Chapter 18: Breasts and Regional Lymphatic System · 2019-09-16 · Test Bank for Physical...

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Test Bank for Physical Examination and Health Assessment 2nd Edition by Jarvis Chapter 18: Breasts and Regional Lymphatic System Test Bank MULTIPLE CHOICE 1. Which of the following statements about the internal structures of the breast is true? a. The breast is mainly muscle, with very little fibrous tissue. b. The breast is composed of fibrous, glandular, and adipose tissues. c. The breast is composed mostly of milk ducts, known as lactiferous ducts. d. The breast is composed of glandular tissue, which supports the breast by being attached to the chest wall. ANS: B The breast is composed of (1) glandular tissue; (2) fibrous tissue, including the suspensory ligaments; and (3) adipose tissue. DIF: Knowledge REF: Page 405

Transcript of Chapter 18: Breasts and Regional Lymphatic System · 2019-09-16 · Test Bank for Physical...

Test Bank for Physical Examination and Health

Assessment 2nd Edition by Jarvis

Chapter 18: Breasts and Regional Lymphatic System

Test Bank

MULTIPLE CHOICE

1. Which of the following statements about the internal structures of the breast is

true?

a. The breast is mainly muscle, with very little fibrous tissue.

b. The breast is composed of fibrous, glandular, and adipose tissues.

c. The breast is composed mostly of milk ducts, known as lactiferous ducts.

d. The breast is composed of glandular tissue, which supports the breast by being

attached to the chest wall.

ANS: B

The breast is composed of (1) glandular tissue; (2) fibrous tissue, including the

suspensory

ligaments; and (3) adipose tissue.

DIF: Knowledge REF: Page 405

2. During breast examination, it is especially important for the nurse to examine

the upper

outer quadrant of the breast because it is:

a. the largest quadrant of the breast.

b. the area where most breast tumours occur.

c. where most of the suspensory ligaments are attached.

d. more prone to injury and calcifications than are other areas in the breast.

ANS: B

In the upper outer quadrant, note 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.

The

upper outer quadrant is the site of most breast tumours.

DIF: Application REF: Page 405

3. During assessment of a woman’s axillary lymph system, the nurse will assess

the:

a. central, axillary, lateral, and sternal nodes.

b. pectoral, lateral, anterior, and sternal nodes.

c. central, lateral, pectoral, and subscapular nodes.

d. lateral, pectoral, axillary, and suprascapular nodes.

ANS: C

The breast has extensive lymphatic drainage. Four groups of axillary nodes are

present: (1)

central, (2) pectoral (anterior), (3) subscapular (posterior), and (4) lateral. From the

central

axillary nodes, drainage flows up to the infraclavicular and supraclavicular nodes.

Test Bank

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DIF: Application REF: Pages 405–406

4. If a patient reports a recent infection in the breast, the nurse would expect to

find:

a. nonspecific node enlargement.

b. ipsilateral axillary node enlargement.

c. contralateral axillary node enlargement.

d. inguinal and cervical node enlargement.

ANS: B

The breast has extensive lymphatic drainage. Most of the lymph, more than 75%,

drains

into the ipsilateral axillary nodes.

DIF: Application REF: Page 405

5. A 9-year-old girl is in the clinic for a sports physical assessment. Getting over

her initial

shyness, she 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; they

will

develop.‖

c. ―You will probably get your periods before you notice any significant

development

of your breasts.‖

d. ―I understand that it is hard when you feel different from your friends. Breasts

usually develop between 8 and 10 years of age.‖

ANS: D

Adolescent breast development usually begins, on an average, between the ages of

8 and

10 years. The onset of breast development precedes menarche by about 2 years.

DIF: Application REF: Page 423

6. A patient contacts the clinic and tells the nurse that she is worried that her 10-

year-old

daughter may have breast cancer. She describes a unilateral enlargement of the

right breast

with associated tenderness. Which of the following would be the nurse’s best

response?

a. Tell the mother that breast development is usually fairly symmetrical, so the

daughter should be examined right away.

b. Tell the mother that she should bring her daughter in right away because breast

cancer is fairly common in preadolescent girls.

c. Tell the mother that a clinical examination of her daughter would help rule out

her

suspicions, but it is most likely that the condition is due to normal breast

development.

d. Tell the mother that it is unusual for newly developing breasts to feel tender

because

at this stage they would not have developed much fibrous tissue.

ANS: C

Occasionally, one breast may grow faster than the other, producing temporary

asymmetry

as well as tenderness. This may cause some distress, so reassurance should be

provided.

Tenderness in the development of breasts is also common. Test Bank

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DIF: Application REF: Pages 406–407

7. A 14-year-old girl is anxious about not having reached menarche yet. When

taking a

history, which of the following should the nurse ascertain?

a. The age she began to develop breasts

b. The age her mother developed breasts

c. The age she began to develop pubic hair

d. The age she began to develop axillary hair

ANS: A

Breast development takes an average of 3 years from stage 2 to stage 5, although

the range

can be as wide as 1.5 to 6 years. The onset of breast development precedes

menarche by

about 2 years. Menarche occurs during breast development stage 3 or 4, usually

just after

the peak of the adolescent growth spurt, around 12 years.

DIF: Analysis REF: Page 407

8. A woman is in the family planning clinic to obtain birth control information.

She states that

her breasts ―change all through the month‖ and that she is worried that this may be

unusual.

Which of the following would be the nurse’s best response?

a. Tell her that it is unusual. Breasts of nonpregnant females usually remain

unchanged

throughout the month.

b. Tell her that it is very common for breasts to change in response to stress and

assess

her life for stressful events.

c. Tell her that because of hormonal changes during the monthly menstrual cycle,

cyclical breast changes are common.

d. Tell her that breast changes normally occur only during pregnancy and that a

pregnancy test is needed at this time.

ANS: C

Breasts of the nonpregnant woman change with the ebb and flow of hormones

during the

monthly menstrual cycle.

DIF: Application REF: Page 408

9. A woman has just learned that she is pregnant. What are some things the nurse

should teach

the woman about breasts?

a. She can expect the areolae to become larger and darker in colour.

b. Breasts may begin secreting milk after the fourth month of pregnancy.

c. Breasts should be inspected for visible veins, which should be reported

immediately

if present.

d. Breast changes are fairly uncommon during pregnancy; most of the changes

occur

after delivery.

ANS: A

The areolae become larger and become a darker brown as pregnancy progresses,

and the

tubercles become more prominent. (The brown colour fades following lactation,

but the

areolae never return to the original colour.) Test Bank

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DIF: Comprehension REF: Page 408

10. The nurse is teaching a pregnant woman about breast milk. Which of the

following

statements would be true?

a. Breast milk is secreted immediately after delivery of the baby.

b. Breast milk is rich in protein and sugars (lactose) but has very little fat.

c. Colostrum, a thin, watery fluid, is present on days 4 and 5 postpartum (after the

birth).

d. Colostrum is a fluid that contains antibodies and is usually present after the

fourth

month of pregnancy.

ANS: D

After the fourth month of pregnancy, colostrum may be expressed. This thick

yellow fluid

is the precursor of milk, containing the same amount of protein and lactose but

practically

no fat. The breasts produce colostrum during the first few days after delivery.

Colostrum is

rich with antibodies that protect the newborn against infection, so breastfeeding is

important for the infant.

DIF: Application REF: Page 408

11. A 65-year-old patient remarks that she just cannot believe that her breasts sag

so much. She

thinks it could be due to lack of exercise. What explanation should the nurse offer

her?

a. Only women with large breasts experience sagging after menopause.

b. Sagging of breasts after menopause is usually due to decreasing muscle mass

within

the breast.

c. After menopause, a high-protein diet will help maintain muscle mass, which

would

prevent sagging of breasts.

d. After menopause, the glandular and fat tissues atrophy, causing breast size and

elasticity to decrease, resulting in sagging.

ANS: D

After menopause, the glandular tissue atrophies and is replaced with connective

tissue. The

fat envelope atrophies also, beginning in the middle years and becoming marked in

the

eighth and ninth decades. These changes decrease breast size and elasticity, so the

breasts

droop, appearing flattened and flabby.

DIF: Comprehension REF: Page 424

12. While 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; it is not unusual for men to have benign breast enlargement.

c. Explain that this condition may be the result of hormonal changes, and

recommend

that he consult his physician.

d. Tell him that gynecomastia in men is usually associated with prostate

enlargement,

and recommend that he undergo thorough screening.

ANS: C Test Bank

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Gynecomastia may reappear in the aging male and may be due to testosterone

deficiency.

DIF: Analysis REF: Page 430, Table 18-8

13. During a breast health interview, a patient states that she occasionally

experiences 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, so let’s just

ignore

it.‖

ANS: B

Breast pain occurs with trauma, inflammation, infection, or benign breast disease.

DIF: Analysis REF: Page 410

14. During history-taking, a female patient reports that she has noticed a few

drops of clear

discharge from her right nipple. What should the nurse do next?

a. Immediately report this to the physician.

b. Discontinue the interview, and refer the patient for a mammogram.

c. Question the patient about medications she is taking.

d. Make a note about the discharge, but ask no further questions because clear

discharge is often found in healthy women.

ANS: C

Record the use of medications such as oral contraceptives, phenothiazines,

diuretics,

digitalis, steroids, methyldopa, and calcium channel blockers that may cause clear

nipple

discharge.

DIF: Application REF: Page 411

15. During 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 the

following questions would be important for the nurse to ask?

a. Is the rash raised and red?

b. Does the rash appear cyclically?

c. Where did it 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?

ANS: C

Paget’s disease starts with a small crust on the nipple apex and then spreads to the

areola.

Eczema or any other type of dermatitis rarely starts at the nipple, unless it results

from

breastfeeding. It usually starts on the areola or surrounding skin and then spreads

to the

nipple.

DIF: Analysis REF: Page 411 Test Bank

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16. A patient is newly diagnosed with benign breast disease. Which of the

following

statements about benign breast disease is true? The presence of benign breast

disease:

a. makes it more difficult to examine the breasts.

b. frequently turns into cancer in a woman’s later years.

c. is easily resolved with hormone replacement therapy.

d. is usually diagnosed before a woman reaches the childbearing age.

ANS: A

The presence of benign breast disease (formerly called fibrocystic breast disease)

makes it

more difficult to examine the breasts; the general lumpiness of the breast may

conceal a

new lump.

DIF: Application REF: Page 411

17. During the annual physical examination, a 43-year-old patient states that she

does not

perform 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. mammography may detect a lump that is not palpable, but it is important to get

to

know your own breasts.

b. BSE is 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 BSE as long as a physician examines her breasts

yearly.

ANS: A

The practice of BSE, routine clinical breast examination, and mammograms are

complementary screening measures. Mammography can reveal cancers too small

to be

detected by the woman herself or even by the most experienced examiner. Monthly

BSE is

no longer recommended for women 40 to 74 years of age who are at a low to

average risk

for the development of breast cancer.

DIF: Comprehension REF: Page 413

18. During assessment, 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 on

breastfeeding.

Which of the following statements about breastfeeding is accurate?

a. Breastfed babies tend to be more colicky.

b. Breastfeeding may reduce the risk of ear infections.

c. Breastfed babies feed more frequently than do infants on formula.

d. Breastfeeding is natural to women, and every woman can do it.

ANS: B

In addition to providing the perfect food and antibodies for the baby, breastfeeding

promotes bonding and provides relaxation

DIF: Application REF: Page 412

Test Bank

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19. Which of the following women has risk factors that place her at a higher risk

for breast

cancer?

a. A 37-year-old who is slightly overweight

b. A 42-year-old who had a diagnosis of ovarian cancer

c. A 45-year-old who has never been pregnant

d. A 65-year-old whose mother had breast cancer

ANS: D

Risk factors for breast cancer: first-degree relative with breast cancer (mother,

sister,

daughter) and age between 50 and 69 years. Refer to Table 18-2 in the text for

other risk

factors.

DIF: Application REF: Pages 409, 412

20. During examination, the nurse notices that a woman’s left breast is slightly

larger than her

right breast. Which of the following is true?

a. Breasts should always be symmetrical.

b. This probably resulted from breastfeeding and is nothing to worry about.

c. This finding is not unusual, but the nurse should verify that this change is not

new.

d. This finding is very unusual and means that the woman may have an

inflammation

or growth.

ANS: C

Note symmetry of breast size and shape. It is common to have 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.

DIF: Analysis REF: Page 414

21. Which of the following is an abnormal finding during the inspection phase of

breast

examination?

a. Nipples in different planes (deviated)

b. The left breast slightly larger than the right

c. Skin of a nonpregnant woman marked with linear striae

d. Breasts of a pregnant woman having a fine blue network of veins visible under

the

skin

ANS: A

Nipples should be symmetrical on the same plane on the two breasts. If there is

deviation in

pointing, it suggests an underlying cancer that causes fibrosis in the mammary

ducts,

pulling the nipple angle toward it.

DIF: Comprehension REF: Pages 415, 426 (Table 18-3)

22. During physical examination, the nurse notes that a female patient has an

inverted left

nipple. Which of the following statements about inverted nipples is most accurate?

a. Normal nipple inversion is usually bilateral.

b. Unilateral nipple inversion is always a serious sign.

c. It should be determined whether the inversion is a recent change. Test Bank

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18-8

d. Nipple inversion is not significant unless accompanied by an underlying

palpable

mass.

ANS: C

Distinguish a recent nipple inversion from one that has existed for many years or

since

puberty. Normal nipple inversion may be unilateral or bilateral, and usually the

inverted

nipple can be pulled out (i.e., it is not fixed). Recent nipple inversion signifies

acquired

disease.

DIF: Analysis REF: Page 415

23. During breast examination, which of the following is the correct procedure to

screen for

nipple or skin retraction?

a. Have the woman bend and touch her toes with the tips of her fingers.

b. Have the woman lie down on her left side, and note any retraction.

c. Have the woman change from a supine position to a standing position, and note

any

lag or retraction.

d. Have the woman slowly lift her arms above her head, and note any retraction or

lag

in movement.

ANS: D

Direct the woman to change position while checking the breasts for signs of skin

retraction.

First, ask her to lift her arms slowly over her head. Both breasts should move up

symmetrically. Retraction signs are seen in the presence of fibrosis in the breast

tissue,

which is usually caused by growing neoplasms. Note any lag in the movement of a

breast.

DIF: Application REF: Page 416

24. During breast palpation, which of the following positions is most likely to

clearly delineate

significant lumps?

a. Supine, with arms raised over her head

b. Sitting, with arms relaxed at the sides

c. Supine, with arms relaxed at the sides

d. Sitting, with arms flexed and fingertips touching shoulders

ANS: A

Help the woman to a supine position. Tuck a small pad under the breast to be

palpated, and

raise her arm over her head. These manoeuvres will flatten the breast tissue and

displace it

medially. Any significant lumps will then be felt more distinctly.

DIF: Application REF: Page 418

25. Which of the following clinical situations would the nurse consider as being

outside

normal limits?

a. A patient has had one pregnancy. She states that she believes she may be

entering

menopause. Her breast examination reveals breasts that are soft and sag slightly.

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. She reports that she should begin her period

Test Bank

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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 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.

ANS: D

After palpating over the four breast quadrants, palpate the nipple. Note any

induration or

subareolar mass. Use your thumb and forefinger to apply gentle pressure or a

stripping

action to the nipple. If any discharge appears, note its colour and consistency.

Except in

pregnancy and lactation, discharge is abnormal.

DIF: Analysis REF: Page 420

26. A patient states during the assessment that she noticed a new lump in her left

breast near

her axilla while in the shower a few days ago. 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 and the axilla last.

ANS: B

If the woman mentions a breast lump she has discovered herself, examine the

unaffected

breast first to establish a baseline of normal consistency for this individual.

DIF: Application REF: Page 420

27. While palpating, the nurse has found a lump in a female patient’s right breast.

The nurse

documents this as a small, round, firm, distinct lump located at the 2:00 position, 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. This entry is missing information

about:

a. the shape of the lump.

b. the lump’s consistency.

c. the exact size of the lump.

d. whether the lump is solitary or multiple.

ANS: C

If you do feel a lump or mass, note these characteristics: (1) location, (2) size—

measure in

consistency, (5)

motility, (6) distinctness, (7) nipple, (8) the skin over the lump, (9) tenderness, and

(10)

lymphadenopathy.

DIF: Application REF: Page 421

28. The nurse is conducting a class about breast health. Which of the following

statements is

true?

a. The best time to perform BSE is in the middle of the menstrual cycle.

b. The woman needs to do BSE every month. Test Bank

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c. Breast volume is smallest from day 4 to 7 of your menstrual cycle and is a good

time

to get to know your breast structure.

d. If she suspects that she is pregnant, the woman should not perform BSE until

her

baby is born.

ANS: C

The best time to conduct 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.

DIF: Application REF: Page 408

29. Which of the following statements reflects the best approach to teaching a

woman about

BSE?

a. ―BSE is more important for you, since you have never had any children.‖

b. ―BSE is very important because one out of nine women will develop breast

cancer.‖

c. ―Monthly BSE is no longer routinely recommended for women who have a low

to

average risk for developing breast cancer.‖

d. ―BSE will save your life because there is a likelihood of finding a cancerous

lump

between mammograms.‖

ANS: C

BSEs are no longer routinely recommended to women between the ages of 40 and

74 with

a low to average risk for the development of breast cancer.

DIF: Application REF: Page 413

30. A 55-year-old postmenopausal woman is being seen in the clinic for her

annual physical

examination. She is concerned about the changes she has noticed in her breasts in

the past 5

years. She states that her breasts have decreased in size and that the elasticity has

decreased

so much 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. It is due to the

increased

levels of progesterone during the aging process.‖

c. ―Decreases in progesterone and estrogen after menopause cause atrophy of the

glandular tissue in the breast. This 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 decreases in elasticity and size.‖

ANS: C

Ovarian secretion of estrogen and progesterone decreases after menopause. This

causes the

breast glandular tissue to atrophy.

DIF: Application REF: Page 424

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31. 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 had

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’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 changes

in

the mass each month.‖

c. ―This is probably nothing to worry about because it has been present for years

and

has been determined to be noncancerous by your physician.‖

d. ―Because you are experiencing no pain and the size has not changed, continue

to

monitor the lump and return to the clinic in 3 months.‖

ANS: A

A lump that has been present for years and is not exhibiting changes may not be

serious but

still should be explored. Any recent change or new lump should be further

investigated.

DIF: Analysis REF: Page 411

32. Which assessment finding regarding the shape of a breast lump would

indicate that the

woman may have breast cancer?

a. Circular

b. Elongated

c. Star-shaped

d. Lobular

ANS: C

The shape of a breast lump often associated with breast cancer is irregular and star-

shaped.

DIF: Application REF: Page 428, Table 18-5

33. The nurse is discussing mammography with a postmenopausal 64-year-old

woman. How

often does the nurse recommend that the patient have a mammography exam?

a. Annually

b. Every 2 to 3 years

c. Every 5 years

d. Mammography is not recommended after 60 years of age.

ANS: B

Women aged 50–69 years should have a mammogram every 2 to 3 years.

DIF: Comprehension REF: Page 414, Box 18-1

34. While examining a patient’s breasts, the nurse finds the left breast slightly

larger than the

right and the presence of Montgomery’s glands bilaterally. The nurse would:

a. palpate over the venous patterns, checking for drainage. Test Bank

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18-12

b. consider these normal findings and proceed with the examination.

c. ask extensive history questions regarding the woman’s breast asymmetry.

d. continue with the examination and then refer the patient for further evaluation

of the

Montgomery’s glands.

ANS: B

Normal findings of the breast include one breast (most often the left) slightly larger

than

the other and the presence of Montgomery’s glands across the areola.

DIF: Analysis REF: Pages 405, 414

35. During 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 of

the

following statements about this finding is correct?

a. It is a normal variation and not a significant finding.

b. It is a significant finding and requires further investigation.

c. It also contains glandular tissue and may leak milk during pregnancy and

lactation.

d. The patient is correct; it is actually a mole that happens to be located under the

breast.

ANS: A

A supernumerary nipple looks like a mole, but close examination reveals a tiny

nipple and

areola. It is, however, not a significant finding.

DIF: Analysis REF: Page 416

36. While examining a 75-year-old woman, the nurse notes that the skin over her

right breast is

thickened and the hair follicles appear exaggerated. This condition is known as:

a. dimpling.

b. retraction.

c. peau d’orange.

d. benign breast disease.

ANS: C

Lymphatic obstruction produces edema, which thickens the skin and exaggerates

the

appearance of hair follicles. The skin has a pigskin or orange-peel look, and this

condition

is indicative of cancer.

DIF: Comprehension REF: Page 426, Table 18-3

37. A breastfeeding mother is diagnosed with a breast abscess. Which of the

following

instructions from the nurse is correct? The mother needs to:

a. continue to nurse on both sides to encourage milk flow.

b. discontinue nursing immediately to allow for healing.

c. temporarily discontinue nursing on the affected breast, manually express the

milk,

and discard it.

d. temporarily discontinue nursing on the affected breast but can manually express

the

milk and give it to the baby.

Test Bank

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ANS: C

With a breast abscess, the patient must temporarily discontinue nursing on the

affected

breast, manually express the milk, and discard it.

DIF: Application REF: Page 430, Table 18-7

38. A new mother, who has been breastfeeding for 1 month, calls the clinic to

report that an

area of her left breast is red, swollen, tender, very hot, and hard. She has a fever of

38.3°C.

She has also had symptoms of flu, such as chills, sweating, and tiredness. From

this

description, what condition does the nurse suspect?

a. Mastitis

b. Paget’s disease

c. Plugged milk duct

d. Mammary duct ectasia

ANS: A

The symptoms indicate mastitis, which stems from infection or stasis caused by a

plugged

duct. With a plugged duct, infection is not present.

DIF: Comprehension REF: Page 429, Table 18-7

39. During breast examination, the nurse notes that the woman’s nipple is flat,

broad, and fixed.

The patient states that this ―started happening a few months ago.‖ This finding

suggests:

a. dimpling.

b. a retracted nipple.

c. nipple inversion.

d. deviation in nipple pointing.

ANS: B

The retracted nipple looks flatter and broader, like an underlying crater. Recent

retraction

suggests cancer, which causes fibrosis of the entire duct system and pulls in the

nipple.

Retraction also may occur with benign lesions such as ectasia of the ducts. Do not

confuse

retraction with the normal longstanding type of nipple inversion, in which

broadening is

not seen and the nipple is not fixed.

DIF: Analysis REF: Page 426, Table 18-3

40. A 54-year-old man comes to the clinic with a ―horrible problem.‖ He tells the

nurse that he

has just discovered a lump in his breast and is fearful of cancer. 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 masses in men are less noticeable because of minimal breast tissue.

c. Fewer than 1% of all breast cancers occur in men.

d. Most breast masses in men are diagnosed as gynecomastia.

ANS: C

Fewer than 1% of all breast cancers occur in men. Breast masses are noticeable

early

because of minimal breast tissue.

Test Bank

Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All

rights reserved.

18-14

DIF: Application REF: Page 430, Table 18-8

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 keeps

in mind

certain characteristics of a cancerous mass. (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

ANS: A, D, F

Cancerous breast masses are solitary, unilateral, and nontender, and become solid,

hard,

dense, and fixed to underlying tissues or skin as cancer becomes invasive. Borders

are

irregular and poorly delineated. The masses are often painless, although the person

may

experience occasional pain. The most common site is the upper outer quadrant.

Responses

B, C, and E reflect the characteristics of benign breast disease.

DIF: Analysis REF: Page 428, Table 18-5