Chapter 20: Assessment Breasts and Lymphatic System

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

A. Upper outer quadrant Explanation: The upper outer quadrant, which extends into the axillary area, is referred to as the tail of Spence. Most breast tumors occur in this quadrant. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, STRUCTURE AND FUNCTION, p. 425.

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

B. Single, firm, fixed nodule Explanation: Any mass that is firm, fixed, poorly circumscribed, and qualitatively different from surrounding tissue strongly suggests cancer. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 425.

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

C. Flat pads of three fingers Explanation: The nurse should use the flat pads of three fingers to palpate the breast of the client for accurate assessment. The tips of four fingers, palms of both hands, or palm and fingers of one hand are not used for assessing the breasts as they may not give accurate results on examination. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 428.

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? A. Acanthosis nigricans B. Peau d'orange C. Hidradenitis suppurativa

A. Acanthosis nigricans Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 426.

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

A. Gynecomastia Explanation: Gynecomastia is breast enlargement. Cysts are lumps that may be found in the breasts. Abscesses are an infection. Fibroadenoma is a well-defined , usually single or multiple, nontender, firm or rubbery, round or lobular mass that is freely movable. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 427.

What is considered a modifiable risk factor for breast cancer? A. Obesity B. Age C. Genetics D. Asthma

A. Obesity Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 419.

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? A. Palpate for any irregular or hard masses. B. Provide dietary teaching. C. Advise the mother that these hormonal changes are normal. D. Recommend continued observation for the next 1-2 years.

A. Palpate for any irregular or hard masses. Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 425.

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

A. They should be examined carefully along the surgical scar for masses. Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 426.

Which characteristics are present in a cancerous breast lesion? Select all that apply. A. irregular in shape B. elastic in consistency C. well delineated from surrounding tissue D. usually nontender E. may cause retraction of the nipple

A. irregular in shape D. usually nontender E. may cause retraction of the nipple Explanation: A cancerous breast is likely to be irregular in shape, firm or even hard to the touch, not clearly delineated, usually nontender, and may cause noticeable retraction of the nipple. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 425.

The lymph nodes that are responsible for drainage from the arms are the: A. lateral lymph nodes. B. central lymph nodes. C. anterior lymph nodes. D. posterior lymph nodes.

A. lateral lymph nodes.

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 A. tumor. B. fibrocystic breast. C. genetic deviation. D. fibroadenoma.

A. tumor. Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 424.

A nurse is performing a comprehensive assessment on an older female client. Which of the following observations about the breasts does the nurse determine as abnormal and requiring further assessment? A. unilateral dark discharge B. flatter, smaller nipples C. decrease in size D. pendulous

A. unilateral dark discharge Explanation: Unilateral dark discharge is not a normal finding and must be further assessed. Smaller, flatter nipples are normal age-related changes. Decrease in size and firmness of the breasts are due to decreased estrogen. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 416.

After performing an assessment on a new client, the nurse determines that the client is at high risk for breast cancer based on which of the following findings? Select all that apply. A. The client is currently using barrier methods of birth control. B. A family member died from breast cancer. C. The client started menses before the age of 12. D. The client has irregular menstrual cycles. E. The client gave birth to their first child after age 30.

B. A family member died from breast cancer. C. The client started menses before the age of 12. E. The client gave birth to their first child after age 30. Explanation: Risk factors for breast cancer include family history, early menses (before age 12) or delayed menses, menopause (after age 52), never giving birth or giving birth to the first child after age 30, and use of oral contraceptives. The use of barrier forms of birth control is not a risk factor for breast cancer. Irregular menses is not a risk factor. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 416.

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

B. Age, family history, reproductive history Explanation: While numerous risk factors have been identified for breast cancer, age, family history, and reproductive history are among the most significant. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 416.

While interviewing a client, the nurse asks her what her typical daily diet consists of. Which of the following is associated with an increased risk for breast cancer? A. Two cups of coffee per day B. High-fat diet C. A glass of wine daily D. High-sugar diet

B. High-fat diet Explanation: A high-fat diet may increase the risk for breast cancer. Alcohol intake exceeding two drinks per day and tobacco use has been associated with a higher risk for breast cancer. Caffeine can aggravate fibrocystic breast disease, but is not associated with breast cancer. A high-sugar diet is not associated with breast cancer. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, HEALTH ASSESSMENT, p. 416.

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? A. Breast cancer B. Inflammation C. Fibrocystic breast disease D. Extramammary duct location

B. Inflammation Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 415.

When palpating a breast, what must the nurse examine the breast tissue carefully for? (Select all that apply.) A. Dimples B. Nodules C. Tenderness D. Consistency E. Rash

B. Nodules C. Tenderness D. Consistency Explanation: Examine the breast tissue carefully for consistency of the tissues, tenderness, and nodules. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 425.

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

B. One breast larger than the other Explanation: Asymmetry in size of the breasts is a common benign finding. The others are concerning for underlying malignancy. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 422.

A nurse is teaching a client about self breast examination. What would the nurse emphasize? (Mark all that apply.) A. Pain B. Timing C. Palpation D. Inspection E. Pallor

B. Timing C. Palpation D. Inspection Explanation: It is important to guide clients through self breast examination that emphasizes timing, inspection, and palpation. Pain and pallor are not emphasized when teaching self breast examination. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 417.

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 A. nonsteroidal anti-inflammatory drugs. B. contraceptives. C. insulin. D. antibiotics.

B. contraceptives Explanation: Discharge may be seen in endocrine disorders and with certain medications (i.e., antihypertensives, tricyclic antidepressants, and estrogen). Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 416.

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? A. "Actually, the recent statistics show that BSE plays a key role in reducing a woman's risks of death from breast cancer." B. "It's true that BSE doesn't really help to detect cancerous masses, but it's still a good way to be systematic about assessing your own health." C. "BSE is certainly not a replacement for other screening methods, but a high proportion of breast masses are in fact detected by women themselves." D. "As long as you are conscientious about getting mammograms and clinical examinations regularly, there is likely no need for you to continue doing BSE."

C. "BSE is certainly not a replacement for other screening methods, but a high proportion of breast masses are in fact detected by women themselves." Explanation: While BSE does not reduce breast cancer mortality, the fact remains that a high proportion of breast masses are detected by women themselves. BSE should be coupled with mammography and clinical examination. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 417.

While palpating a client's nipples, the nurse notes a clear discharge from one breast. This unilateral discharge could best be explained by which of the following? Select all that apply. A. Endocrine disorder B. Tricyclic antidepressant use C. Benign intraductal papilloma D. Fibrocystic disease E. Cancer of the breast

C. Benign intraductal papilloma D. Fibrocystic disease E. Cancer of the breast Explanation: Discharge from one breast may indicate benign intraductal papilloma, fibrocystic disease, or cancer of the breast. Discharge may be seen in endocrine disorders and with certain medications (i.e., antihypertensives, tricyclic antidepressants, and estrogen), but it would tend to be bilateral in these cases. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 425.

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? A. Fibroadenoma B. Lipoma C. Paget's disease D. Mastalgia

C. Paget's disease Explanation: 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). Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 423.

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

C. Palpate the affected breast but avoid the scar Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 426.

During an instruction session on breast self-examination, the nurse would instruct a client to perform the exam at which time? A. Three days after the menstrual period begins B. Immediately before the menstrual period begins C. Right after the menstrual period ends D. On the 14th day of the menstrual period

C. Right after the menstrual period ends Explanation: The best time for breast self-examination is right after menstruation or between the fourth and seventh day of the cycle is regular. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, pp. 419-420.

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 A. additional tumors. B. poor lymphatic drainage. C. an infectious process. D. metastasis to the right breast.

C. an infectious process. Explanation: Redness and inflammation of the scar area may indicate infection. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 426.

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

C. fatty tissue. Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Internal Breast Anatomy, p. 414.

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? A. "The mammary ducts are in this region." B. "I'm checking the integrity of your fibrous tissue." C. "This is where most of the fatty breast tissue is located." D. "The upper outer quadrant of the breast extends into the axillae."

D. "The upper outer quadrant of the breast extends into the axillae." Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 425.

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

D. Appearance, feel, and shape of the breasts and nipples Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 417.

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? A. Inform the physician immediately B. Record the finding and proceed with the examination C. Ask the client whether she has any family history of breast cancer D. Ask the client whether the larger breast has increased in size recently

D. Ask the client whether the larger breast has increased in size recently Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 422.

The nurse practitioner is examining a client and notes an axillary lymph node approximately 1.5 cm in size, tender, and movable. The nurse practitioner also notes an erythematous 3-cm abrasion on the client's upper arm. The client tells the nurse practitioner that she fell in the garden while fertilizing her plants. What nursing diagnosis would the nurse practitioner include in the plan of care? A. Grieving related to probable diagnosis of breast cancer B. Inflammation related to abrasions C. Infectious process related to abrasions D. Fear related to possible diagnosis of breast cancer

D. Fear related to possible diagnosis of breast cancer Explanation: The greatest fear a woman has related to these symptoms is that she has breast cancer, although often the cause is benign. The scenario describes inflammation at the sight of the abrasion; it does not state that the client has an infectious process. Grieving would not be addressed prior to a diagnosis being confirmed. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Objective Data: Physical Examination, p. 427.

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

D. Palpates the breasts using an up and down approach Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, pp. 419-420.

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

D. Picking a set day of the month that the client will remember on which to perform BSE Explanation: 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. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, HEALTH ASSESSMENT, p. 417.

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 A. late menopause. B. a family history of breast cancer. C. consumption of a high-fat diet. D. having a baby before the age of 20 years.

D. having a baby before the age of 20 years. Explanation: Having a baby before 20 years of age does not increase the risk of breast cancer. The risk of breast cancer is greater for women who have never given birth or for those who had their first child after age 30. A family history of breast cancer, consumption of a high-fat diet, and late menopause are all factors that increase the risk of breast cancer. Reference: Weber, J.R., & Kelley, J.H., Health Assessment in Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 20: Assessing Breasts and Lymphatic System, Collecting Subjective Data: The Nursing Health History, p. 419.