased progesterone levels and increased estrogen levels cause changes in fat deposits, ductile maturity, and pigmentation of the breasts.

false (15-20 lobes each)

T/F: Each breast has 5-10 lobes of glandular tissue radiating around the nipple in a spoke-like patter..

true

T/F: Each breast lobe is composed of 20-40 lobules (alveoli) containing milk producing acini cells.

true

T/F: Expected variations of the areola include pink, brown, or black colored areola, round or oval shaped and bilaterally similar, montgomery's tubercles may appear as slightly raised bumps on the areolar tissue, and hairs on the nipple may be seen.

true

T/F: Expected variations of the female nipples include flat, protruded, or inverted (can be normal if it is not a new finding and can be everted with manipulation, or abnormal) nipples - considered normal if they have remained the same throughout adult life and appear bilaterally symmetrical.Lesions, crusting, bleeding, and discharge are not expected.

true

T/F: Explain to the female client that at least three positions will be used during the assessments of the breast.

true

T/F: If the female client has pendulous breasts, the nurse should place one hand under the breast to support it while the other hand is palpating.

false (client should lean forward to let breasts fall forward)

T/F: Inspection of the breasts can be done with the client leaning back on the exam table.

true

T/F: Inspection of the breasts can be done with the client's hands pressed together at the waist level.

true

T/F: Spence glands are sebaceous glands that produce oils to lubricate and moisturize the areola and nipple.

false (exam should begin with client sitting upright)

T/F: The client should be in a supine position at the beginning of breast assessment.

true

T/F: The finger pads of the first three fingers should be used in a slightly rotary motion during palpation of the breast.

false (between the thumb and forefinger)

T/F: The nipple should be compressed between the second and third digit.

false (the towel or pillow should be placed under the breast that is being examined)

T/F: The nurse should place a small pillow or rolled towel under the breast that is not being examined.

false (there are a variety of patterns to select)

T/F: The only pattern that covers the entire breast in the concentric circle pattern.

true

T/F: When palpating one breast, the nurse should cover the breast that is not being examined.

axillary tail

Tail of Spence.

smaller, flatter

The nipples become ______ and _____ in the older adult.

1

The nurse knows that incidence of breast cancer in the female is highest in the: 1. axillary tail. 2. upper inner quadrant. 3. lower outer quadrant. 4. lower inner quadrant.

1

The nurse notes the aroela is speckled with _____ glands. 1. sebaceous. 2. serous. 3. apocrine. 4. mucus.

increases

The risk for breast cancer ______ with age; 18% of cases are diagnosed between ages 40-50, and 77% are older than age 50.

montgomery's gland

The sebaceous glands on the areola, which enlarge and produce a secretion that protects and lubricates the nipples during lactation.

breast development

Thelarche, also known as _____ _____, initially begins in preadolescence and continues through adolescence.

colostrum

Thick, yellow discharge that may leak from breasts in the month prior to birth in preparation for lactation.

malignancy

Thickening of the nipple tissue, a mass, and loss of elasticity are signs consistent with _____.

3

What is the reason for palpating axillary lymph nodes during a clinical breast examination? 1. axillary lymph nodes fluctuate during the month in response to the menstrual cycle. 2. axillary node tenderness is the most common initial symptom of breast cancer. 3. the lymph network in the breast primarily drains toward the axillary lymph nodes. 4. this is a matter of convenience because of the close proximity of the axillae to the breasts.

3

Which finding is considered abnormal when conducting an exam on a 68 year old woman? 1. dark pink areola. 2. pendulous breasts. 3. serous nipple drainage. 4. granular feeling when palpating the breast.

4

Which of the following lymph nodes does not drain the breast and axillae? 1. brachial nodes. 2. internal mammary nodes. 3. interpectoral nodes. 4. superficial cervical chain.

4

Which of the following would the nurse document as an abnormal assessment finding during the menstrual cycle? 1. breast tenderness. 2. breast pain. 3. breast swelling. 4. nipple discharge.

3

Which statement by the nurse best explains changes in breast tissue during menopause? The breast tissue experiences: 1. an increase in glandular tissue. 2. a decrease in fatty tissue. 3. relaxation of the suspensory ligaments. 4. an increase in erectile sensitivity to the nipple.

body-image (self-esteem)

Women with very small, very large, or asymmetrical breasts are at higher risk for _____-_____ disturbance.

ductal ectasia

_____ _____ is a benign breast disease characterized inflammation and dilation involving one or multiple subareolar ducts. It affects perimenopausal and postmenopausal women. Manifestations include an initial sticky nipple discharge that is commonly colored dark green or black. As the disease progresses, inflammatory signs and symptoms occur. May experience burning or itching of the nipple and edema in the areolar area. Discharge may become purulent or sanguinous. Breast abscess can occur.

intraductal papilloma

_____ _____ is a small, benign, tumor growth in the major ducts usually within 1-2 cm of the areolar edge. One or more ducts may be affected. This commonly occurs in women 40-60 years of age. Manifestations include spontaneous, bloody discharge from the nipple, and occasionally, a painful mass is palpated.

noninvasive

_____ breast cancer includes ductal carcinoma in situ and lobule carcinoma in situ. The term "in situ" is used to describe an early, noninvasive stage of cancer. Manifestations include an abnormal mammogram, and can be occasionally detected as a lump with well defined margins or nipple discharge.

invasive

_____ breast cancer is the most common type. Arises from the ducts or lobules. Most prevalent in women aged 40-60 years. Manifests as a solitary, unilateral, nontender lump, thickening, or mass. As the mass grows, there may be breast asymmetry, discoloration, unilateral vein prominence, peau d'orange, ulceration, dimpling, puckering, or retraction of the skin. Lesion is sometimes fixed to underlying tissue. Irregular borders and poorly delineated. Nipple may be inverted or deverted. A serosanguinous or clear nipple discharge may be present. There may be crusting around the nipples or erosion of the nipple or areola. Lymph nodes may be palpable in the axilla.

fibrocystic

_____ changes to the breast refers to a variety of conditions associated with multiple benign masses within the breast caused by ductal enlargement and the formation of fluid-filled cysts, commonly seen along middle-aged women. Manifestations include one or more palpable masses that are round, well-delineated, mobile, and tender. The degree of discomfort experienced can range from slightly tender to very painful; the cysts can often fluctuate in size and tenderness with the menstrual cycle. Symptoms tend to subside after menopause.

fibroadenoma

_____ is a common benign breast tumor among young women that consists of glandular and fibrous tissue. Manifestations include, unilaterally, a small, solitary, firm, rubbery, nontender lump. This tumor does not change premenstrually.

mastitis

_____ is an inflammatory condition of the breast usually caused by a bacterial infection. Occurs most often in lactating women secondary to milk stasis or a plugged duct. Incidence is highest first few weeks post delivery. In nonlacting women, it may result from foreign bodies such as nipple rings, breast implants, or trauma. Infection generally occurs in one breast which appears as red, edematous, tender, warm, and hard. Axillary lymph nodes are often enlarged and tender. Pt usually experiences associated chills and general malaise.

concentric circles

A technique for palpation of the breasts is _____ _____.

one year

Adolescent male "breast buds" usually disappear within _____ _____of onset.

lowest

Asian and Hispanic women have the _____ rates of breast cancer.

gynecomastia

Benign temporary breast enlargement in one or both breasts in males. The neonate may experience this secondary to the mother's hormones. The older male may experience this secondary to a decrease in testosterone levels. It is most common in adolescent males during puberty, older adult men, or men who are overweight.

pituitary

Breast pain or lumps accompanied by headaches or changes in vision along with nipple discharge may suggest a _____ tumor or mass.

symmetry, dimpling, shape, lumps

Compare breasts for _____, _____, _____, and _____.

thumb, forefinger

Compress the nipple with the _____ and _____.

4

During a routine health exam a 47 y/o female patient tells the nurse that she performs a BSE "once in a while". The nurse should base his or her response on the fact: 1. those who routinely perform BSE are more likely to survive breast cancer. 2. because breast cancer is always found by health care professionals, BSE is no longer indicated. 3. performance of BSE is an important indication of a patient's compliance with health care. 4. BSE is now considered optional; it is a personal choice.

darker, increase

During pregnancy, the nipples and areolae become _____ in color and _____ in size.

discharge, retractions (retractions could indicate malignancy; a nipple that is pointing or pulled in a different direction)

Examine the nipples for _____ and recent _____.

acini cells

Glandular tissue in each breast that produces milk.

glandular

In the female, fatty tissue will replace ______ tissue at menopause.

galactorrhea

Inappropriate lactation not associated with childbearing or breastfeeding.

witch's milk, hormones

Infants may produce a small, water, whitish, thin discharge from the breasts known as _____ _____. This secretion will subside as the maternal _____ decreases.

axillary tail

Instruct the client not to forget the _____ _____.

nipple

Instruct the client to palpate from the periphery of the breasts to the ______.

breast self-exames

Many women avoid doing ______ _____because their culture has prohibited looking at or touching oneself.

shower

Many women palpate their breasts while they ______.