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

During breast examination, it is especially important for the nurse to examine the upper outer quadrant of the breast because it is: a.. Breasts usually develop between 8 and 10 years of

Jarvis: Physical Examination & Health Assessment, 2nd Canadian Edition

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

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

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

DIF:

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

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

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:

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

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

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?

DIF:

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

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.)

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)

DIF:

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

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

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

DIF:

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

and recommend that he undergo thorough screening

ANS: C

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

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

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

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

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

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

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

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

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

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

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

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?

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