Question 1

A woman has just learned that she is pregnant.What are some things the nurse should teach her about her breasts?

Accepted Answer

The areolae become larger and grow a darker brown as pregnancy progresses,and the tubercles become more prominent.(The brown color fades after lactation,but the areolae never return to the original color).A venous pattern is prominent over the skin surface and does not need to be reported as it is an expected finding.After the fourth month,colostrum,a thick,yellow fluid (precursor to milk)may be expressed from the breasts.

Question 2

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:

Accepted Answer

Adolescent breast development usually begins between 8 and 10 years of age.The nurse should not belittle the girl's feelings by using statements like "don't worry" or by sharing personal experiences.The beginning of breast development precedes menarche by about 2 years.

Question 3

If a patient reports a recent breast infection,then the nurse should expect to find _____ node enlargement.

Accepted Answer

The breast has extensive lymphatic drainage.Most of the lymph,more than 75%,drains into the ipsilateral,or same side,axillary nodes.

Question 4

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?

Accepted Answer

The incidence of breast cancer varies with different cultural groups.White women have a higher incidence of breast cancer than African-American women starting at age 45 years;but African-American women have a higher incidence before age 45 years.Asian,Hispanic,and American Indian women have a lower risk for development of breast cancer (American Cancer Society,2009-2010).

Question 5

Which of the following statements is true regarding the internal structures of the breast? The breast is:

Accepted Answer

The breast is composed of glandular tissue,fibrous tissue (including the suspensory ligaments),and adipose tissue.

Question 6

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?

Accepted Answer

The use of some medications,such as oral contraceptives,phenothiazines,diuretics,digitalis,steroids,methyldopa,and calcium channel blockers,may cause clear nipple discharge.Bloody or blood-tinged discharge from the nipple,not clear,is significant,especially if a lump is also present.In the pregnant female,colostrum would be a thick,yellowish liquid,and it would be expressed after the fourth month of pregnancy.

Question 7

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:

Accepted Answer

The monthly practice of breast self-examination,along with clinical breast examination and mammograms are complementary screening measures.Mammography can reveal cancers too small to be detected by the woman or by the most experienced examiner.However,interval lumps may become palpable between mammograms.

Question 8

In performing an assessment of a woman's axillary lymph system,the nurse should assess which of these nodes?

Accepted Answer

The breast has extensive lymphatic drainage.Four groups of axillary nodes are present: (1)central,(2)pectoral (anterior),(3)subscapular (posterior),and (4)lateral.

Question 9

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?

Accepted Answer

Occasionally one breast may grow faster than the other,producing a temporary asymmetry.This may cause some distress;reassurance is necessary.Tenderness is common also.

Question 10

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:

Accepted Answer

The presence of benign breast disease (formerly fibrocystic breast disease)makes it harder to examine the breasts;the general lumpiness of the breast conceals a new lump.The other statements are not true.

Question 11

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:

Accepted Answer

Full development from stage 2 to stage 5 takes an average of 3 years,although the range is 1.5 to 6 years.Pubic hair develops during this time,and axillary hair appears 2 years after the onset of pubic hair.The beginning of breast development precedes menarche by about 2 years.Menarche occurs in breast development stage 3 or 4,usually just after the peak of the adolescent growth spurt,which occurs around age 12 years.See Figure 17-6.

Question 12

The nurse is teaching a pregnant woman about breast milk.Which statement by the nurse is correct?

Accepted Answer

After the fourth month,colostrum may be expressed.This thick yellow fluid is the precursor of milk,and it contains the same amount of protein and lactose but practically no fat.The breasts produce colostrum for the first few days after delivery.It is rich with antibodies that protect the newborn against infection,so breastfeeding is important.

Question 13

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?

Accepted Answer

It is important for the nurse to determine where the rash first appeared.Paget's disease starts with a small crust on the nipple apex and then spreads to the areola.Eczema or other dermatitis rarely starts at nipple unless it results from breastfeeding.It usually starts on the areola or surrounding skin and then spreads to the nipple.See Table 17-6.

Question 14

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?

Accepted Answer

African-American women have a higher incidence of breast cancer before age 45 years than white women,and are more likely to die of their disease.In addition,African-American women are significantly more likely to be diagnosed with regional or distant breast cancer than are white women.This racial difference in mortality rates may be related to insufficient use of screening measures and lack of access to health care.

Question 15

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:

Accepted Answer

The upper outer quadrant is the site of most breast tumors.In the upper outer quadrant,the nurse should notice 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.

Question 16

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?

Accepted Answer

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

Question 17

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?

Accepted Answer

Breasts of the nonpregnant woman change with the ebb and flow of hormones during the monthly menstrual cycle.During the 3 to 4 days before menstruation,the breasts feel full,tight,heavy,and occasionally sore.The breast volume is smallest on days 4 to 7 of the menstrual cycle.

Question 18

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?

Accepted Answer

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 and sag,looking flattened and flabby.

Question 19

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:

Accepted Answer

Breast pain occurs with trauma,inflammation,infection,or benign breast disease.The nurse will need to gather more information about the patient's pain rather than make statements that ignore the patient's concerns.

Question 20

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?

Accepted Answer

Research has shown that girls with overweight or obese BMI levels have a higher occurrence of early onset of breast budding (before age 8 years for African-American girls and age 10 years for white girls)and early menarche.

Quiz 17: Breasts and Regional Lymphatics