Health assessment week 3
A 45-year-old farmer comes in for a skin evaluation and complains of hair loss on his head. He has noticed that his hair seems to be breaking off in patches and that he has some scaling on his head. The nurse would begin the examination suspecting: 1.tinea capitis. 2.tinea corporis. 3.toxic alopecia. 4.seborrheic dermatitis.
1
A 75-year-old woman who has a history of diabetes and peripheral vascular disease has been trying to remove a corn on the bottom of her foot with a pair of scissors. The nurse will encourage her to stop trying to remove the corn with her scissors because: 1.the woman could be at increased risk for infection and lesions because of her chronic disease. 2.with her diabetes, she has increased circulation to her foot and it could cause severe bleeding. 3.she is 75 years old and is unable to see, so she puts herself at greater risk for self- injury with the scissors. 4.with her peripheral vascular disease, her range of motion is limited and she may not be able to reach the corn safely.
1
A patient tells the nurse that he has noticed that one of his nevi has started to burn and bleed. When assessing his skin, the nurse would pay special attention to the danger signs for pigmented lesions and would be concerned with which additional finding? 1.Color variation 2.Border regularity 3.Symmetry of lesions 4.Diameter less than 6 mm
1
During an examination, the nurse finds that a patient has excess dryness of the skin. The best term to describe this condition is: 1.xerosis. 2.pruritus. 3.scoliosis. 4.seborritus.
1
The nurse is caring for a black child who has been diagnosed with marasmus. The nurse would expect to find: 1.the hair to be less kinky and to be a copper-red color. 2.the head to be larger than normal, with wide-set eyes. 3.the skin on the hands and feet to be scaly and tender. 4.the lymph nodes in the groin to be enlarged and tender.
1
The nurse is examining a patient who tells the nurse, "I sure sweat a lot, especially on my face and feet but it doesn't have an odor." The nurse knows that this could be related to: 1.the eccrine glands. 2.the apocrine glands. 3.a disorder of the stratum corneum. 4.a disorder of the stratum germinativum.
1
The nurse just noted from a patient's medical record that the patient has a lesion that is confluent in nature. On examination, the nurse would expect to find: 1.lesions that run together. 2.annular lesions that have grown together. 3.lesions arranged in a line along a nerve route. 4.lesions that are grouped or clustered together.
1
When performing an assessment of a 65-year-old man with a history of hypertension and coronary artery disease, the nurse notes the presence of pitting edema in the lower legs bilaterally. The skin is puffy and tight but of normal color. There is no increased redness or tenderness over his lower legs, and the peripheral pulses are equal and strong. In this situation, which of the following is the most likely cause of the edema? 1.Heart failure 2.Venous thrombosis 3.A local inflammation 4.Blockage of lymphatic drainage
1
The nurse needs to be familiar with the various lesions that may be identified on assessment of the skin. Match each description given below with the appropriate term. 1.Tiny punctate hemorrhages, 1-3 mm, round and discrete, dark red, purple, or brown in color 2.A large patch of capillary bleeding into tissues 3.A hypertrophic scar 4.Elevated cavity containing free fluid, up to 1 cm. Clear serum flows if wall is ruptured. 5.Also known as a friction blister 6.Solid, elevated, hard or soft, larger than 1 cm
1. Bulla 2. Petechiae 3. Nodule 4. Keloid 5. Vesicle 6. Ecchymosis (bruise) ASN: 2,6,4,5,1,3
A 22-year-old-woman comes to the clinic because of a severe sunburn and states, "I was just out in the sun for a couple of minutes." The nurse begins a medication review with her, paying special attention to the medication she is taking for: 1.pain. 2.acne. 3.heartburn. 4.hyperthyroidism.
2
A 40-year-old woman reports a change in mole size, accompanied by color changes, itching, burning, and bleeding over the past month. She has a dark complexion and has no family history of skin cancer, but she has had many blistering sunburns in the past. The nurse would would: 1.tell the patient to watch the lesion and report back in 2 months. 2.refer the patient because of the suspicion of melanoma on the basis of her symptoms. 3.ask additional questions regarding environmental irritants that may have caused this condition. 4.suspect that this is a compound nevus, which is very common in young to middle- aged adults.
2
A 52-year-old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she has noticed it for several months and it has slowly grown larger. The nurse suspects which condition? 1.Acne 2.Basal cell carcinoma 3.Malignant melanoma 4.Squamous cell carcinoma
2
A few days after a summer hiking trip, a 25-year-old man comes to the clinic with a rash. On examination, the nurse notes that the rash is red, macular, with a bull's eye pattern across his midriff and behind his knees. The nurse suspects: 1.rubeola. 2.Lyme disease. 3.allergy to mosquito bites. 4.Rocky Mountain spotted fever.
2
A patient has tingling sensations in her feet and has noticed that her tongue has become very red and painful. The nurse suspects that she has: 1.polycythemia. 2.pernicious anemia. 3.micronucleus anemia. 4.iron deficiency anemia.
2
A patient's mother has noticed that her son, who has been to a new babysitter, has some blisters and scabs on his face and buttocks. On examination, the nurse notices moist, thin-roofed vesicles with a thin erythematous base and suspects: 1.eczema. 2.impetigo. 3.herpes zoster. 4.diaper dermatitis.
2
A semiconscious woman is brought to the emergency department after she was found on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red color. The nurse suspects that this coloring is due to: 1.polycythemia. 2.carbon monoxide poisoning. 3.carotenemia. 4.uremia.
2
A thorough skin assessment is very important because the skin holds information about: 1.support systems. 2.circulatory status. 3.socioeconomic status. 4.psychological wellness.
2
During a skin assessment, the nurse notices that a Mexican-American patient has skin that is yellowish-brown in color. However, the skin on the hard/soft palate is a pink in color. From this finding, the nurse could probably rule out: 1.pallor. 2.jaundice. 3.cyanosis. 4.iron deficiency.
2
Jaundice is exhibited by a yellow skin color, indicating rising levels of bilirubin in the blood. Which of the following findings is indicative of true jaundice? 1.Yellow patches throughout the sclera 2.Yellow color of the sclera that extends up to the iris 3.Skin that appears yellow when examined under low light 4.Yellow deposits on the palms and soles of the feet where jaundice first appears
2
The nurse is assessing the skin of a patient who has AIDS and notices a widely disseminated, violet-colored tumor covering the skin and mucous membranes. The nurse would conclude that: 1.he is in the first stage of AIDS. 2.he is in the advanced stage of AIDS. 3.this person has been exposed to a viral infection. 4.these lesions indicate an advanced case of herpes zoster.
2
40. The nurse has discovered decreased skin turgor in a patient and knows that this is an expected finding in which of the following conditions? 1.Cases of severe obesity 2.During childhood growth spurts 3.In an individual who is severely dehydrated 4.With conditions of connective tissue disorders such as scleroderma
3
A 13-year old girl is interested in obtaining information about the cause of her acne. The nurse would share with her that acne is: 1.contagious. 2.caused by a poor diet. 3.found in about 70% of all teens. 4.has been found to be related to poor hygiene.
3
A 32-year-old female patient complains that she has noticed several small, slightly raised, bright red dots on her chest. On examination, the nurse expects that the spots are probably: 1.anascara. 2.scleroderma. 3.senile angiomas. 4.latent myeloma.
3
A 35-year-old pregnant woman comes to the clinic for a monthly appointment. During the assessment, the nurse notices that she has a brown patch of hyperpigmentation on her face. The nurse continues the skin assessment aware that another finding may be: 1.keratosis. 2.mitoasma. 3.linea nigra. 4.linea gravida.
3
A 70-year-old woman who loves to garden has small, flat, brown macules over her arms and hands. She asks, "What causes these liver spots?" The nurse tells her: 1."They are signs of decreased hematocrit related to anemia." 2."They are due to destruction of melanin in your skin from exposure to the sun." 3."They are clusters of melanocytes that appear after extensive sun exposure." 4."They are areas of hyperpigmentation related to decreased perfusion and vasoconstriction."
3
A black patient is in the intensive care unit because of impending shock after an accident. The nurse would expect to find what characteristics in this patient's skin? 1.Ruddy blue 2.Generalized pallor 3.Ashen, gray, or dull 4.Patchy areas of pallor
3
A newborn infant is in the clinic for a well-baby check. The nurse observes the infant for the possibility of fluid loss because of which of the following? 1.Subcutaneous fat deposits are high in the newborn 2.Sebaceous glands are over productive in the newborn 3.The newborn's skin is more permeable than that of the adult 4.The amount of vernix caseosa rises dramatically in the newborn
3
A patient comes in for a physical, and she complains of "freezing to death" while waiting for her examination. The nurse notes that her skin is pale and cool and attributes this finding to: 1.venous pooling. 2.peripheral vasodilation. 3.peripheral vasoconstriction. 4.decreased arterial perfusion.
3
A patient comes to the clinic and tells the nurse that he has been confined to his recliner chair for about 3 days with his feet down and he wants the nurse to evaluate his feet. During the assessment, the nurse might expect to find: 1.pallor. 2.coolness. 3.distended veins. 4.decreased capillary filling time.
3
A patient has been admitted for severe iron deficiency anemia. The nurse can expect to see what finding in the patient's fingernails? 1.Splinter hemorrhages 2.Paronchyia 3.Koilonychia (spoon nails) 4.Beau's lines
3
A patient is especially worried about an area of skin on her feet that has turned white. The health care provider has told her that her condition is vitiligo. The nurse explains to her that vitiligo is: 1.caused by an excess of melanin pigment. 2.caused by an excess of apocrine glands in her feet. 3.caused by the complete absence of melanin pigment. 4.related to impetigo and that it can be treated with an ointment.
3
A physician has diagnosed a patient with purpura. After leaving the room, a nursing student asks the nurse what the physician saw that led to that diagnosis. The nurse should say: 1."He is referring to that blue dilation of blood vessels in a star-shaped linear pattern on the legs." 2."He is referring to that fiery red, star-shaped marking on the cheek that has a solid circular center." 3."He is referring to that confluent and extensive patch of petechiae and ecchymoses on the feet." 4."He is referring to those tiny little areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in color."
3
An Inuit visiting Nevada from Anchorage has come to the clinic in July during the hottest part of the day. It so happens that the clinic's air conditioning is broken and the temperature is very hot. The nurse knows that which of the following is true about the Inuit sweating tendencies? 1.They will sweat profusely all over their bodies because they are not used to the hot temperatures. 2.They don't sweat because their diet is so high in roughage that their apocrine glands are less efficient in hot climates. 3.They will sweat more on their faces because this is an adaptation that has been made over time for survival in their environment. 4.They have an overabundance of eccrine sweat glands and so the nurse might expect them to have body odor because of the bacterial flora reacting with the apocrine sweat.
3
Because hair for humans is no longer needed for protection from cold or trauma, it is called: 1.vellus. 2.vagus. 3.vestigial. 4.vestibule.
3
The nurse is discussing epidermal appendages with a patient. Which of the following would be included in the discussion? 1.Skin 2.Arms 3.Sweat glands 4.Parotid glands
3
When assessing inflammation in a dark-skinned person, the nurse may need to: 1.assess the skin for cyanosis and swelling. 2.assess the oral mucosa for generalized erythema. 3.palpate the skin for edema and increased warmth. 4.palpate for tenderness and local areas of ecchymosis.
3
A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment of his skin, the nurse might expect to find the following: 1.anasarca. 2.scleroderma. 3.pedal erythema. 4.clubbing of the nails.
4
A father brings in his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says that his baby has not been able to keep any formula down and that the diarrhea has been at least every 2 hours. The nurse suspects dehydration. Where should the nurse test skin mobility and turgor in this infant? 1.Over the sternum 2.Over the forehead 3.Over the forearms 4.Over the abdomen
4
A man has come in to the clinic for a skin assessment because he is afraid he might have skin cancer. During the skin assessment the nurse notices several areas of pigmentation that look greasy, dark, and "stuck on" his skin. Which is the best prediction? 1.He probably has senile lentigines, which do not become cancerous. 2.He probably has actinic keratoses, a precursor to basal cell carcinoma. 3.He probably has acrochordons, precursors to squamous cell carcinoma. 4.He probably has seborrheic keratoses, which do not become cancerous.
4
A mother brings her child in to the clinic for an examination of the scalp and hair. She states that the child has developed some places where there are irregularly shaped patches with broken-off, stub-like hair and she is worried that this could be some form of premature baldness. She tells the nurse that the child's hair is always kept very short. The nurse reassures her by telling her that it is: 1.folliculitis and that it can be treated with an antibiotic. 2.traumatic alopecia that can be treated with antifungal medications. 3.tinea capitis and that it is highly contagious and needs immediate attention. 4.trichotillomania and that her child probably has a habit of twirling her hair absent- mindedly.
4
A newborn infant has Down syndrome. During the skin assessment, the nurse notices a transient mottling in the trunk and extremities in response to the cooler examination room temperature. The infant's mother also notices the mottling and asks what it is. The nurse knows that this mottling is called: 1.café au lait. 2.carotenemia. 3.acrocyanosis. 4.cutis marmorata.
4
A patient comes to the clinic and states that he has noticed that his skin is redder than normal. The nurse understands this condition to be due to hyperemia and knows that it can be caused by: 1.decreased amounts of bilirubin in the blood. 2.excess blood in the underlying blood vessels. 3.decreased perfusion to the surrounding tissues. 4.excess blood in the dilated superficial capillaries.
4
A patient has had a "terrible itch" for several months that he has been scratching continuously. On examination, the nurse might expect to find: 1.a keloid. 2.a fissure. 3.keratosis. 4.lichenification.
4
A woman is leaving on a trip to Hawaii and has come in for a checkup. During the examination the nurse notices that she is diabetic and takes oral hypoglycemic agents. She needs to be concerned about which of the following? 1.An increased possibility of bruising 2.Skin sensitivity as a result of exposure to salt water 3.Lack of availability of glucose monitoring supplies 4.The importance of sunscreen and avoiding direct sunlight
4
During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse knows that this is because of a decrease in the number of functioning: 1.metrocytes. 2.fungacytes. 3.phagocytes. 4.melanocytes.
4
The nurse educator is preparing an education module for the nursing staff on the dermis layer of skin. Which of the following would be included in the module? 1.The dermis contains mostly fat cells. 2.The dermis consists mostly of keratin. 3.The dermis is replaced every 4 weeks. 4.The dermis contains sensory receptors
4
The nurse educator is preparing an education module for the nursing staff on the epidermal layer of skin. Which of the following would be included in the module? 1.The epidermis is very vascular. 2.The epidermis is thick and tough. 3.The epidermis is thin and non-stratified. 4.The epidermis is replaced every 4 weeks.
4
The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry. This finding would be related to: 1.increased vascularity of the skin in the elderly. 2.increased numbers of sweat and sebaceous glands in the elderly. 3.an increase in elastin and a decrease in subcutaneous fat in the elderly. 4.an increased loss of elastin and a decrease in subcutaneous fat in the elderly.
4
The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the nurse would report this as a: 1.bulla. 2.wheal. 3.nodule. 4.papule.
4
The nurse notices that a patient has bluish-white, red-based spots in her mouth that are elevated about 1 mm to 3 mm. What other signs would the nurse expect to find in this patient? 1.A pink, papular rash on the face and neck 2.Pruritic vesicles over her trunk and neck 3.Hyperpigmentation on the chest, abdomen, and the back of the arms 4.A red-purple, maculopapular, blotchy rash behind the ears and on the face
4
Which of the following assessment findings is most consistent with clubbing of the fingernails? 1.A nail base that is firm to palpation and slightly tender 2.Curved nails with a convex profile and ridges across the nail 3.A nail base that feels spongy with an angle of the nail base of 150 degrees 4.An angle of the nail base of 180 degrees or greater with a nail base that feels spongy
4
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. 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
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 the changes in the mass each month." c. "The lump is probably nothing to worry about because it has been present for years and was determined to be noncancerous 5 years ago." d. "Because you are experiencing no pain and the size has not changed, you should 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 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 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
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 immediately report these. d. During pregnancy, breast changes are fairly uncommon; most of the changes occur after the birth.
A
During a routine visit, M.B, age 78, asks about small, round, flat, brown macule on the hands. What is your best response after assessing the areas? A) "These are the result of sun exposure and do not require treatment" B) " These are related to exposure to the sun, they may become cancerous" C) " These are the skin tags that occur with aging, no treatment is required" D) " I'm glad you brought this to my attention. I will arrange for a biopsy"
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. 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 as a physician checks her breasts annually.
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. 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
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
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. Black b. White c. Asian d. American Indian
A
To assess for early jaundice, you will assess: A) Sclera and hard palate B) Nail beds C) Lips D) All visible skin surfaces
A
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, F
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
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
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 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
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
Select the best description of the secretion of the eccrine glands. A) Thick, milky B) Dilute saline solution C) Protective lipid substance D) Keratin
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 glands, checking for drainage. b. Consider these findings as normal, and proceed with the examination. c. Ask extensive health history questions regarding the woman's breast asymmetry. d. Continue with the examination, and then refer the patient for further evaluation of the Montgomery glands.
B
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. Malnutrition b. Hyperthyroidism c. Type 2 diabetes mellitus d. Liver disease e. History of alcohol abuse
B, D, E
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 cancers occurs in men. d. Most breast masses in men are diagnosed as gynecomastia.
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 and 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 and 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 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. Breast development is usually fairly symmetric and that the daughter should be examined right away. b. She should bring in her daughter right away because breast cancer is fairly common in preadolescent girls. c. Although an examination of her daughter would rule out a problem, her breast development is most likely normal. d. It is unusual for breasts that are first developing to feel tender because they haven't developed much fibrous tissue.
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. Continual changes in her breasts are unusual. The breasts of nonpregnant women usually stay pretty much the same all month long. b. Breast changes in response to stress are very common and that she should assess her life for stressful events. c. Because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common. d. Breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time.
C
An area of thin shiny skin with decreased visibility of normal skin markings is most likely: A) Lichenification B) Plaque C) Atrophy D) Keloid
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
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. 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
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 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
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
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. This variation is normal and not a significant finding. b. This finding is significant and needs further investigation. c. A supernumerary nipple also contains glandular tissue and may leak milk during pregnancy and lactation. d. The patient is correct—a supernumerary nipple is actually a mole that happens to be located under the breast.
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. 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
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. Benign breast enlargement in men is not unusual. 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 recommend that he be thoroughly screened.
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 b. Pectoral, lateral, anterior, and sternal c. Central, lateral, pectoral, and subscapular d. Lateral, pectoral, axillary, and suprascapular
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. Shape of the lump b. Consistency of the lump c. 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 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 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 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
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 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
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
Which of the following statements is true regarding the internal structures of the breast? The breast is: 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.
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
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. 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 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 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
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
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
Which of these clinical situations would the nurse consider to be outside normal limits? a. A patient has had one pregnancy and states that she believes she may be entering menopause. Her breast examination reveals breasts that are soft and slightly sagging. 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 and 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
