Health Assessment Chapter 17 Breasts and Regional Lymphatics

The nurse is teaching an adolescent who was diagnosed with fibroadenoma in the left breast. Which statement by the nurse would be appropriate?

"It is benign and may resolve spontaneously."

The nurse is caring for a lactating patient who has a breast abscess on the right breast. Which instructions should the nurse provide to this patient?

"Nurse only on the unaffected side."

The number of lobes within the breast ranges from:

15 to 20.

An expected postmenopausal breast change is:

decreased breast size.

A known risk factor for breast cancer is:

early menarche or late menopause.

Gynecomastia occurs with:

liver cirrhosis.

Which intervention does the nurse perform while examining the axillae of a patient?

Move the arm through the range of motion.

The nurse is assessing a 13-year-old male patient who is concerned about the sudden enlargement of his breasts. Which responses by the nurse are appropriate? *Select all that apply.* *A.* "It is a normal but temporary occurrence at your age." *B.* "If the enlargement is only on one side, it is a cause for concern." *C.* "The enlargement will go away and may reappear in old age." *D.* "Further investigation may be needed for further diagnosis." *E.* "The enlargement is the result of a normal growth of breast tissue."

*A.* "It is a normal but temporary occurrence at your age." *C.* "The enlargement will go away and may reappear in old age." *E.* "The enlargement is the result of a normal growth of breast tissue."

While teaching a group of patients about breast cancer, which factors does the nurse relate to an increased risk of breast cancer? *Select all that apply.* *A.* Consumption of alcohol *B.* Intake of seafood and olive oil *C.* Postmenopausal weight gain *D.* Recreational physical activity *E.* Use of canned fish and mayonnaise

*A.* Consumption of alcohol *C.* Postmenopausal weight gain *E.* Use of canned fish and mayonnaise

Which factors are responsible for a 1.1 to 2.0 relative risk of breast cancer? *Select all that apply.* *A.* Exposure to diethylstilbestrol (DES) *B.* Mammographically dense breasts *C.* Absence of full-term pregnancies *D.* High-dose radiation to the chest *E.* Menopause after 55 years of age

*A.* Exposure to diethylstilbestrol (DES) *C.* Absence of full-term pregnancies *E.* Menopause after 55 years of age

The nurse is caring for a patient with benign fibrocystic breast disease. What does the nurse expect to find in this patient? *Select all that apply.* *A.* Presence of multiple tender masses *B.* Presence of irregularly shaped lumps *C.* Presence of dull, heavy, cyclic pain *D.* Presence of constant growth of lumps *E.* Presence of cysts and fibroadenomas

*A.* Presence of multiple tender masses *C.* Presence of dull, heavy, cyclic pain *E.* Presence of cysts and fibroadenomas

Which areas does the nurse examine to rule out any obstruction of lymphatic drainage? *Select all that apply.* *A.* The axillary region *B.* The midclavicular region *C.* The inframammary ridge *D.* The infraclavicular region *E.* The supraclavicular region

*A.* The axillary region *D.* The infraclavicular region *E.* The supraclavicular region

What does the nurse teach a patient about changes in the breast during pregnancy? *Select all that apply.* *A.* Changes in the breast begin in the fourth month. *B.* Breast milk is produced 1 to 3 days after delivery. *C.* Colostrum is rich in proteins, lactose, and fat. *D.* The breast surface develops a venous pattern. *E.* Colostrum may be expressed beginning in the fourth month of pregnancy.

*B.* Breast milk is produced 1 to 3 days after delivery. *D.* The breast surface develops a venous pattern. *E.* Colostrum may be expressed beginning in the fourth month of pregnancy.

What are the appropriate nursing interventions while examining the breast of a male patient? *Select all that apply.* *A.* Encourage the standard screening mammography. *B.* Palpate the nipple area and axillary lymph nodes. *C.* Combine with the examination of the anterior thorax. *D.* Inspect the chest wall and the skin surface for lumps. *E.* Refer mobile tissue under the nipple for investigation.

*B.* Palpate the nipple area and axillary lymph nodes. *C.* Combine with the examination of the anterior thorax. *D.* Inspect the chest wall and the skin surface for lumps.

The nurse is assessing a nonpregnant patient who reports spontaneous nipple discharge. What are appropriate interventions by the nurse? *Select all that apply.* *A.* Depress the nipple tissue with the fingertips. *B.* Press the areola inward with the index finger. *C.* Note the quadrant producing the discharge. *D.* Note the number of droplets being discharged. *E.* Wipe off the droplets with a soft tissue or towel.

*B.* Press the areola inward with the index finger. *C.* Note the quadrant producing the discharge. *D.* Note the number of droplets being discharged.

What interventions are appropriate for a nurse caring for a 22-year-old female patient who expresses the desire to learn the process of breast self-examination (BSE)? *Select all that apply.* *A.* Perform BSE just before the menstrual period. *B.* Provide the patient with a pamphlet about BSE. *C.* Encourage a return demonstration of the teaching. *D.* Tell the patient to inspect the breasts in the shower. *E.* Instruct the patient to palpate in a supine position.

*B.* Provide the patient with a pamphlet about BSE. *C.* Encourage a return demonstration of the teaching. *E.* Instruct the patient to palpate in a supine position.

Arrange the stages of breast development from the preadolescent stage to maturity in the order in which the changes take place. *1.* An elevated nipple with lactiferous ducts is present. *2.* The areola and nipple form a secondary mound over the breast. *3.* The areola widens and a small mound of breast and nipple develops. *4.* The areola is flush with the breast contour and only the nipple protrudes. *5.* The breast and areola enlarge and the nipple is flush with the breast surface.

1, 3, 5, 2, 4 *1.* An elevated nipple with lactiferous ducts is present. *3.* The areola widens and a small mound of breast and nipple develops. *5.* The breast and areola enlarge and the nipple is flush with the breast surface. *2.* The areola and nipple form a secondary mound over the breast. *4.* The areola is flush with the breast contour and only the nipple protrudes.

Which patient is likely to have mammary duct ectasia?

A perimenopausal woman who has lactated

The nurse is caring for a lactating patient. Which assessment finding indicates the presence of a plugged duct?

A section of the breast appears red and tender.

What is a normal finding in the breasts of a prepubertal child?

The areola has darker pigmentation with flat nipples.

What is a sign of skin tether in the breast?

The areola seems distorted and has a dimple

During the physical examination of a prepubertal child, the nurse documents "premature the larche." What does this indicate?

Early development of breasts without hormone-dependent signs

Which information should the nurse provide to a lactating patient with a plugged duct?

Ensure complete emptying of the breast.

The nurse is assessing a patient who reports finding a lump in the left breast. Which intervention by the nurse is most appropriate?

Examine the features of the right breast followed by the left breast.

The nurse is evaluating the relative risk for breast cancer in a patient. Which factor contributes to a relative risk greater than 4.0?

History of genetic mutations for BRCA1 or BRCA2

What is the cause of gynecomastia in a patient with Cushing syndrome?

Inability to metabolize estrogens

The nurse is assessing a patient with large, pendulous breasts for retraction. Which is the best intervention by the nurse?

Instruct the patient to lean forward as the nurse supports the arms.

Where does more than 75% of lymph from the breasts drain?

Ipsilateral axillary nodes

The nurse is caring for a patient with cracked nipples due to breastfeeding. What instructions should the nurse provide to the patient?

Keep the area clean, dry, and exposed to the air.

The nurse is caring for a patient with a plugged duct. How much time does it take to resolve this condition if properly treated?

Less than a day

The nurse is assessing a patient in the perimenopausal stage. The patient has itching and burning around the nipple with white purulent discharge. What is the likely diagnosis for this patient?

Mammary duct ectasia

What is the term used by the nurse to describe pain in the breast?

Mastalgia

The nurse is caring for a patient in the second month of lactation. The patient has an inflammatory mass forming outward from the areola and flu-like symptoms. What is the diagnosis for this patient?

Mastitis

The breast has four groups of axillary nodes. Where is the central axillary node located?

Over the ribs and serratus anterior muscle

Which assessment finding does the nurse associate with fibrocystic disease?

Pain increase before menses

What assessment finding does the nurse identify with gynecomastia in an older male patient?

Presence of a bilateral, tender, firm mass

Which assessment finding in a patient may indicate breast cancer?

Presence of a unilateral, dense, irregular mass

The nurse is assessing a patient who reports feeling nodules in the breast. Further assessment reveals that the patient is in the midcycle of menstruation. What is the best intervention by the nurse?

Repeat the examination a week after menstruation.

What is the best intervention by the nurse while assessing a patient over the age of 50?

Suggest use of talcum powder for breast self-examination.

What changes related to aging does the nurse expect to find during the examination of the breast in an elderly patient?

The breasts decrease in size and elasticity.

The nurse is assessing a patient's breasts. Which finding does the nurse identify as abnormal?

The presence of localized redness with heat

Which assessment finding does the nurse associate with a diagnosis of peau d'orange?

The skin is thickened, and the hair follicles exaggerated.

Which part of the breast is called the tail of Spence?

The superior lateral corner

The nurse is assessing a patient after a mastectomy on the right side. Which assessment finding is a cause for concern?

There is redness and warmth around the scar.

The nurse is doing a breast assessment of a pregnant patient. On palpitation, the nurse finds that the breasts feel nodular. The patient does not complain of any pain. What does the nurse deduce from these findings?

This is a normal finding.

The nurse takes special care while checking a patient's tail of Spence. What is the reason for this intervention?

To detect breast cancer

Before a breast examination, the nurse asks the patient to lie down and raise her arms. What is the rationale behind this instruction?

To flatten the breast tissue

What is the function of the Cooper's ligaments in the breast?

To support the breast tissue

A normal common breast variation is:

a supernumerary nipple.

The group of axillary lymph nodes that drains the other three groups of nodes is the:

central nodes.

The relative proportion of glandular, fibrous, and adipose breast tissue depends on:

nutritional state.

An older woman is having an annual mammogram. Before the mammogram, the nurse does a breast examination. Expected normal findings would include:

palpable, firm, stringy lactiferous ducts.

Breast development in an adolescent girl usually:

precedes menstruation by about 2 years.

The most common site of cancerous breast tumors is in the:

upper outer quadrant.