Jarvis: Physical Examination & Health Assessment, 2nd Canadian Edition Chapter 18: Breasts and Regional Lymphatic System Test Bank MULTIPLE CHOICE 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 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 During assessment of a woman’s axillary lymph system, the nurse will assess the: central, axillary, lateral, and sternal nodes pectoral, lateral, anterior, and sternal nodes central, lateral, pectoral, and subscapular nodes lateral, pectoral, axillary, and suprascapular nodes a b c d Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-2 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 Application REF: Pages 405–406 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 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 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 and 10 years of age.” ANS: D Adolescent breast development usually begins, on an average, between the ages of and 10 years The onset of breast development precedes menarche by about years DIF: Application REF: Page 423 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-3 DIF: 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 Application REF: Pages 406–407 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 years from stage to stage 5, although the range can be as wide as 1.5 to years The onset of breast development precedes menarche by about years Menarche occurs during breast development stage or 4, usually just after the peak of the adolescent growth spurt, around 12 years DIF: Analysis REF: Page 407 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? Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-4 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 DIF: Application REF: Page 408 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.) 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 and postpartum (after the birth) Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-5 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank DIF: d Tell him that gynecomastia in men is usually associated with prostate enlargement, and recommend that he undergo thorough screening ANS: C Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved 18-6 Test Bank 18-7 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 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 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 her actions make it worse? Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-8 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-9 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 infants on formula d Breastfeeding is natural to women, and every woman can 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 19 Which of the following women has risk factors that place her at a higher risk for breast cancer? A 37-year-old who is slightly overweight A 42-year-old who had a diagnosis of ovarian cancer A 45-year-old who has never been pregnant A 65-year-old whose mother had breast cancer a b c d 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-10 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? Nipples in different planes (deviated) The left breast slightly larger than the right Skin of a nonpregnant woman marked with linear striae Breasts of a pregnant woman having a fine blue network of veins visible under the skin a b c d 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-11 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? Supine, with arms raised over her head Sitting, with arms relaxed at the sides Supine, with arms relaxed at the sides Sitting, with arms flexed and fingertips touching shoulders a b c d 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-12 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, 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 feel a lump or mass, note these characteristics: (1) location, (2) size—measure in centimetres in three dimensions: width length thickness, (3) shape, (4) consistency, (5) motility, (6) distinctness, (7) nipple, (8) the skin over the lump, (9) tenderness, and (10) lymphadenopathy DIF: Application REF: Page 421 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-13 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 BSE every month c Breast volume is smallest from day to 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 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 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.” Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-14 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 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 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 o’clock, approximately 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-15 ANS: C The shape of a breast lump often associated with breast cancer is irregular and starshaped 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 to years c Every years d Mammography is not recommended after 60 years of age ANS: B Women aged 50–69 years should have a mammogram every to 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-16 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 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 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-17 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved Test Bank 18-18 Fewer than 1% of all breast cancers occur in men Breast masses are noticeable early because of minimal breast tissue DIF: Application REF: Page 430, Table 18-8 MULTIPLE RESPONSE 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 Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd All rights reserved ... rights reserved Test Bank 18-9 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... infants on formula d Breastfeeding is natural to women, and every woman can it ANS: B In addition to providing the perfect food and antibodies for the baby, breastfeeding promotes bonding and provides... rights reserved 18-6 Test Bank 18-7 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,