Chapter 17: Breasts and Regional Lymphatics

When a breastfeeding mother is diagnosed with a breast abscess, which of these instructions from the nurse is correct? The mother needs to: A) continue to nurse on both sides to encourage milk flow. B) discontinue nursing immediately to allow for healing. C) temporarily discontinue nursing on affected breast and manually express milk and discard it. D) temporarily discontinue nursing on affected breast but can manually express milk and give it to the baby.

c

While examining a 75-year-old woman, the nurse notices that the skin over her right breast is thickened and the hair follicles are exaggerated. This condition is known as: A) dimpling. B) retraction. C) peau d'orange. D) benign breast disease.

c

During a breast health interview, a patient states that she has noticed pain in her left breast. The nurse's most appropriate response to this would be: a. "Don't worry about the pain; breast cancer is not painful." b. "I would like some more information about the pain in your left breast." c. "Oh, I had pain like that after my son was born; it turned out to be a blocked milk duct." d. "Breast pain is almost always the result of benign breast disease."

b

During an examination of a 7-year-old girl, the nurse notices that the girl is showing breast budding. What should the nurse do next? a. ask her if her periods have started. b. assess the girl's weight and body mass index (BMI). c. ask the girl's mother at what age she started to develop breasts. d. nothing; this is a normal finding.

b

During an interview, a patient reveals that she is pregnant. She states that she is not sure whether she will breastfeed her baby and asks for some information about this. Which of these statements by the nurse is accurate with regard to breastfeeding? a. "Breastfed babies tend to be more colicky." b. "Breastfeeding provides the perfect food and antibodies for your baby." c. "Breastfed babies eat more often than infants on formula." d. "Breastfeeding is second nature and every woman can do it."

b

If a patient reports a recent breast infection, then the nurse should expect to find _____ node enlargement. a. nonspecific b. ipsilateral axillary c. contralateral axillary d. inguinal and cervical

b

In performing a breast examination, the nurse knows that it is especially important to examine the upper outer quadrant of the breast. The reason for this is that the upper outer quadrant is: a. the largest quadrant of the breast. b. the location of most breast tumors. c. where most of the suspensory ligaments attach. d. more prone to injury and calcifications than other locations in the breast.

b

Which of the following statements is true regarding the internal structures of the breast? The breast is: a. mainly muscle, with very little fibrous tissue. b. composed of fibrous, glandular, and adipose tissue. c. composed mostly of milk ducts, known as lactiferous ducts. d. composed of glandular tissue, which supports the breast by attaching to the chest wall.

b

While inspecting a patient's breasts, the nurse finds that the left breast is slightly larger than the right with the presence of Montgomery's glands bilaterally. The nurse should: A) palpate over the Montgomery's glands, checking for drainage. B) consider these normal findings and proceed with the examination. C) ask extensive history questions regarding the woman's breast asymmetry. D) continue with examination and then refer the patient for further evaluation of the Montgomery's glands.

b

During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for about 2 weeks. In trying to find the cause of the rash, which of these would be important for the nurse to determine? a. Is the rash raised and red? b. Does it appear to be cyclic? c. Where did it first appear—on the nipple, the areola, or the surrounding skin? d. What was she doing when she first noticed the rash, and do her actions make it worse?

c

During an examination of a woman, the nurse notices that her left breast is slightly larger than her right breast. Which of these statements is true about this finding? a. breasts should always be symmetric. b. this finding is probably due to breastfeeding and is nothing to worry about. c. this finding is not unusual, but the nurse should verify that this change is not new. d. this finding is very unusual and means she may have an inflammation or growth.

c

During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate? a. normal nipple inversion is usually bilateral. b. a unilateral inversion of a nipple is always a serious sign. c. it should be determined whether the inversion is a recent change. d. nipple inversion is not significant unless accompanied by an underlying palpable mass.

c

In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Which of the following describes the nurse's best course of action? a. recommend that he make an appointment with his physician for a mammogram. b. ignore it; it is not unusual for men to have benign breast enlargement. c. explain that this condition may be the result of hormonal changes and recommend that he see his physician. d. tell him that gynecomastia in men is usually associated with prostate enlargement and recommend that he be screened thoroughly.

c

In performing an assessment of a woman's axillary lymph system, the nurse should assess which of these nodes? a. central, axillary, lateral, and sternal nodes b. pectoral, lateral, anterior, and sternal nodes c. central, lateral, pectoral, and subscapular nodes d. lateral, pectoral, axillary, and suprascapular nodes

c

The nurse has palpated a lump in a female patient's right breast. The nurse documents this as a small, round, firm, distinct, lump located at 2 o'clock, 2 cm from the nipple. It is nontender and fixed. There is no associated retraction of skin or nipple, no erythema, and no axillary lymphadenopathy. Which of these statements reveals the information that is missing from the documentation? It is missing information about: a. the shape of the lump. b. the lump's consistency. c. the size of the lump. d. whether the lump is solitary or multiple.

c

The nurse is conducting a class about breast self-examination (BSE). Which of these statements indicates proper BSE technique? a. the best time to perform BSE is in the middle of the menstrual cycle. b. the woman needs to do BSE only bimonthly unless she has fibrocystic breast tissue. c. the best time to perform BSE is 4 to 7 days after the first day of the menstrual period. d. if she suspects that she is pregnant, the woman should not perform a BSE until her baby is born.

c

The nurse is preparing for a class in early detection of breast cancer. Which statement is true with regard to breast cancer in African-American women in the United States? a. breast cancer is not a threat to African-American women. b. African-American women have a lower incidence of regional or distant breast cancer than white women. c. African-American women are more likely to die of breast cancer at any age. d. breast cancer incidence in African-American women is higher than that of white women after age 45.

c

The nurse is preparing to teach a woman about breast self-examination (BSE). Which statement by the nurse is correct? a. "BSE is more important than ever for you because you have never had any children." b. "BSE is so important because one out of nine women will develop breast cancer in her lifetime." c. "BSE on a monthly basis will help you feel familiar with your own breasts and their normal variations." d. "BSE will save your life because you are likely to find a cancerous lump between mammograms."

c

A 54-year-old man comes to the clinic with a "horrible problem." He tells the nurse that he has just discovered a lump on his breast and is fearful of cancer. The nurse knows that which statement about breast cancer in males is true? A) Breast masses in men are difficult to detect because of minimal breast tissue. B) Breast cancer in men rarely spreads to the lymph nodes. C) One percent of all breast cancer occurs in men. D) Most breast masses in men are diagnosed as gynecomastia.

c

-solid -dense -fixed -firm or hard irregular axillary nodes -skin dimpling -nipple retraction -elevation -discharge

advanced cancer S&S

During a breast examination on a female patient, the nurse notices that the nipple is flat, broad, and fixed. The patient states it "started doing that a few months ago." This finding suggests: A) dimpling. B) a retracted nipple. C) nipple inversion. D) deviation in nipple pointing.

b

-only breast structures present are the lactiferous ducts within the nipple -no alveoli have developed -little change occurs until puberty

birth

The nurse is performing a breast examination. Which of these statements best describes the correct procedure to use when screening for nipple and skin retraction during a breast examination? Have the woman: a. bend over and touch her toes. b. lie down on her left side and notice any retraction. c. shift from a supine position to a standing position; notice any lag or retraction. d. slowly lift her arms above her head and note any retraction or lag in movement.

d

-rudimentary structure -consists of thin disk of undeveloped tissue and underlying nipple -areola well developed, although nipple is small

male breast

A 14-year-old girl is anxious about not having reached menarche. When taking the history, the nurse should ascertain which of the following? The age: a. she began to develop breasts b. her mother developed breasts c. she began to develop pubic hair d. she began to develop axillary hair.

a

A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her physician evaluated the lump and determined that it "was nothing to worry about." The examination validates the presence of a mass in the right upper outer quadrant at 1 o'clock, approximately 5 cm from the nipple. It is firm, mobile, nontender, with borders that are not well defined. The nurse's recommendation to her is: A) "Because of the change in consistency of the lump, it should be further evaluated by a physician." B) "The changes could be related to your menstrual cycles. Keep track of changes in the mass each month." C) "This is probably nothing to worry about because it has been present for years and was determined to be noncancerous at that time." D) "Because you are experiencing no pain and the size has not changed, continue to monitor the lump and return to the clinic in 3 months."

a

A new mother calls the clinic to report that part of her left breast is red, swollen, tender, very hot, and hard. She has a fever of 101 F. She has also had symptoms of the flu, such as chills, sweating, and feeling tired. The nurse notices that she has been breastfeeding for 1 month. From her description, what condition does the nurse suspect? A) Mastitis B) Paget's disease C) Plugged milk duct D) Mammary duct ectasia

a

A patient is newly diagnosed with benign breast disease. The nurse recognizes that which statement about benign breast disease is true? The presence of benign breast disease: a. makes it harder to examine the breasts. b. frequently turns into cancer in a woman's later years. c. is easily reduced with hormone replacement therapy. d. is usually diagnosed before a woman reaches childbearing age.

a

A woman has just learned that she is pregnant. What are some things the nurse should teach her about her breasts? a. she can expect her areolae to become larger and darker in color. b. breasts may begin secreting milk after the fourth month of pregnancy. c. she should inspect her breasts for visible veins and report this immediately. d. during pregnancy, breast changes are fairly uncommon; most of the changes occur after the birth.

a

During an annual physical exam, a 43-year-old patient states that she doesn't perform monthly breast self-examinations (BSE). She tells the nurse that she believes that mammograms "do a much better job than I ever could to find a lump." The nurse should explain to her that: a. BSEs may detect lumps that appear between mammograms. b. breast self-examination is unnecessary until the age of 50 years. c. she is correct, mammography is a good replacement for breast self-examination. d. she doesn't need to perform breast self-examination as long as a physician checks her breasts yearly.

a

During an examination, the nurse notes a supernumerary nipple just under the patient's left breast. The patient tells the nurse that she always thought it was a mole. Which statement about this finding is correct? A) It is a normal variation and not a significant finding. B) It is a significant finding and needs further investigation. C) It also contains glandular tissue and may leak milk during pregnancy and lactation. D) The patient is correct—it is actually a mole that happens to be located under the breast.

a

The nurse is assisting with a self-breast examination clinic. Which of these women reflect abnormal findings during the inspection phase of breast examination? a. woman whose nipples are in different planes (deviated) b. woman whose left breast is slightly larger than her right c. nonpregnant woman whose skin is marked with linear striae d. pregnant woman whose breasts have a fine blue network of veins visible under the skin

a

The nurse is discussing breast self-examination with a postmenopausal woman. The best time for postmenopausal women to perform breast self-examination is: A) the same day every month. B) daily, during the shower or bath. C) 1 week after her menstrual period. D) every year with her annual gynecologic examination.

a

The nurse is palpating a female patient's breasts during an examination. Which of these positions is most likely to make significant lumps more distinct during breast palpation? a. supine with arms raised over her head b. sitting with arms relaxed at the sides c. supine with arms relaxed at the sides d. sitting with arms flexed and fingertips touching shoulders

a

The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the United States, has the highest risk for development of breast cancer? a. African-American b. White c. Asian d. American Indian

a

The nurse is examining a 62-year-old man and notes that he has gynecomastia bilaterally. The nurse should explore his history for which related conditions? Select all that apply. A) Obesity B) Malnutrition C) Hyperthyroidism D) Type 2 diabetes mellitus E) Liver disease F) History of alcohol abuse

a, c, e, and f

The nurse is assessing the breasts of a 68-year-old woman and discovers a mass in the upper outer quadrant of the left breast. When assessing this mass, the nurse keeps in mind that characteristics of a cancerous mass include which of the following? Select all that apply. A) Nontender mass B) Dull, heavy pain on palpation C) Rubbery texture and mobile D) Hard, dense, and immobile E) Regular border F) Irregular, poorly delineated border

a, d, and f

During a history interview, a female patient states that she has noticed a few drops of clear discharge from her right nipple. What should the nurse do next? a. contact the physician immediately to report the discharge. b. ask her if she is possibly pregnant. c. ask her some additional questions about the medications she is taking. d. immediately obtain a sample for culture and sensitivity testing.

c

A 55-year-old postmenopausal woman is being seen in the clinic for a yearly examination. She is concerned about changes in her breasts that she has noticed over the past 5 years. She states that her breasts have decreased in size and that the elasticity has changed so that her breasts seem "flat and flabby." The nurse's best reply would be: A) "This change occurs most often because of long-term use of bras that do not provide enough support to the breast tissues." B) "This is a normal change that occurs as women get older. It is due to the increased levels of progesterone during the aging process." C) "Decreases in hormones after menopause causes atrophy of the glandular tissue in the breast. This is a normal process of aging." D) "Postural changes in the spine make it appear that your breasts have changed in shape. Exercises to strengthen the muscles of the upper back and chest wall will help to prevent the changes in elasticity and size."

c

A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the nurse's best response? a. tell the mother that breast development is usually fairly symmetric and she should be examined right away. b. tell the mother that she should bring her daughter in right away because breast cancer is fairly common in preadolescent girls. c. tell the mother that, although an examination of her daughter would rule out a problem, it is most likely normal breast development. d. tell the mother that it is unusual for breasts that are first developing to feel tender because they haven't developed much fibrous tissue.

c

A patient states during the interview that she noticed a new lump in the shower a few days ago. It was on her left breast near her axilla. The nurse should plan to: a. palpate the lump first. b. palpate the unaffected breast first. c. avoid palpating the lump because it could be a cyst, which might rupture. d. palpate the breast with the lump first but plan to palpate the axilla last.

c

A woman is in the family planning clinic seeking birth control information. She states that her breasts "change all month long" and that she is worried that this is unusual. What is the nurse's best response? a. tell her that it is unusual. The breasts of nonpregnant females usually stay pretty much the same all month long. b. tell her that it is very common for breasts to change in response to stress and that she should assess her life for stressful events. c. tell her that, because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common. d. tell her that breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time.

c

During a discussion about breast self-examination with a 30-year-old woman, which of these statements by the nurse is most appropriate? A) "The best time to examine your breasts is during ovulation." B) "Examine your breasts every month on the same day of the month." C) "Examine your breasts shortly after your menstrual period each month." D) "The best time to examine your breasts is immediately before menstruation."

c

The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? a. "Your breast milk is present immediately after delivery of the baby." b. "Breast milk is rich in protein and sugars (lactose) but has very little fat." c. "The colostrum, which is present right after birth, does not contain the same nutrition as breast milk does." d. "You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy."

d

-main lymphatic drainage -receives lymph from other 3 nodes -drainage then flows up to the infraclavicular and supraclavicular nodes

central axillary nodes

A 65-year-old patient remarks that she just can't believe that her breasts sag so much. She states it must be from lack of exercise. What explanation should the nurse offer her? a. after menopause, only women with large breasts experience sagging. b. after menopause, sagging is usually due to decreased muscle mass within the breast. c. after menopause, a diet that is high in protein will help maintain muscle mass, which keeps the breasts from sagging. d. after menopause, the glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag.

d

A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally asks, "Am I normal? I don't seem to need a bra yet, but I have some friends who do. What if I never get breasts?" The nurse's best response would be: a. "Don't worry, you still have plenty of time to develop." b. "I know just how you feel, I was a late bloomer myself. Just be patient and they will grow." c. "You will probably get your periods before you notice any significant growth in your breasts." d. "I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age."

d

The nurse is reviewing risk factors for breast cancer. Which of these women have risk factors that place them at a higher risk for breast cancer? a. 37 year old who is slightly overweight b. 42 year old who has had ovarian cancer c. 45 year old who has never been pregnant d. 65 year old whose mother had breast cancer

d

Which of these clinical situations would the nurse consider to be outside normal limits? a. a patient has had one pregnancy. She states that she believes she may be entering menopause. Her breast examination reveals breasts that are soft and sag slightly. b. a patient has never been pregnant. Her breast examination reveals large pendulous breasts that have a firm, transverse ridge along the lower quadrant in both breasts. c. a patient has never been pregnant. She reports that she should begin her period tomorrow. Her breast examination reveals breast tissue that is nodular and somewhat engorged. She states that the examination was slightly painful. d. a patient has had two pregnancies and she breastfed both of her children. Her youngest child is now 10 years old. Her breast examination reveals breast tissue that is somewhat soft and she has a small amount of thick yellow discharge from both nipples.

d

-nipples may be retracted but can be pulled outward -breasts feel more granular on palpation; terminal ducts around nipple feel more prominent and stringy -thickening of inframammary ridge at lower breast is normal, and feels more prominent with age -glandular and fat tissue atrophies, causing a decrease in breast size and elasticity, causing breasts to droop and sag, looking flat, flabby -drooping accenuated with kyphosis -reinforce value of BSE -women over 50 have increase risk of breast cancer

developmental differences: aging adult female

-changes begin during 2nd month and are an early sign of pregnancy for most women -ductal system expands and breasts enlarge - feel more nodular -areolae becomes larger, darker in color as pregnancy progresses -venous pattern more prominent -colostrum (contains protein and lactose, no fat) produced by 4th month - high in antibodies that protect newborn

developmental differences: pregnancy

-estrogen hormones stimulate breast changes -breasts enlarge, mostly as a result of extensive fat deposition - occurrence varies with ethnicity -duct system grows and branches -masses of small, solid cells develop at the duct endings - potential alveoli

developmental differences; adolescent: puberty

-breast develops along the ridge over the thorax, and the rest of the ridge usually atrophies -occasionally a supernumerary nipple persists and is visible somewhere along the track of the mammary ridge

embryonic development

-may have problems with arthritis, limited ROM, or decreased vision that inhibit self-care -suggest aids to self-exam (talcum powder helps fingers glide over skin)

objective data: aging adult female

-can be abbreviated, but do not omit -inspect chest wall: noting skin surface and any lumps or swelling -palpate nipple area for any lump or tissue enlargement: it should feel even, with no nodules -palpate axillary lymph nodes

objective data: male breast exam

-can perform in shower (soap and water assist palpation) or lying supine -do in front of mirror -establish regular schedule of self-care ~BEST TIME: right after menstrual period, when breasts are smallest and least congested -pregnant/menopausal women w/o periods: advise to select a familiar date to examine breasts each month (bday or day rent is due) -will familiarize women with her breasts and normal variation; emphasize absence of lumps (not presence) -encourage to report any unusual findings promptly

self-breast exam (SBE)

-solitary -unilateral -nontender -single focus on one area - may be interspersed with other nodules -borders irregular and poorly delineated -grows constantly -often painless, although person may feel some pain -most common in upper outer quadrant -deviated nipple (causing fibrosis in mammary ducts)

signs/symptoms of breast cancer