Chapter 18: Breasts, Axillae, and Regional Lymphatics
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. Which of the following statements is true regarding the internal structures of the breast?
a.
Fibrous, glandular, and adipose tissues
b.
Primarily muscle with very little fibrous tissue
c.
Primarily milk ducts, known as lactiferous ducts
d.
Glandular tissue, which supports the breast by attaching to the chest wall
2. In performing a breast examination, the nurse knows that examining the upper outer quadrant
of the breast is especially important. What is the reason for this?
a.
It is the largest quadrant of the breast.
b.
It is the most common location of breast tumors.
c.
It is where the majority of suspensory ligaments attach.
d.
It is more prone to injury and calcifications than other locations in the breast.
3. 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
4. If a patient reports a recent breast infection, then the nurse should expect to find what type of
node enlargement?
a.
Nonspecific
b.
Ipsilateral axillary
c.
Inguinal and cervical
d.
Contralateral axillary
5. A 9-year-old girl is in the clinic for a sport physical examination. 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?” Which response by the nurse is best?
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.”
6. 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. Which response
by the nurse to the mother is best?
a.
“Breast development is usually fairly symmetric your daughter should be
examined right away.”
b.
“You should bring in your daughter right away because breast cancer is fairly
common in preadolescent girls.”
c.
“Although an examination of your 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.”
7. 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?
a.
The age her mother developed breasts
b.
The age she began to develop pubic hair
c.
The age she began developing axillary hair
d.
The age the girl began to develop breasts
8. 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 best
response by the nurse?
a.
“Continual changes in your 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 you should assess your
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. You should get a
pregnancy test done as soon as possible.”
9. A woman has just learned that she is pregnant. What should the nurse teach this patient about
changes in 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.
10. 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.”
11. 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?
a.
After menopause, only women with large breasts experience sagging.
b.
After menopause, sagging is usually due to decreased muscle mass within the
breast.
c.
After menopause, a diet that is high in protein will help maintain muscle mass,
which keeps the breasts from sagging.
d.
After menopause, the glandular and fat tissue atrophies, causing breast size and
elasticity to diminish, resulting in breasts that sag.
12. 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.
Acknowledge it as benign breast enlargement which is not unusual in men.
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.
13. 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.
Nothing; breast budding is a normal finding.
b.
Ask the young girl if her periods have started.
c.
Assess the girl’s weight and body mass index (BMI).
d.
Ask the girl’s mother at what age she started to develop breasts.
14. The nurse is preparing for a class on breast cancer. Which statement is true with regard to
cultural differences in breast cancer in the United States?
a.
Black women have a lower incidence of aggressive, triple negative breast cancer.
b.
The relative 5-year survival rate for black women is lower than that for Caucasian
women.
c.
For every stage of breast cancer, Asian/Pacific Islander women have the lowest
rate of survival.
d.
Ashkenazi Jewish women have a significantly lower prevalence of BRCA1 and
BRCA2 gene mutations.
15. During a breast health interview, a patient states that she has noticed pain in her left breast.
Which statement by the nurse is most appropriate?
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.”
16. 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.
Ask her if she is possibly pregnant.
b.
Immediately contact the physician to report the discharge.
c.
Immediately obtain a sample for culture and sensitivity testing.
d.
Ask the patient some additional questions about the medications she is taking.
17. 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?”
18. A patient is newly diagnosed with benign breast disease. The nurse recognizes which
statement about benign breast disease to be true?
a.
It makes it more difficult to examine the breasts.
b.
It is easily reduced with hormone replacement therapy.
c.
It frequently turns into cancer in a woman’s later years.
d.
It is usually diagnosed before a woman reaches childbearing age.
19. 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.” What should the nurse
include in his or her response to this patient?
a.
BSEs may detect lumps that appear between mammograms.
b.
She is correct—mammography is a good replacement for BSE.
c.
The American Cancer Society recommends women over 40 years old perform a
monthly BSE.
d.
She does not need to perform BSEs as long as a physician checks her breasts
annually.
20. 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.
“Breastfed babies eat more often than infants on formula.”
c.
“Breastfeeding is second nature, and every woman can do it.”
d.
“Breastfeeding provides the perfect food and antibodies for your baby.”
21. 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.
66-year-old whose mother had breast cancer
22. 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.
Asymmetry of the breasts is unusual and the patient should be referred to
physician.
b.
Asymmetry of the breasts is common, but the nurse should verify that this finding
is not new.
c.
Asymmetry of breast size and shape is very unusual and means she may have an
inflammation or growth.
d.
Asymmetry of breast size and shape is probably due to breastfeeding and is
nothing to worry about.
23. The nurse is assisting with a BSE clinic. Which of these women reflects 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
24. 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.
25. 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?
a.
Have the patient bend over and touch her toes.
b.
Have the patient lie down on her left side and observe for any retraction.
c.
Have the patient shift from a supine position to a standing position, and note any
lag or retraction.
d.
Have the patient slowly lift her arms above her head, and note any retraction or lag
in movement.
26. 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
27. 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.
28. 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. How should the nurse proceed?
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.
29. 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.
Size of the lump
b.
Shape of the lump
c.
Consistency of the lump
d.
Whether the lump is solitary or multiple
30. 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.
A woman should perform BSEs 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 after her baby is born.
31. 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.” Which is the best reply by the nurse?
a.
“This change occurs most often because of long-term use of bras that do not
provide enough support to the breast tissues.”
b.
“Decreases in hormones after menopause causes atrophy of the glandular tissue in
the breast and is a normal process of aging.”
c.
“This is a normal change that occurs as women get older and is due to the
increased levels of progesterone during the aging process.”
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.”
32. A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a
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 nurse’s 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. What is
the best response by the nurse?
a.
“Because of the change in consistency of the lump, it should be further evaluated
by a physician.”
b.
“The changes could be r/t 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.”
33. 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. How should the nurse proceed?
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.
34. 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.
35. 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. What is this condition called?
a.
Dimpling
b.
Retraction
c.
Peau d’orange
d.
Benign breast disease
36. 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
37. 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.” What does this
finding suggest?
a.
Dimpling
b.
Retracted nipple
c.
Nipple inversion
d.
Deviation in nipple pointing
38. 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 cancer in men rarely spreads to the lymph nodes.
b.
Less than one percent of all breast cancers occurs in men.
c.
Most breast masses in men are diagnosed as gynecomastia.
d.
Breast masses in men are difficult to detect because of minimal breast tissue.
MULTIPLE RESPONSE
1. 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.
Regular border
c.
Hard, dense, and immobile
d.
Rubbery texture and mobile
e.
Dull, heavy pain on palpation
f.
Irregular, poorly delineated border
2. 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.
Liver disease
c.
Hyperthyroidism
d.
Type 2 diabetes mellitus
e.
History of alcohol abuse