Chapter 18: Breasts and Axillae, Jarvis

Which description would be characteristic of fibroadenoma? A. Solid, hard, and dense solitary mass B. Freely movable and feels firm and elastic C. Irregular and poorly delineated borders D. Usually found in the upper outer quadrant

B. Freely moveable and feels firm and elastic A fibroadenoma is a benign tumor that is a freely movable solitary mass. It feels firm and elastic. A cancerous lump is a solid, hard, and dense solitary mass, whereas a fibroadenoma is a solid, firm, and rubbery mass. Pg 405

State the stages of breast development from preadolescent to maturity in the order it takes place. - the areola is flush with the breast contour, and only the nipple protrudes - the breast and areola enlarge, and the nipple is flush with the breast surface - the areola widens and a small mound of breast and nipple develops - the areola and nipple form a secondary mound over the breast - an elevated nipple with lactiferous ducts is present

- an elevated nipple with lactiferous ducts is present - the areola widens and a small mound of breast and nipple develops - the breast and areola enlarge, and the nipple is flush with the breast surface - the areola and nipple form a secondary mound over the breast - the areola is flush with the breast contour, and only the nipple protrudes pg 386

The largest amount of glandular breast tissue lies in the: a. upper inner quadrant. b. lower inner. c. tail of Spence. d. upper outer quadrant. e. lower outer.

ANS: D The greatest amount of glandular tissue in the breast lies in the upper outer quadrant. Tail of Spence, the cone shape of breast tissue that projects up into the axilla, close to the pectoral group of axillary lymph nodes, is part of the upper outer quadrant. pg 384

In which location would the Montgomery glands be found? a. Axilla b. Areola c. Nipple d. Glandular tissue

B. Areola Montgomery glands are small and elevated sebaceous glands located in the areola. They secrete a protective lipid material during lactation. Pg 383

During an annual physical examination, a 43-year-old patient states that she does not perform monthly breast self-examinations (BSEs). 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. BSEs are unnecessary until the age of 50 years. c. She is correct—mammography is a good replacement for BSE. d. She does not need to perform BSEs as long

a. BSEs may detect lumps that appear between mammograms. The monthly practice of BSE, along with clinical breast examination and mammograms, are complementary screening measures. Mammography can reveal cancers too small to be detected by the woman or by the most experienced examiner. However, interval lumps may become palpable between mammograms.

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

a. Black The incidence of breast cancer varies within different cultural groups. White women have a higher incidence of breast cancer than black women starting at age 45 years; but black women have a higher incidence before age 45 years. Asian, Hispanic, and American Indian women have a lower risk for development of breast cancer (American Cancer Society, 2009-2010).

Which factors increase the risk of breast cancer? Select all that apply. a. Consumption of alcohol b. Intake of fruits and vegetables c. Post menopausal weight gain d. Recreational physical activity e. Intake of seafood and olive oil

a. Consumption of alcohol c. Post menopausal weight gain Pg. 391, Table 18.2

A patient is newly diagnosed with benign breast disease. The nurse recognizes which statement about benign breast disease to be true? The presence of benign breast disease: a. Makes it hard 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. Makes it hard to examine the breasts. The presence of benign breast disease (formerly fibrocystic breast disease) makes it hard to examine the breasts; the general lumpiness of the breast conceals a new lump. The other statements are not true.

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 38.3° C. She also has had symptoms of influenza, 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 disease c. Plugged milk duct d. Mammary duct ectasia

a. Mastitis The symptoms describe mastitis, which stems from an infection or stasis caused by a plugged duct. A plugged duct does not have infection present. Table 18.6, pg 407

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 is aware 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. Nontender mass d. Hard, dense, and immobile f. Irregular, poorly delineated border Cancerous breast masses are solitary, unilateral, and nontender. They are solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive. Their borders are irregular and poorly delineated. They are often painless, although the person may experience pain. They are most common in the upper outer quadrant. A dull, heavy pain on palpation and a mass with a rubbery texture and a regular bord

The nurse is discussing BSEs with a postmenopausal woman. The best time for postmenopausal women to perform BSEs is: a. On the same day every month. b. Daily, during the shower or bath. c. One week after her menstrual period. d. Every year with her annual gynecologic examination.

a. On the same day every month. Postmenopausal women are no longer experiencing regular menstrual cycles but need to continue to perform BSEs on a monthly basis. Choosing the same day of the month is a helpful reminder to perform the examination.

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 the arms raised over her head b. Sitting with the arms relaxed at her sides c. Supine with the arms relaxed at her sides d. Sitting with the arms flexed and fingertips touching her shoulders

a. Supine with the arms raised over her head The nurse should help the woman to a supine position, tuck a small pad under the side to be palpated, and help the woman raise her arm over her head. These maneuvers will flatten the breast tissue and medially displace it. Any significant lumps will then feel more distinct.

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

a. The girl began to develop breasts. Full development from stage 2 to stage 5 takes an average of 3 years, although the range is 1 to 6 years. Pubic hair develops during this time, and axillary hair appears 2 years after the onset of pubic hair. The beginning of breast development precedes menarche by approximately 2 years. Menarche occurs in breast development stage 3 or 4, usually just after the peak of the adolescent growth spurt, which occurs around age 12 years. Table 18.1 pg 386

Which breast change is typical after menopause? a. Thickening of the inframammary ridge b. Hypertrophy of glandular tissue c. Increase in number of lactiferous ducts d. Reduction of fat deposits e. Shortening of Cooper's ligaments

a. Thickening of the inframammary ridge After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper's ligaments relax.

The nurse is assisting with a BSE 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. Woman whose nipples are in different planes (deviated). The nipples should be symmetrically placed on the same plane on the two breasts. With deviation in pointing, an underlying cancer may cause fibrosis in the mammary ducts, which pulls the nipple angle toward it. The other examples are normal findings pg 393

In a woman complaining of a breast lump it is most important to ask about: a. its relationship to menses. b. weight gain. c. sleep patterns. d. immunization status. e. alcohol consumption.

a. its relationship to menses. Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation.

Which signs and symptoms indicate fibrocystic disease? Select all that apply. a. mastalgia b. nipple discharge c. asymmetry in breast size d. swelling and tenderness e. jagged linear stretch marks

a. mastalgia b. nipple discharge d. swelling and tenderness Table 18.4, pg 405

A peppering of non-tender nonsuppurative Montgomery tubercles is considered to be a: a. normal finding. b. sign of carcinoma. c. skin disease. d. symptom of malnutrition. e. sign of late menarche.

a. normal finding Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.

Which instruction is given to the patient during a screening for retraction of the breasts? Select all that apply. a. push the palms together b. put both hands on the hips c. rotate the hips to the opposite side d. lift both arms slowly over the head e. lie down and raise an arm over the head

a. push the palms together b. put both hands on the hips d. lift both the arms slowly over the head Growing neoplasms cause fibrosis in the breast, and the breast tissue shows signs of retraction. When the arms are lifted, the nurse observes for symmetric upward movements. A lag in movement is a sign of reraction. Hands on hips followed by pushing the palms together contract the pectoralis major muscles, causing a slight lifting of both the breasts. A dimpling or pucker indicates skin retraction. pg 394

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? 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. "Breastfeeding provides the perfect food and antibodies for your baby." Exclusively breastfeeding for 6 months provides the perfect food and antibodies for the baby, decreases the risk of ear infections, promotes bonding, and provides relaxation.

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. "I would like some more information about the pain in your left breast." Breast pain occurs with trauma, inflammation, infection, or benign breast disease. The nurse will need to gather more information about the patient's pain rather than make statements that ignore the patient's concerns.

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 the young girl 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; breast budding is a normal finding.

b. Assess the girl's weight and body mass index (BMI). Research has shown that girls with overweight or obese BMI levels have a higher occurrence of early onset of breast budding (before age 8 years for black girls and age 10 years for white girls) and early menarche.

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

b. Fibrous, glandular, and adipose tissues. The breast is made up of glandular, fibrous (including the suspensory ligaments), and adipose tissues. Pg. 383

The nurse is examining a 62-year-old man and notes that he has bilateral gynecomastia. The nurse should explore his health history for which related conditions? Select all that apply. a. Malnutrition b. Hyperthyroidism c. Type 2 diabetes mellitus d. Liver disease e. History of alcohol abuse

b. Hyperthyroidism d. Liver disease e. History of alcohol abuse Gynecomastia occurs with Cushing syndrome, liver cirrhosis, adrenal disease, hyperthyroidism, and numerous drugs, such as alcohol and marijuana use, estrogen treatment for prostate cancer, antibiotics (metronidazole, isoniazid), digoxin, angiotensin-converting enzyme (ACE) inhibitors, diazepam, and tricyclic antidepressants.

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. Ipsilateral axillary The breast has extensive lymphatic drainage. Most of the lymph, more than 75%, drains into the ipsilateral, or same side, axillary nodes. pg. 384

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.

b. Palpate the unaffected breast first. If the woman mentions a breast lump she has discovered herself, then the nurse should examine the unaffected breast first to learn a baseline of normal consistency for this individual.

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. Retracted nipple. c. Nipple inversion. d. Deviation in nipple pointing.

b. Retracted nipple. The retracted nipple looks flatter and broader, similar to an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. It also may occur with benign lesions such as ectasia of the ducts. The nurse should not confuse retraction with the normal long-standing type of nipple inversion, which has no broadening and is not fixed.

Inspection of the breasts usually begins with the patient in which position? a. Lateral b. Sitting c. Standing d. Supine e. Prone

b. Sitting Inspection begins with the patient in a sitting position with arms hanging loosely at the sides. pg 392

In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. 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. The location of most breast tumors. The upper outer quadrant is the site of most breast tumors. In the upper outer quadrant, the nurse should notice the axillary tail of Spence, the cone-shaped breast tissue that projects up into the axilla, close to the pectoral group of axillary lymph nodes.

Documentation of a breast mass location is: a. according to illustration without a narrative. b. according to clock positions from the nipple. c. measured with calipers from the nipple. d. measured in centimeters from the sternal notch. e. measured in centimeters from the axilla.

b. according to clock positions from the nipple Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well. Documentation should include: location, size, shape, consistency, movable, distinctness, nipple, skin over the lump, tenderness, lymphadenopathy pg 397, 398

Recent unilateral inversion of a previously everted nipple suggests: a. obesity. b. cancer. c. benign breast disease. d. pregnancy. e. mastitis.

b. cancer Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition. pg. 393; pg 403 Table 18.3

When palpating breast tissue the examiner should use the _____ at each site. a. fingertips b. finger pads c. palms of the hands d. the ulnar surface of the hands e. thumbs

b. finger pads The finger pads are used for breast palpation because they are more sensitive than the fingertips. pg. 395

Which description would be characteristic of fibroadenoma? a. solid, hard, and dense solitary mass b. freely movable and feels firm and elastic c. irregular and poorly delineated borders d. usually found in the upper outer quadrant

b. freely movable and feels firm and elastic A benign tumor that is a freely movable solitay mass. It feels firm and elastic; fingers slide it easily thorugh tissue. Table 18.4, pg 405

Male gynecomastia associated with recreational or prescription drug use can be expected to: a. lessen when the body becomes accustomed to the drug. b. resolve after the drug is discontinued. c. leave permanent breast enlargement when the drug is discontinued. d. cause purulent drainage if left untreated. e. lead to an increased risk of breast cancer.

b. resolve after the drug is discontinued. Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention. pg 399

The nurse is preparing to teach a woman about 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 become familiar with your own breasts and feel their normal variations." d. "BSE will save your life because you are likely to find a cancerous lump between mammograms."

c. "BSE on a monthly basis will help you become familiar with your own breasts and feel their normal variations." The nurse should stress that a regular monthly BSE will familiarize the woman with her own breasts and their normal variations. BSE is a positive step that will reassure her of her healthy state. While teaching, the nurse should focus on the positive aspects of BSE and avoid citing frightening mortality statistics about breast cancer, which may generate excessive fear and denial

A 55-year-old postmenopausal woman is concerned about changes in her breasts over the past 5 years. They have decreased in size and are "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 after menopause c. "Decreases in hormones after menopause causes atrophy of the glandular tissue in the breast and is a normal process of aging."

c. "Decreases in hormones after menopause causes atrophy of the glandular tissue in the breast and is a normal process of aging." The hormonal changes of menopause cause the breast glandular tissue to atrophy, making the breasts more pendulous, flattened, and sagging.

During a discussion about BSEs 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. "Examine your breasts shortly after your menstrual period each month." The best time to conduct a BSE is shortly after the menstrual period when the breasts are the smallest and least congested.

During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for approximately 2 weeks. In trying to find the cause of the rash, which question would be important for the nurse to ask? a. "Is the rash raised and red?" b. "Does it appear to be cyclic?" c. "Where did the rash 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. "Where did the rash first appear—on the nipple, the areola, or the surrounding skin?" The location where the rash first appeared is important for the nurse to determine. Paget disease starts with a small crust on the nipple apex and then spreads to the areola. Eczema or other dermatitis rarely starts at the nipple unless it is a result of breastfeeding. It usually starts on the areola or surrounding skin and then spreads to the nipple pg 389

Most of the benefit of mammography screening occurs in which age group? a. 24 to 50 b. 35 to 49 c. 50 to 74 d. 65 to 84 e. Over age 75

c. 50 to 74 Breast cancer mortality is reduced with mammography screening, although estimates are of borderline statistical significance, the magnitudes of effect are small for younger ages, and results vary depending on how cases were accrued in trials. Most of the benefits of mammography results from screening during ages 50 to 74 years. There are insufficient data to assess the benefits and harms of screening women age 75 years or older.

A concerned mother of a 10yo describes a unilateral enlargement of the right breast with associated tenderness. What would be the nurse's best response? a. Breast development is usually fairly symmetric and the daughter should be examined right away. b. She should bring in her daughter right away because breast cancer is prevalent in adolescent girls c. Although an examination of her daughter would rule out a problem, her breast development is most likely normal.

c. Although an examination of her daughter would rule out a problem, her breast development is most likely normal. Occasionally, one breast may grow faster than the other, producing a temporary asymmetry, which may cause some distress; reassurance is necessary. Tenderness is also common.

During a health 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. Immediately contact the physician to report the discharge. b. Ask her if she is possibly pregnant. c. Ask the patient some additional questions about the medications she is taking. d. Immediately obtain a sample for culture and sensitivity testing.

c. Ask the patient some additional questions about the medications she is taking. The use of some medications, such as oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, and calcium channel blockers, may cause clear nipple discharge. Bloody or blood-tinged discharge from the nipple, not clear, is significant, especially if a lump is also present. In the pregnant female, colostrum would be a thick, yellowish liquid, and it would be normally expressed after the fourt

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. Asymmetry of breast size and shape is probably due to breastfeeding and is nothing to worry about. c. Asymmetry is not unusual, but the nurse should verify that this change is not new. d. Asymmetry of breast size and shape is very unusual and means she may have an inflammation or growth.

c. Asymmetry is not unusual, but the nurse should verify that this change is not new. The nurse should notice symmetry of size and shape. It is common to have a slight asymmetry in size; often the left breast is slightly larger than the right. A sudden increase in the size of one breast signifies inflammation or new growth.

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

c. Black women are more likely to die of breast cancer at any age. Black women have a higher incidence of breast cancer before age 45 years than white women and are more likely to die of their disease. In addition, black women are significantly more likely to be diagnosed with regional or distant breast cancer than are white women. These racial differences in mortality rates may be related to an insufficient use of screening measures and a lack of access to health care.

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 b. Pectoral, lateral, anterior, and sternal c. Central, lateral, pectoral, and subscapular d. Lateral, pectoral, axillary, and suprascapular

c. Central, lateral, pectoral, and subscapular The breast has extensive lymphatic drainage. Four groups of axillary nodes are present: (1) central, (2) pectoral (anterior), (3) subscapular (posterior), and (4) lateral. Pg. 384- 385, Figure 18.4

A 70-year-old male patient has bilateral gynecomastia. Which of the following describes the nurse's best course of action? a. Recommend making an appointment with his HCP for a mammogram. b. Ignore it. Benign breast enlargement in men is normal. c. Explain that this condition may be the result of hormonal changes, and recommend that he see his physician. d. Explain that gynecomastia in men is usually associated with prostate enlargement and he should see his HCP immediately

c. Explain that this condition may be the result of hormonal changes, and recommend that he see his physician. Gynecomastia may reappear in the aging man and may be attributable to a testosterone deficiency.

A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer? a. Drinking three glasses of wine per week b. Early menopause c. Nulliparity d. Late menarche e. Young age at birth of first child

c. Nulliparity Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily. Table 18.2 pg 391

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 which statement about breast cancer in men 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 cancers occurs in men. d. Most breast masses in men are diagnosed as gynecomastia.

c. One percent of all breast cancers occurs in men. One percent of all breast cancers occurs in men. The early spreading to axillary lymph nodes is attributable to minimal breast tissue.

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. Peau d'orange. This condition is known as peau d'orange. Lymphatic obstruction produces edema, which thickens the skin and exaggerates the hair follicles. The skin has a pig-skin or orange-peel appearance, and this condition suggests cancer.

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. No associated retraction of the skin or nipple, no erythema, and no axillary lymphadenopathy are observed. What information is missing from the documentation? a. Shape of the lump b. Consistency of the lump c. Size of the lump d. Whether the lump is solitary or multiple

c. Size of the lump If the nurse feels a lump or mass, then he or she should note these characteristics: (1) location, (2) size—judge in centimeters in three dimensions: width length thickness, (3) shape, (4) consistency, (5) motility, (6) distinctness, (7) nipple, (8) the skin over the lump, (9) tenderness, and (10) lymphadenopathy. pgs 397, 398

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. Immediately discontinue nursing to allow for healing. c. Temporarily discontinue nursing on the affected breast, and manually express milk and discard it. d. Temporarily discontinue nursing on affected breast, but manually express milk and give it to the baby.

c. Temporarily discontinue nursing on the affected breast, and manually express milk and discard it. With a breast abscess, the patient must temporarily discontinue nursing on the affected breast, manually express the milk, and then discard it. Nursing can continue on the unaffected side.

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

c. The best time to perform a BSE is 4 to 7 days after the first day of the menstrual period. The best time to perform BSE is right after the menstrual period (day 4 to 7 of the cycle), when the breasts are the smallest and least congested. Health Promotion and Patient Teaching- Teach Breast Self Examination pg 401, box 18.21

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. Unilateral inversion of a nipple is always a serious sign. c. Whether the inversion is a recent change should be determined. d. Nipple inversion is not significant unless accompanied by an underlying palpable mass.

c. Whether the inversion is a recent change should be determined. The nurse should distinguish between a recently retracted nipple from one that has been inverted for many years or since puberty. Normal nipple inversion may be unilateral or bilateral and usually can be pulled out; that is, if it is not fixed. Recent nipple retraction signifies acquired disease pg 393

In patients with breast cancer peau d'orange skin is often first evident: a.in the axilla. b. in the upper inner quadrant. c. on or around the nipple. d. at the inframammary ridge. e. in the tail of Spence.

c. on or around the nipple The areola is the most common initial site to visualize peau d'orange skin. Abnormal finding- Edema (Peau d'Orange) Widespread peaux d'orange results from skin infiltration of cancer and skin edema. pg 404

Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is non-tender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed: a. retention cyst. b. case of Paget disease. c. supernumerary nipple. d. fat necrosis. e. Montgomery tubercle.

c. supernumerary nipple. Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the "milk line"). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples. pg 393

Which assessment finding may indicate breast cancer? a. oval, freely movable mass b. firm, rubbery, elastic mass c. unilateral, dense, irregular mass d. thick tissue in hte lower quadrant

c. unilateral, dense, irregular mass Cancers that spread into surrounding breast tissue are invasive cancers. May present as a solitary, unilateral, 3-dimensional, usually nontender mass. pg 405

During examination, the 9yr old patient asks, "Am I normal? I don't need a bra yet, but my friends do. The nurse's best response would be: a. "Don't worry, you still have plenty of time" b. "You're just a late bloomer. 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. "I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age." Adolescent breast development usually begins between 8 and 10 years of age. The nurse should not belittle the girl's feelings by using statements like "don't worry" or by sharing personal experiences. The beginning of breast development precedes menarche by approximately 2 years.

The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? a. "Your breast milk is immediately present after the delivery of your 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 nutrients as breast milk." d. "You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy."

d. "You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy." After the fourth month, colostrum may be expressed. This thick yellow fluid is the precursor of milk, and it contains the same amount of protein and lactose but practically no fat. The breasts produce colostrum for the first few days after delivery. It is rich with antibodies that protect the newborn against infection; therefore, breastfeeding is important.

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. 65 year old whose mother had breast cancer Risk factors for breast cancer include having a first-degree relative with breast cancer (mother, sister, or daughter) and being older than 50 years of age. (Refer to Table 18.2 for other risk factors.)

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, and note any lag or retraction. d. Slowly lift her arms above her head, and note any retraction or lag in movement.

d. Slowly lift her arms above her head, and note any retraction or lag in movement. The woman should be directed to change position while checking the breasts for signs of skin retraction. Initially, she should be asked to lift her arms slowly over her head. Both breasts should move up symmetrically. Retraction signs are due to fibrosis in the breast tissue, usually caused by growing neoplasms. The nurse should notice whether movement of one breast is lagging. pg 393, 394

Around 75% of women are menstruating by which Tanner stage of breast development? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Stage 5

d. Stage 4 About one-fourth of women begin menstruation at stage 4. Around 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5. pg 386

Which condition is more common in African American women than in white women? a. Light areolae b. Nipple inversion c. Retracted areolae d. Supernumerary nipples e. Nipple and areolar colors do not match

d. Supernumerary nipples The incidence of supernumerary nipples is higher in African American women than in white women.

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

d. The glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag. After menopause, the glandular tissue atrophies and is replaced with connective tissue. The fat envelope also atrophies, beginning in the middle years and becoming significant in the eighth and ninth decades of life. These changes decrease breast size and elasticity; consequently, the breasts droop and sag, looking flattened and flabby. pg 401

To spread the breast tissue evenly over the chest wall you should ask the woman to lie supine with: a. her arms straight alongside her body. b. both arms overhead with her palms upward. c. her hands clasped just above her umbilicus. d. one arm overhead and a pillow under her shoulder. e. both hands pressed against her hips.

d. one arm overhead and a pillow under her shoulder. Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder. pg 395

If a firm transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient's breast you should: a. ask the patient if she has a history of breast cancer. b. refer the patient for a biopsy. c. ask the patient to have a mammogram as soon as possible. d. record the finding in the patient's record. e. tell the patient to stop drinking alcohol.

d. record the finding in the patient's record. The inframammary ridge thickens and can be felt more easily with age. It is an expected normal finding without indications for further action. pg 401

You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area you suspect that you felt a node. To improve your hooked technique you should: a. apply lotion to your hands. b. use both hands simultaneously. c. ask the patient to press both palms together. d. ask the patient to lower her shoulder on that side. e. ask the patient to turn her head toward that side.

e. ask the patient to turn her head toward that side. Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa.

You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are symmetrical with bilateral multiple tender masses that are freely movable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with: a. fibroadenoma. b. Paget disease. c. cancer. d. mammary duct ectasia. e. fibrocystic changes.

e. fibrocystic changes. Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.

When examining axillary lymph nodes the patient's arm is: a. raised full above the head. b. extended at the side. c. pressed against the hip. d. crossed over the chest. e. flexed at the elbow.

e. flexed at the elbow To examine the axilla, support the patient's lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla. pg 395

Montgomery tubercles are most prominent in the breasts of: b. patients with lung disease. c. adolescent girls. d. prepubertal girls. e. pregnant women.

e. pregnant women Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women.