Chapter 20 Prep U.odt

Chapter 20 PrepU
1. The nurse is examining the breast of a clinic client and palpates a lump. What would the nurse
be sure to document about this lump? Select all that apply.
a. Consistency
b. Distinctness
c. Mobility
2. The nurse practitioner is examining a client and notes an axillary lymph node approximately 1.5
cm in size, tender, and movable. The nurse practitioner also notes an erythematous 3-cm
abrasion on the client's upper arm. The client tells the nurse practitioner that she fell in the
garden while fertilizing her plants. What nursing diagnosis would the nurse practitioner include
in the plan of care?
a. Fear related to possible diagnosis of breast cancer
3. The lateral lymph nodes are located along the upper humerus and drain most of the arm.
a. True
4. A 43-year-old store clerk comes to the office upset because she has found an enlarged lymph
node under her left arm. She states she found it yesterday when she was feeling pain under her
arm during movement. She states the lymph node is about an inch long and is very painful. She
checks her breasts monthly and gets a yearly mammogram (her last was 2 months ago); until
now everything has been normal. She states she is so upset because her mother died in her 50s
of breast cancer. The client does not smoke, drink, or use illegal drugs. Her father is in good
health. Examination shows a tense woman appearing her stated age. Visual inspection of her left
axilla reveals a tense red area with no surrounding scarring. On palpation, the examiner feels a
2-cm tender movable lymph node underlying hot skin. Other shoddy nodes are also in the area.
Visualization of both breasts is normal. Palpation of her right axilla and both breasts is
unremarkable. Examination of the left arm reveals a scabbed-over superficial laceration over
her left hand. Upon questioning, the client remembers that she cut her hand gardening last
week. What disorder of the axilla is most likely responsible for her symptoms?
a. Lymphadenopathy of infectious origin
5. Which of the following assessment findings is most likely benign on breast examination?
a. One breast larger than the other
6. Screening measures for breast cancer include all of the following except:
a. Breast x-rays
7. The nurse reviews factors related to which of the following areas to assess a client's risk of
breast cancer?
a. Age, family history, reproductive history
8. Mrs. Ash, a client in her 50s, has told the nurse during her most recent visit to the clinic that she
and her circle of friends have discontinued breast self-examination (BSE) since hearing and
reading that the practice is now considered ineffective. How can the nurse best respond to Mrs.
Ash?
a. “BSE is certainly not a replacement for other screening methods, but a high proportion of
breast masses are in fact detected by women themselves.”
9. During the breast examination of a client, the nurse notes red, scaly, and crusty areas over the
areola. The nurse understands that this appearance of the skin is due to what type of breast
condition?
a. Paget disease
10. A nurse is inspecting a client's breasts. The nurse notices that one breast is larger than the other.
Which action should the nurse take next?
a. Ask the client whether the larger breast has increased in size recently
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11. The client tells the nurse "I am so glad I had a mastectomy and I will never have breast cancer
again." How should the nurse best respond?
a. "We need to continue to perform examinations. Breast cancer can reoccur."
12. A client has been found to have a breast lump and an ultrasound has been ordered. The client
voices concerns to the nurse she is afraid of the painful testing she is going to endure. How
should the nurse best respond?
a. "This noninvasive test uses high frequency waves to determine if the mass is solid or
cystic."
13. During a breast assessment the nurse finds scaly lesions at the nipple with a lump behind the
nipple. The nurse suspects what?
a. Paget disease
14. The size and shape of the breasts in females are related to the amount of
a. fatty tissue.
15. The nurse is working with a community group to set up teaching programs to increase
awareness among African American women about preventive screening techniques for breast
cancer. In the teaching program, the nurse should plan to include
a. breast cancer patients of the same race.
16. The nurse is preparing to examine the breasts of a female client who had a left radical
mastectomy 3 years ago. When examining the client, the nurse observes redness at the scar area.
The nurse should explain to the client that this may be indicative of
a. an infectious process.
17. The lymph nodes that are responsible for drainage from the arms are the
a. lateral lymph nodes.
18. Benign conditions of the breast include
a. fibrocystic changes
19. Which characteristic would support the determination that a client is at high risk for breast
cancer?
a. first degree relative with a history of either BRCA1 or BRCA2 mutation
20. A client asks why the nurse touches the area near the arm pit when conducting a breast
examination. What should the nurse respond to this client?
a. “The upper outer quadrant of the breast extends into the axillae.”
21. When performing a breast assessment on a clinic patient, the nurse practitioner notes scaly
lesions that begin at the nipple and move toward a lump behind the nipple well. The NP would
know that further assessment for what would be necessary?
a. Paget's disease
22. During the physical examination of a client's breast, which finding should the nurse recognize
as a possible indication of a malignant tumor?
a. Retraction of nipples
23. A 44-year-old woman comes to the clinic complaining of severe dry skin in the area over her
right nipple. She denies any trauma to the area. She noticed the skin change during a self-breast
examination 2 months ago. She also admits that she had felt a lump under the nipple but kept
putting off making an appointment. She does admit to 6 months of fatigue but no weight loss,
weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism.
She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug
use. Examination shows a middle-aged woman appearing her stated age. Inspection of her right
breast reveals a scaly eczema-like crust around her nipple. Underneath a nontender 2-cm mass
is palpable. The axilla contains only soft moveable nodes. The left breast examination and axilla
are unremarkable. What visible skin change of the breast does she have?
a. Paget's disease
24. During the physical examination of a female client, the nurse notes that the client's axillary
lymph nodes are enlarged, hard, and fixed. The nurse recognizes that these findings are
consistent with what disease process?
a. Malignancy
25. The parents of a newborn express concern upon seeing the pediatrician palpate and gently
express a small amount of whitish, milk-like liquid from the baby's nipples. They anxiously ask,
“What can be done to fix this problem?” What is the nurse's best response?
a. "Nothing is wrong with your baby. This liquid will clear up spontaneously."
26. The nurse is assessing a 15 year old male and finds soft, fatty enlargement of breast tissue. The
nurse would document this as what?
a. Gynecomastia
27. Elevated sebaceous glands, known as Montgomery glands, are located in the breast’s
a. areolas.
28. The nurse plans to instruct an adult female client with regular menstrual cycles, who is not
taking oral contraceptives, about breast self-examination. The nurse should plan to instruct the
client to perform breast self-examination
a. right after menstruation.
29. What instruction should the nurse provide to a client to assess for dimpling or retraction of
breast tissue?
a. raise arms over the head
30. The nurse instructs a client on breast self-examination techniques. Which observation indicates
that teaching has been effective?
a. Palpates the breasts using an up and down approach
31. A nurse teaches a group of young women about how to properly perform a self breast
examination. How should the nurse explain the best time to perform the exam?
a. Right after the menstrual flow stops
32. The nurse asks the patient to sit with the arms at both sides when beginning the clinical breast
examination. With this position, the nurse will assess: (Select all that apply.)
a. Appearance of the skin
b. Size and symmetry of the breasts
c. Characteristics of the nipples
d. Contour of the breasts
33. Nurse G. is conducting a teaching session on breast self-examination to a group of women at a
health fair sponsored by the local community centre. Which of the following instructions is
most accurate?
a. “Remember that doing BSE regularly is not a replacement for regularly-scheduled
mammograms or clinical examinations.”
34. A nonpregnant female presents to the health care facility and reports new onset of breast
discharge. The nurse assesses the discharge to be milky in appearance without breast tenderness
or masses. What additional data should the nurse obtain from this client?
a. Prescribed medications such as antipsychotic agents
35. While interviewing a client, the nurse asks her what her typical daily diet consists of. Which of
the following is associated with an increased risk for breast cancer?
a. High-fat diet
36. A mother brings her adolescent son into the clinic because she is concerned about his
development of breast tissue. Her son denies use of any medications and is slender in
appearance. What should be the nurse's next action?
a. Palpate for any irregular or hard masses.
37. The nurse has discussed the risks for breast cancer with a group of high school seniors. The
nurse determines that one of the students needs further instructions when the student says that
one risk factor is
a. having a baby before the age of 20 years.
38. The nurse plans to instruct an adult female client with regular menstrual cycles, who is not
taking oral contraceptives, about breast self-examination. The nurse should plan to instruct the
client to perform breast self-examination
a. right after menstruation.
39. A client has had a recent mastectomy and visits the clinic for postoperative evaluation. The
client tells the nurse that she has been depressed and feels as if she is less of a woman. The most
appropriate nursing diagnosis for this client is
a. disturbed body image related to mastectomy.
40. Montgomery glands secrete
a. protective lubricant
41. A 72-year-old retired saleswoman comes to the office with a bloody discharge from her left
breast for 3 months. She denies any trauma to her breast. Her past medical history includes high
blood pressure and abdominal surgery for colon cancer. Her aunt died of ovarian cancer and her
father died of colon cancer. Her mother died of a stroke. The client denies tobacco, alcohol, or
drug use. She is a widow and has three healthy children. On examination her breasts are
symmetrical with no skin changes. The nurse can express bloody discharge from the client's left
nipple. No discrete masses are palpable, but her left axilla has a hard 1-cm fixed node. The
remainder or her heart, lung, abdominal, and pelvic examinations are unremarkable. What is the
most likely cause of nipple discharge in her circumstance?
a. Breast cancer
42. A 56-year-old woman comes to the clinic reporting that her left breast looks unusual. She says
that for 2 months the angle of the nipple has changed direction. She does not do self-breast
examinations so she doesn't know if she has a lump. She has no history of weight loss, weight
gain, fever, or night sweats. Her past medical history is significant for high blood pressure. She
smokes two packs of cigarettes a day and drinks three to four drinks per weekend night. Her
paternal aunt died of breast cancer in her forties. Her mother is healthy, but her father died of
prostate cancer. Examination shows a middle-aged woman appearing older than her stated age.
Inspection of her left breast reveals a flattened nipple deviating towards the lateral side. On
palpation the nipple feels thickened. Lateral to the areola is a nontender 4-cm mass. The axilla
contains several fixed nodes. The right breast examination and axilla are unremarkable. What
visible skin change of the breast does she have?
a. Nipple retraction
43. When inspecting the nipples, which of the following findings is unexpected?
a. Retraction of the left nipple
44. During the physical examination of a client, a nurse notes that the client has tenderness of the
breasts. Which question should the nurse ask the client with regard to this finding?
a. “Are you taking oral contraceptive pills?”
45. A nurse is inspecting the superficial venous pattern of a nonpregnant client's breasts. Which of
the following findings could be an indicator of malignancy? Select all that apply.
a. Veins appearing more prominent
b. Veins appearing in an asymmetric pattern
46. The client reports to the nurse that she is concerned she has cancer as she has been experiencing
clear discharge from her breasts. What is the best response of the nurse?
a. "Do you take any medications?"
47. The nurse is assessing an adult male client when the nurse observes gynecomastia in the client.
The nurse should ask the client if he is taking any medications for
a. depression.
48. The nurse is caring for a female client who has received a diagnosis of fibrocystic breast
disease. The nurse has instructed the client about the disease. The nurse determines that the
client needs further instructions when the client says she should avoid drinking
a. grapefruit juice.
49. What information would the nurse include when educating a client concerning magnetic
resonance imaging (MRI) as a screening for breast cancer?
a. Specificity is such that false positive readings can occur.
50. The nurse is concerned that a client has undiagnosed cancer of the breast. What assessment
finding is most likely related to this clinical determination?
a. dimpling of the breast
51. When assessing the breasts, the client asks why is it important to lift her arms over her head.
What is the basis for the nurse’s response?
a. Adds tension to suspensory ligaments
52. Which factors should the nurse include in a discussion with a young female to assist the client
to reduce her risk for breast cancer? Select all that apply.
a. Engage in regular, strenuous physical activity
b. Pregnancy is beneficial before 30 years of age
c. Breast-feed if possible
53. When performing a breast assessment, the nurse finds a lump. Further assessment should
include what? Select all that apply.
a. Location
b. Distinctness
c. Shape
d. Mobility
54. The functional part of the breast that allows for milk production consists of tissue termed
a. glandular.
55. The nurse is assessing a 50-year-old client’s breasts and observes a spontaneous discharge of
fluid from the left nipple. The nurse should
a. refer the client for a cytology examination.
56. A client denies performing breast self-examination however practices breast awareness. What is
this client focusing on when following this practice?
a. Appearance, feel, and shape of the breasts and nipples
57. The nurse instructs a female client on breast self-examination. Which part of the breast should
the nurse explain as being the area where most cancers occur? Select the part on the diagram.
58. The nurse encourages a client to perform a monthly self-breast examination between what days
of the menstrual cycle?
a. 4 to 7
59. Which of the following are the four major axillary node groups?
a. Pectoral, subscapular, lateral, central
60. When examining the breasts of a client, the nurse finds a collection of fatty tissue that appears
as a lump. The nurse knows that this is which of the following conditions?
a. Lipoma
61. How should a nurse instruct a client to perform a breast self-examination to most effectively
cover the entire breast?
a. Up-and-down pattern starting at the underarm and moving across the breast
62. The client is complaining of breast pain and the nurse finds a lump upon further assessment.
The nurse suspects this could be what?
a. Mammary duct ectasia
63. What pattern of palpation is currently the best validated technique for detecting breast masses?
a. Vertical strip pattern
64. Elevated sebaceous glands, known as Montgomery glands, are located in the breast’s
a. areolas.
65. The nurse is caring for an adult female client when the client tells the nurse that she has had a
clear discharge from her nipples for the past month. The nurse should ask the client if she has
been taking
a. contraceptives.
66. The nurse observes dimpling in an adult female client’s breasts. The nurse should explain to the
client that dimpling of the breast may indicate a
a. tumor.
67. A nurse should ask a client to assume which position to begin the examination of the breasts?
a. Sitting
68. A 63-year-old nurse comes to the office upset because she has found an enlarged lymph node
under her right arm. She states she found it last week while taking a shower. She isn't sure if she
has any breast lumps because she doesn't know how to do self-breast examinations. She states
her last mammogram was 5 years ago and it was normal. Her past medical history is significant
for high blood pressure and chronic obstructive pulmonary disease. She quit smoking 2 years
ago after a 55-pack a year history. She denies any illegal drugs and drinks alcohol rarely. Her
mother died of a heart attack and her father died of a stroke. She has no children. Examination
shows an older woman appearing her stated age. Visual inspection of her right axilla reveals
nothing unusual. Palpation reveals a 2-cm hard fixed lymph node. She denies any tenderness.
Visualization of both breasts is normal. Palpation of her left axilla and breast is unremarkable.
On palpation of the right breast, the nurse detects a nontender 1-cm lump in the tail of Spence.
What disorder of the axilla is most likely responsible for her symptoms?
a. Breast cancer
69. A 48-year-old woman has presented to her primary care provider concerned about the recent
detection of a mass in her left breast. The mass is tender on palpation, and the nurse notes that it
is round, well-delineated, and mobile. There is no evidence of nipple retraction on inspection.
Which of the following breast masses would the nurse first suspect?
a. Cyst
70. During the breast examination of a client, the nurse notes firm but rubbery lesions in both
breasts. The client comments that the lesions become tender just before menses. The nurse
understands that these symptoms are most likely due to which breast condition?
a. Fibrocystic lesions
71. A nurse is examining the breasts of a 75-year-old woman. Which of the following are normal
findings in the breasts of an older adult?
a. Smaller, flatter nipples
b. Nipples that are less erectile on stimulation
c. Pendulous breasts
72. Your patient is noted to have thickening of the skin and unusually prominent pores on her right
breast. What might you suspect?
a. Lymphatic obstruction
74. When would be the best time during the month for a post-menopausal woman to perform self-
breast examination?
a. A convenient day of each month
75. A nurse palpates the breasts of a client for masses during the physical examination. The nurse
knows that if a tumor if malignant, which characteristics will be present? Select all that apply.
a. hard and nontender
b. fixed to underlying tissues
c. irregular in shape
76. During the breast examination of a client, the nurse notes an orange-peel or “peau d'orange”
appearance of the skin of the breast. The nurse understands that this appearance of the skin is
due to what type of breast condition?
a. Metastatic disease
77. A nurse teaches a group of young women about how to properly perform a self-breast
examination. How should the nurse explain the best time to perform the exam
a. Right after the menstrual flow stops (or between the fourth and seventh days of the cycle if
the cycle is regular)
78. Which technique is appropriate for the nurse to use to palpate a client's breast?
a. Flat pads of three fingers
79. At puberty, the female breasts enlarge in response to estrogen and
a. Progesterone
80. The risk of breast cancer is greater:
a. Women who have never given birth or for those who had their first child after age 30.
b. A family history of breast cancer
c. consumption of a high-fat diet,
d. late menopause are all factors that increase the risk of breast cancer.
81. The nurse instructs a female client on breast self-examination. Why does the nurse recommend
the pattern shown for the client to use?
a. It is the best technique to detect masses (vertical strip)
82. A mother of three young children is newly diagnosed with breast cancer. The client tells the
nurse that she is so sad and cannot stop crying. She adds that she feels like she is less of a
woman and is having trouble sleeping. When initiating the plan of care, what would be the most
appropriate nursing diagnosis to address the client’s immediate needs?
a. Grieving
83. Which is true of women who have had a unilateral mastectomy?
a. They should be examined carefully along the surgical scar for masses.
84. When palpating the female breast for masses, the nurse distinguishes which of the following
characteristics as a potentially cancerous mass?
a. Single, firm, fixed nodule
85. After assessing the breasts of a female client, the nurse should explain to the client that most
breast tumors occur in the
a. Upper outer quadrant
86. When examining the male breast, for what does the nurse inspect?
a. Swelling of the nipple
b. Ulceration of the areola
c. Nipple drainage
87. A nurse is discussing breast self-examination (BSE) with a 60-year-old woman. Which of the
following should the nurse recommend?
a. Picking a set day of the month that the client will remember on which to perform BSE
88. The nurse instructs a client on breast self-examination techniques. Which observation indicates
that teaching has been effective?
a. Palpates the breasts using an up and down approach
89. A patient is concerned about a right breast lump. What questions can the nurse ask to effectively
assess the associated manifestations of this mass?
a. “Is there pain with the lump?”
b. “Is there any discharge from the lump?”
c. “Are you menstruating when the lump is present?”
90. A nurse is examining the breasts of a woman who has had a mastectomy. Which of the
following should the nurse do?
a. Palpate the scar for redness, lesions, lumps, swelling, or tenderness
91. The nurse notes that a client’s left breast feels significantly warmer than the right breast. What
should the nurse consider is occurring with this client?
a. Inflammation
92. When should a woman conduct self breast examination with respect to her menses?
a. 5 to 7 days following her menses
93. Which questions should the nurse include when counseling a client about minimizing
modifiable (things you can control) risk factors for breast cancer?
a. "Are you aware that alcohol use increases the risk of breast cancer?"
b. "Do you engage in some form of regular exercise?"
c. "What type of menopausal hormone therapy (MRT) are you taking?"
94. A client is concerned about a dark skin lesion on her anterolateral abdomen. The lesion has not
changed, nor is there any discharge or bleeding. On examination there is a medium brown
circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly
pigmented, and is about 7 mm in diameter. What is this lesion?
a. Supernumerary nipple
95. An older female client states she is upset about her sagging breasts. She states, "I know it's
because I haven't been sexually active since my husband died and my hormones are all dried
up." What is the nurse's best response?
a. "What you're experiencing is an expected effect of the aging process."
96. The nurse is preparing to conduct a clinical breast examination of a patient. Current
recommendation suggest that which pattern should be followed when assessing the breast
tissue?
a. Vertical strip
97. During the physical examination, a nurse palpates the breasts of a client for masses. The nurse
knows that if the client has benign breast disease, masses with which characteristics will be
present?
a. Rubbery and mobile
b. Well-demarcated borders
99. A nurse examines a client diagnosed with fibroadenoma. Which characteristic of the lump
should the nurse expect to find in the client?
a. Round, firm, well-defined
100. While conducting a breast health history, a patient denies any breast issues but does
make a comment about not realizing that her milk would still be flowing 10 months after having
her last baby. What response should the nurse provide to the statement?
a. “In which breast does this occur?”
101. The nurse is instructing a patient on conducting breast self-examination. What should
the nurse include in these instructions?
a. Lie down and place one arm behind the head.
b. Use the finger pads of the three middle fingers of the hand.
102. The nurse observes an orange peel appearance, or peau d’orange, of the areolae of a
client’s breasts. The nurse should explain to the client that this is most likely due to
a. blocked lymphatic drainage.
103. Which questions should the nurse include when counseling a client about minimizing
modifiable risk factors for breast cancer?
a. “Are you aware that alcohol use increases the risk of breast cancer?"
b. "Do you engage in some form of regular exercise?"
c. "What type of menopausal hormone therapy (MRT) are you taking?"
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