Ch. 18 Breasts Flashcards
Which of the following statements is true regarding the internal structures of the breast?
a. Fibrous, glandular, and adipose tissues
b. Primarily muscle with very little fibrous tissue
c. Primarily milk ducts, known as lactiferous ducts
d. Glandular tissue, which supports the breast by attaching to the chest wall
ANS: A
The breast is made up of glandular, fibrous (including the suspensory ligaments), and adipose tissues.
In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important.
What is the reason for this?
a. It is the largest quadrant of the breast.
b. It is the most common location of breast tumors.
c. It is where the majority of suspensory ligaments attach.
d. It is more prone to injury and calcifications than other locations in the breast.
ANS: B
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. The other
options are incorrect.
In performing an assessment of a woman’s axillary lymph system, the nurse should assess which of these nodes?
a. Central, axillary, lateral, and sternal
b. Pectoral, lateral, anterior, and sternal
c. Central, lateral, pectoral, and subscapular
d. Lateral, pectoral, axillary, and suprascapular
ANS: C
The breast has extensive lymphatic drainage, but there are no sternal or suprascapular lymph nodes. The four groups of axillary
nodes are the (1) central, (2) pectoral (anterior), (3) subscapular (posterior), and (4) lateral.
If a patient reports a recent breast infection, then the nurse should expect to find what type of node enlargement?
a. Nonspecific
b. Ipsilateral axillary
c. Inguinal and cervical
d. Contralateral axillary
ANS: B
The breast has extensive lymphatic drainage. Most of the lymph, more than 75%, drains into the ipsilateral, or same side, axillary
nodes. If there was a recent breast infection, then the same side (ipsilateral) axillary nodes will likely be enlarged. A recent breast
infection would not cause enlargement of the inguinal or cervical lymph nodes or lymph nodes on the opposite (contralateral) side.
Instead, since the breast has extensive lymphatic drainage with most of the lymph (more than 75%) drains into the ipsilateral, or
same side, axillary nodes. If there was a recent breast infection, then the same side (ipsilateral) axillary nodes will likely be
enlarged.
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 best response by the nurse?
a. “Continual changes in your breasts are unusual. The breasts of nonpregnant
women usually stay pretty much the same all month long.”
b. “Breast changes in response to stress are very common and you should assess
your life for stressful events.”
c. “Because of the changing hormones during the monthly menstrual cycle, cyclic
breast changes are common.”
d. “Breast changes normally occur only during pregnancy. You should get a
pregnancy test done as soon as possible.”
ANS: C
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.
A woman has just learned that she is pregnant. What should the nurse teach this patient about changes in her breasts?
a. She can expect her areolae to become larger and darker in color.
b. Breasts may begin secreting milk after the fourth month of pregnancy.
c. She should inspect her breasts for visible veins and immediately report these.
d. During pregnancy, breast changes are fairly uncommon; most of the changes
occur after the birth.
ANS: A
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 their original color). A venous pattern is an expected finding and
prominent over the skin surface and does not need to be reported. After the fourth month of pregnancy, colostrum, a thick, yellow
fluid (precursor to milk), may be expressed from the breasts.
A 65-year-old patient remarks that she just cannot believe that her breasts “sag so much.” She states it must be from a lack of
exercise. What explanation should the nurse offer her?
a. After menopause, only women with large breasts experience sagging.
b. After menopause, sagging is usually due to decreased muscle mass within the
breast.
c. After menopause, a diet that is high in protein will help maintain muscle mass,
which keeps the breasts from sagging.
d. After menopause, the glandular and fat tissue atrophies, causing breast size and
elasticity to diminish, resulting in breasts that sag
ANS: D
After menopause, the glandular tissue atrophies and is replaced with connective tissue. The fat envelope also atrophies, beginning
in the middle years and becoming significant in the eighth and ninth decades of life. These changes decrease breast size and
elasticity; consequently, the breasts droop and sag, looking flattened and flabby. There is no or little muscle mass in the breast, so
sagging is not due to decreased muscle mass and a diet high in protein will not help minimize sagging
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?
a. Recommend that he make an appointment with his physician for a mammogram.
b. Acknowledge it as benign breast enlargement which is not unusual in men.
c. Explain that this condition may be the result of hormonal changes, and
recommend that he see his physician.
d. Explain that gynecomastia in men is usually associated with prostate enlargement
and recommend that he be thoroughly screened
ANS: C
Gynecomastia may reappear in the aging man and may be attributable to a testosterone deficiency. The patient should see a
physician to determine the cause and possible treatment. This is not considered a normal finding and a patient should see a
physician to determine the cause and possible treatment. A mammogram is likely not necessary and it is not associated with
prostate enlargement.
During a breast health interview, a patient states that she has noticed pain in her left breast. Which statement by the nurse is most
appropriate?
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.”
ANS: B
Although breast cancer usually occurs from trauma, inflammation, infection, or benign breast disease, rather than cancer, the nurse
should gather more information about the patient’s pain. The nurse should not belittle the patient’s feelings by using statements like
“don’t worry” or by sharing personal experiences.
During a health 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?
a. Ask her if she is possibly pregnant.
b. Immediately contact the physician to report the discharge.
c. Immediately obtain a sample for culture and sensitivity testing.
d. Ask the patient some additional questions about the medications she is taking
ANS: D
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 may be expressed after the fourth month of pregnancy, but
colostrum would be a thick, yellowish liquid, not clear. In the pregnant female, colostrum would be a thick, yellowish liquid, and it
would be normally expressed after the fourth month of pregnancy.
During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for approximately 2
weeks. In trying to find the cause of the rash, which question would be important for the nurse to ask?
a. “Is the rash raised and red?”
b. “Does it appear to be cyclic?”
c. “Where did the rash 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
The location where the rash first appeared is important for the nurse to determine. Paget disease starts with a small crust on the
nipple apex and then spreads to the areola. Eczema or other dermatitis rarely starts at the nipple unless it is a result of
breastfeeding. It usually starts on the areola or surrounding skin and then spreads to the nipple.
A patient is newly diagnosed with benign breast disease. The nurse recognizes which statement about benign breast disease to be
true?
a. It makes it more difficult to examine the breasts.
b. It is easily reduced with hormone replacement therapy.
c. It frequently turns into cancer in a woman’s later years.
d. It is usually diagnosed before a woman reaches childbearing age.
ANS: A
The presence of benign breast disease (formerly fibrocystic breast disease) makes it hard to examine the breasts; the general
lumpiness of the breast conceals a new lump. The other statements are not true. Benign breast disease is not treated with hormone
replacement therapy and it does not usually turn into cancer, although the nodularity associated with benign breast disease makes it
difficult to detect other cancerous lumps. It also is usually diagnosed between 30 and 55 years old (not before childbearing age).
During an annual physical examination, a 43-year-old patient states that she does not perform monthly 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.” What
should the nurse include in his or her response to this patient?
a. BSEs may detect lumps that appear between mammograms.
b. She is correct—mammography is a good replacement for BSE.
c. The American Cancer Society recommends women over 40 years old perform a
monthly BSE.
d. She does not need to perform BSEs as long as a physician checks her breasts
annually.
ANS: A
Although the American Cancer Society no longer recommends a structured monthly BSE because many women with breast cancer
have detected their lumps by chance as when bathing or dressing, the goal of BSE is that a woman becomes familiar with the look
and feel of her breasts so she can detect any change and report it promptly. Intermittent BSEs along with clinical breast
examinations 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
During an interview, 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 about this. Which of these statements by the nurse is accurate?
a. “Breastfed babies tend to be more colicky.”
b. “Breastfed babies eat more often than infants on formula.”
c. “Breastfeeding is second nature, and every woman can do it.”
d. “Breastfeeding provides the perfect food and antibodies for your baby.”
ANS: D
Exclusively breastfeeding for 6 months provides the perfect food and antibodies for the baby, decreases the risk for ear infections,
promotes bonding, and provides relaxation. The other statements are not accurate.
The nurse is reviewing risk factors for breast cancer. Which of these women have risk factors that place them at a higher risk for
breast cancer?
a. 37-year-old who is slightly overweight
b. 42-year-old who has had ovarian cancer
c. 45-year-old who has never been pregnant
d. 66-year-old whose mother had breast cancer The nurse is reviewing risk factors for breast cancer. Which of these women have risk factors that place them at a higher risk for
breast cancer?
a. 37-year-old who is slightly overweight
b. 42-year-old who has had ovarian cancer
c. 45-year-old who has never been pregnant
d. 66-year-old whose mother had breast cancer
ANS: D
The woman at highest risk is the 66-year-old woman whose mother had breast cancer. This woman has two risk factors for breast
cancer with >4.0 relative risk, which are her age (≥65) and a first-degree relative (her mother) with breast cancer. The 37-year-old
woman who is slightly overweight does not have any risk factors for breast cancer. The 42-year-old woman who has had ovarian
cancer has one risk factor for breast cancer with a relative risk for 1.1 to 2.0 and that is her personal history of ovarian cancer. The
45-year-old woman who has never been pregnant has one risk factor for breast cancer with a relative risk for 1.1 to 2.0 and that is
having no full-term pregnancies.
During an examination of a woman, the nurse notices that her left breast is slightly larger than her right breast. Which of these
statements is true about this finding?
a. Asymmetry of the breasts is unusual and the patient should be referred to
physician.
b. Asymmetry of the breasts is common, but the nurse should verify that this finding
is not new.
c. Asymmetry of breast size and shape is very unusual and means she may have an
inflammation or growth.
d. Asymmetry of breast size and shape is probably due to breastfeeding and is
nothing to worry about.
ANS: B
The nurse should notice symmetry of size and shape of the breasts. It is common to have a slight asymmetry in size; often the left
breast is slightly larger than the right. However, a sudden increase in the size of one breast signifies inflammation or new growth.
The nurse should verify that this asymmetry is not new.
The nurse is assisting with a BSE clinic. Which of these women reflects abnormal findings during the inspection phase of breast
examination?
a. Woman whose nipples are in different planes (deviated)
b. Woman whose left breast is slightly larger than her right
c. Nonpregnant woman whose skin is marked with linear striae
d. Pregnant woman whose breasts have a fine blue network of veins visible under
the skin
ANS: A
The nipples should be symmetrically placed on the same plane on the two breasts. With deviation in pointing, an underlying cancer
may cause fibrosis in the mammary ducts, which pulls the nipple angle toward it. The other examples are normal findings. A
woman with a left breast that is slightly larger than her right, a nonpregnant woman whose skin is marked with linear striae, and a
pregnant woman whose breasts have a fine blue network of vein visible under the skin are all normal findings. However, a woman
whose nipples are in different planes, or deviate, is abnormal.
During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this
is most accurate?
a. Normal nipple inversion is usually bilateral.
b. Unilateral inversion of a nipple is always a serious sign.
c. Whether the inversion is a recent change should be determined.
d. Nipple inversion is not significant unless accompanied by an underlying palpable
mass
ANS: C
The nurse should distinguish between a recently retracted nipple from one that has been inverted for many years or since puberty.
Normal nipple inversion may be unilateral or bilateral and usually can be pulled out; that is, if it is not fixed. Recent nipple
retraction signifies acquired disease (see Table 17-3).
The nurse is performing a breast examination. Which of these statements best describes the correct procedure to use when
screening for nipple and skin retraction during a breast examination?
a. Have the patient bend over and touch her toes.
b. Have the patient lie down on her left side and observe for any retraction.
c. Have the patient shift from a supine position to a standing position, and note any
lag or retraction.
d. Have the patient slowly lift her arms above her head, and note any retraction or
lag in movement
ANS: D
The woman should be directed to change position while checking the breasts for signs of skin retraction. Initially, she should be
asked to lift her arms slowly over her head. Both breasts should move up symmetrically. Retraction signs are due to fibrosis in the
breast tissue, usually caused by growing neoplasms. The nurse should notice whether movement of one breast is lagging.
The nurse is palpating a female patient’s breasts during an examination. Which of these positions is most likely to make significant
lumps more distinct during breast palpation?
a. Supine with the arms raised over her head
b. Sitting with the arms relaxed at her sides
c. Supine with the arms relaxed at her sides
d. Sitting with the arms flexed and fingertips touching her shoulders
ANS: A
The nurse should help the woman to a supine position, tuck a small pad under the side to be palpated, and help the woman raise her
arm over her head. These maneuvers will flatten the breast tissue and medially displace it. Any significant lumps will then feel
more distinct.
Which of these clinical situations would the nurse consider to be outside normal limits?
a. A patient has had one pregnancy and states that she believes she may be entering
menopause. Her breast examination reveals breasts that are soft and slightly
sagging.
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 and 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 of 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.
ANS: D
If any discharge appears, the nurse should note its color and consistency. Except in pregnancy and lactation, any discharge is
abnormal. In nulliparous women, normal breast tissue feels firm, smooth, and elastic; after pregnancy, the tissue feels soft and
loose. Premenstrual engorgement is normal, and consists of a slight enlargement, tenderness to palpation, and a generalized
nodularity. A firm, transverse ridge of compressed tissue in the lower quadrants, known as the inframammary ridge, is especially
noticeable in large breasts.
A patient states during the interview that she noticed a new lump in the shower a few days ago. It was on her left breast near her
axilla. How should the nurse proceed?
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 but plan to palpate the axilla last.
ANS: B
If the woman mentions a breast lump she has discovered herself, then the nurse should examine the unaffected breast first to learn a
baseline of normal consistency for this individual.
The nurse has palpated a lump in a female patient’s right breast. The nurse documents this as a small, round, firm, distinct, lump
located at 2 o’clock, 2 cm from the nipple. It is nontender and fixed. No associated retraction of the skin or nipple, no erythema,
and no axillary lymphadenopathy are observed. What information is missing from the documentation?
a. Size of the lump
b. Shape of the lump
c. Consistency of the lump
d. Whether the lump is solitary or multiple
ANS: A
If the nurse feels a lump or mass, then he or she should note these characteristics: (1) location, (2) size judge in centimeters 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.
The nurse is conducting a class on BSE. Which of these statements indicates the proper BSE technique?
a. The best time to perform BSE is in the middle of the menstrual cycle.
b. A woman should perform BSEs bimonthly unless she has fibrocystic breast
tissue.
c. The best time to perform a BSE is 4 to 7 days after the first day of the menstrual
period.
d. If she suspects that she is pregnant, then the woman should not perform a BSE
until after her baby is born.
ANS: C
The best time to conduct a 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. The pregnant or menopausal woman who is not having menstrual periods should be
advised to select a familiar date to examine her breasts each month—for example, her birth date or the day the rent is due. Women
do not need to be advised to perform BSEs bimonthly
