SOLVED!!! NR 509 COMPREHENSIVE REVIEW OF JARVIS 7TH EDITION CHAPTER 17 QUESTIONS (Breasts and Regional Lymphatics Jarvis: Physical Examination & Health Assessment)

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SOLVED!!! NR 509 COMPREHENSIVE REVIEW OF JARVIS 7TH EDITION CHAPTER 17 QUESTIONS (Breasts and Regional Lymphatics Jarvis: Physical Examination & Health Assessment) ◇This material contains comprehen... sive summary of information in the form of great test questions with descriptive answers helpful for exams study. Thorough Review of Jarvis 7th Edition Chapter 17 Questions. All the best Champions! ______ Chapter 17: Breasts and Regional Lymphatics Jarvis: Physical Examination & Health Assessment, 7th Edition MULTIPLE CHOICE 1. Which of the following statements is true regarding the internal structures of the breast? The breast is made up of: a. Primarily muscle with very little fibrous tissue. b. Fibrous, glandular, and adipose tissues. c. Primarily milk ducts, known as lactiferous ducts. d. Glandular tissue, which supports the breast by attaching to the chest wall. ANS: B The breast is made up of glandular, fibrous (including the suspensory ligaments), and adipose tissues. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 386 MSC: Client Needs: General 2. In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason for this is that the upper outer quadrant is: a. The largest quadrant of the breast. b. The location of most breast tumors. c. Where most of the suspensory ligaments attach. d. 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. DIF: Cognitive Level: Applying (Application) REF: p. 386 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. 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. Four groups of axillary nodes are present: (1) central, (2) pectoral (anterior), (3) subscapular (posterior), and (4) lateral. DIF: Cognitive Level: Applying (Application) REF: p. 387 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. If a patient reports a recent breast infection, then the nurse should expect to find ________ node enlargement. a. Nonspecificb. Ipsilateral axillary c. Contralateral axillary d. Inguinal and cervical ANS: B The breast has extensive lymphatic drainage. Most of the lymph, more than 75%, drains into the ipsilateral, or same side, axillary nodes. DIF: Cognitive Level: Applying (Application) REF: p. 387 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 5. A 9-year-old girl is in the clinic for a sport physical examination. After some initial shyness she finally 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: “Don’t worry, you still have plenty of time to develop.” a. b. “I know just how you feel, I was a late bloomer myself. Just be patient, and they will grow.” c. “You will probably get your periods before you notice any significant growth in your breasts.” d. “I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age.” ANS: D Adolescent breast development usually begins between 8 and 10 years of age. The nurse should not belittle the girl’s feelings by using statements like “don’t worry” or by sharing personal experiences. The beginning of breast development precedes menarche by approximately 2 years. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 6. A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the nurse’s best response? Tell the mother that: a. Breast development is usually fairly symmetric and that the daughter should be examined right away. b. She should bring in her daughter right away because breast cancer is fairly common in preadolescent girls. c. Although an examination of her daughter would rule out a problem, her breast development is most likely normal. d. It is unusual for breasts that are first developing to feel tender because they haven’t developed much fibrous tissue. ANS: C Occasionally, one breast may grow faster than the other, producing a temporary asymmetry, which may cause some distress; reassurance is necessary. Tenderness is also common. DIF: Cognitive Level: Applying (Application) REF: p. 388 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation REF: p. 3887. A 14-year-old girl is anxious about not having reached menarche. When taking the health history, the nurse should ascertain which of the following? The age that: a. The girl began to develop breasts. b. Her mother developed breasts. c. She began to develop pubic hair. d. She began to develop axillary hair. ANS: A Full development from stage 2 to stage 5 takes an average of 3 years, although the range is 1 to 6 years. Pubic hair develops during this time, and axillary hair appears 2 years after the onset of pubic hair. The beginning of breast development precedes menarche by approximately 2 years. Menarche occurs in breast development stage 3 or 4, usually just after the peak of the adolescent growth spurt, which occurs around age 12 years (see Figure 17-6). DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Health Promotion and Maintenance 8. 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 nurse’s best response? The nurse should tell her that: a. Continual changes in her 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 that she should assess her 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 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. 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. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance 9. A woman has just learned that she is pregnant. What are some things the nurse should teach her about 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 REF: p. 389 REF: pp. 388-389The 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. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 389 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 10. The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? a. “Your breast milk is immediately present after the delivery of your baby.” b. “Breast milk is rich in protein and sugars (lactose) but has very little fat.” c. “The colostrum, which is present right after birth, does not contain the same nutrients as breast milk.” d. “You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy.” ANS: D After the fourth month, colostrum may be expressed. This thick yellow fluid is the precursor of milk, and it contains the same amount of protein and lactose but practically no fat. The breasts produce colostrum for the first few days after delivery. It is rich with antibodies that protect the newborn against infection; therefore, breastfeeding is important. DIF: Cognitive Level: Applying (Application) REF: p. 389 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 11. 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? After menopause: a. Only women with large breasts experience sagging. b. Sagging is usually due to decreased muscle mass within the breast. c. A diet that is high in protein will help maintain muscle mass, which keeps the breasts from sagging. d. 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. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance REF: p. 389 12. 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. Ignore it. Benign breast enlargement in men is not unusual. c. Explain that this condition may be the result of hormonal changes, andrecommend 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. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 389 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. During an examination of a 7-year-old girl, the nurse notices that the girl is showing breast budding. What should the nurse do next? a. Ask the young girl if her periods have started. b. Assess the girl’s weight and body mass index (BMI). c. Ask the girl’s mother at what age she started to develop breasts. d. Nothing; breast budding is a normal finding. ANS: B Research has shown that girls with overweight or obese BMI levels have a higher occurrence of early onset of breast budding (before age 8 years for black girls and age 10 years for white girls) and early menarche. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Health Promotion and Maintenance 14. The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the United States, has the highest risk for developing breast cancer? a. Black b. White c. Asian d. American Indian ANS: A The incidence of breast cancer varies within different cultural groups. White women have a higher incidence of breast cancer than black women starting at age 45 years; but black women have a higher incidence before age 45 years. Asian, Hispanic, and American Indian women have a lower risk for development of breast cancer (American Cancer Society, 2009-2010). DIF: Cognitive Level: Understanding (Comprehension) REF: p. 389 MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential 15. The nurse is preparing for a class in early detection of breast cancer. Which statement is true with regard to breast cancer in black women in the United States? a. Breast cancer is not a threat to black women. b. Black women have a lower incidence of regional or distant breast cancer than white women. c. Black women are more likely to die of breast cancer at any age. d. Breast cancer incidence in black women is higher than that of white women after age 45. ANS: C REF: p. 389Black women have a higher incidence of breast cancer before age 45 years than white women and are more likely to die of their disease. In addition, black women are significantly more likely to be diagnosed with regional or distant breast cancer than are white women. These racial differences in mortality rates may be related to an insufficient use of screening measures and a lack of access to health care. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 389 MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential 16. During a breast health interview, a patient states that she has noticed pain in her left breast. The nurse’s most appropriate response to this would be: “Don’t worry about the pain; breast cancer is not painful.” a. 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 Breast pain occurs with trauma, inflammation, infection, or benign breast disease. The nurse will need to gather more information about the patient’s pain rather than make statements that ignore the patient’s concerns. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 391 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. 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? Immediately contact the physician to report the discharge. a. b. Ask her if she is possibly pregnant. c. Ask the patient some additional questions about the medications she is taking. d. Immediately obtain a sample for culture and sensitivity testing. ANS: C 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 would be a thick, yellowish liquid, and it would be normally expressed after the fourth month of pregnancy. DIF: Cognitive Level: Applying (Application) REF: p. 391 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. 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 (see Table 17-6). DIF: Cognitive Level: Analyzing (Analysis) REF: p. 391 MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation 19. A patient is newly diagnosed with benign breast disease. The nurse recognizes which statement about benign breast disease to be true? The presence of benign breast disease: a. Makes it hard to examine the breasts. b. Frequently turns into cancer in a woman’s later years. c. Is easily reduced with hormone replacement therapy. d. 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. DIF: Cognitive Level: Applying (Application) REF: p. 391 MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. 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 [Show More]

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