Test bank for physical examination and health assessment 2nd edition by jarvis

DIF: Knowledge REF: Page 405 outer quadrant of the breast because it is: ANS: B In the upper outer quadrant, note the axillary tail of Spence, the cone-shaped breast tissue that project

Trang 1

Edition

Link download full:

https://getbooksolutions.com/download/test-bank-for-physical-examinat ion-and-health-assessment

Chapter 18: Breasts and Regional Lymphatic System

Test Bank

MULTIPLE CHOICE

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

outer quadrant of the breast because it is:

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

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

Trang 2

DIF: Application REF: Pages 405–406

ANS: B

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

into the ipsilateral axillary nodes

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:

develop.”

of your 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

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?

daughter should be examined right away

cancer is fairly common in preadolescent girls

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

development

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

Trang 3

DIF: Application REF: Pages 406–407

history, which of the following should the nurse ascertain?

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

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?

throughout the month

her life for stressful events

cyclical breast changes are common

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

the woman about breasts?

if present

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.)

Trang 4

DIF: Comprehension REF: Page 408

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

statements would be true?

birth)

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

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?

the breast

prevent sagging of breasts

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

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?

that he consult his physician

and recommend that he undergo thorough screening

ANS: C

Trang 5

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:

duct.”

it.”

ANS: B

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

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?

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

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?

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

Trang 6

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:

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

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:

know your own 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

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?

ANS: B

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

promotes bonding and provides relaxation

Trang 7

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

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

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

examination?

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?

Trang 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

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

nipple or skin retraction?

lag or retraction

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

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

significant lumps?

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

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

normal limits?

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

breasts that have a firm, transverse ridge along the lower quadrant in both breasts

Trang 9

tomorrow Her breast examination reveals breast tissue that is nodular and

somewhat engorged She states that the examination was slightly painful

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

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:

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

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:

ANS: C

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

motility, (6) distinctness, (7) nipple, (8) the skin over the lump, (9) tenderness, and (10)

lymphadenopathy

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

true?

Trang 10

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

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

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

BSE?

average risk for developing breast cancer.”

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

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:

enough support to the breast tissues.”

levels of progesterone during the aging process.”

glandular tissue in the breast This is a normal process of aging.”

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

Trang 11

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 physician.”

the mass each month.”

has been determined to be noncancerous by your physician.”

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

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

woman may have breast cancer?

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?

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:

Định dạng
Số trang	14
Dung lượng	195,59 KB