Question 1

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?

Accepted Answer

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.

Question 2

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:

Accepted Answer

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.

Question 3

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:

Accepted Answer

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.

Question 4

During the physical examination,the nurse notices that a female patient has an inverted left nipple.Which statement regarding this is most accurate?

Accepted Answer

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 (see Table 17-3).

Question 5

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,and nontender,with borders that are not well defined.The nurse replies:

Accepted Answer

A lump that has been present for years and is not exhibiting changes may not be serious but should still be explored.Any recent change or a new lump should be evaluated.The other responses are not correct.

Question 6

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?

Accepted Answer

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.

Question 7

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?

Accepted Answer

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.

Question 8

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?

Accepted Answer

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.

Question 9

When a breastfeeding mother is diagnosed with a breast abscess,which of these instructions from the nurse is correct? The mother needs to:

Accepted Answer

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.

Question 10

The nurse is preparing to teach a woman about BSE.Which statement by the nurse is correct?

Accepted Answer

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 that can obstruct a woman's self-care actions.

Question 11

Which of these clinical situations would the nurse consider to be outside normal limits?

Accepted Answer

If any discharge appears,the nurse should note its color and consistency.Except in pregnancy and lactation,any discharge is abnormal.In nulliparous women,normal breast tissue feels firm,smooth,and elastic; after pregnancy,the tissue feels soft and loose.Premenstrual engorgement is normal,and consists of a slight enlargement,tenderness to palpation,and a generalized nodularity.A firm,transverse ridge of compressed tissue in the lower quadrants,known as the inframammary ridge,is especially noticeable in large breasts.

Question 12

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?

Accepted Answer

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 17- 2 for other risk factors.)

Question 13

A 55-year-old postmenopausal woman is being seen in the clinic for her annual 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:

Accepted Answer

The hormonal changes of menopause cause the breast glandular tissue to atrophy,making the breasts more pendulous,flattened,and sagging.

Question 14

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:

Accepted Answer

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.

Question 15

The nurse is assisting with a BSE clinic.Which of these women reflect abnormal findings during the inspection phase of breast examination?

Accepted Answer

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 (see Table 17-3).

Question 16

The nurse is conducting a class on BSE.Which of these statements indicates the proper BSE technique?

Accepted Answer

The nurse should help each woman establish a regular schedule of self-care.The best time to conduct a BSE is right after the menstrual period,or the fourth through seventh day of the menstrual cycle,when the breasts are the smallest and least congested.The pregnant or menopausal woman who is not having menstrual periods should be advised to select a familiar date to examine her breasts each month-for example,her birth date or the day the rent is due.

Question 17

During a discussion about BSEs with a 30-year-old woman,which of these statements by the nurse is most appropriate?

Accepted Answer

The best time to conduct a BSE is shortly after the menstrual period when the breasts are the smallest and least congested.

Question 18

The nurse is discussing BSEs with a postmenopausal woman.The best time for postmenopausal women to perform BSEs is:

Accepted Answer

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.

Question 19

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?

Accepted Answer

A supernumerary nipple looks like a mole,but close examination reveals a tiny nipple and areola; it is not a significant finding.

Question 20

While inspecting a patient's breasts,the nurse finds that the left breast is slightly larger than the right with the bilateral presence of Montgomery glands.The nurse should:

Accepted Answer

Normal findings of the breast include one breast (most often the left)slightly larger than the other and the presence of Montgomery glands across the areola.

Quiz 17: Breasts and Regional Lymphatics