WorksheetsHA EXAM 3 Pt.2
Total questions: 15
Worksheet time: 45mins
A 48-year-old woman comes to the clinic reporting a new, 2-cm, firm, non-tender mass in her upper outer quadrant and mild axillary fullness on the same side. Which nursing response/action is most appropriate first?
Teach the patient to perform monthly BSE starting immediately.
Arrange for diagnostic imaging (mammogram ± ultrasound) and schedule a prompt provider evaluation.
Recommend watchful waiting for one menstrual cycle since tenderness is absent.
Encourage increased exercise and a low-fat diet to reduce breast tissue density.
During a breast exam on a 67-year-old woman, you document that the breasts are smaller, more pendulous, and the nipples are flatter and less erectile when stimulated. What is the most likely explanation for these findings?
Hormonal changes due to decreased prolactin.
Normal age-related decrease in glandular tissue and estrogen.
Pathologic fibrosis from chronic mastitis.
Early signs of inflammatory breast cancer.
A client asks why starting menses at age 10 increases long-term breast cancer risk. The best nurse explanation is:
Early menses is linked to genetic BRCA mutations.
Early menses increases lifetime exposure to estrogen, which elevates risk.
Early menses directly causes abnormal ductal cell mutations.
Early menses weakens lymphatic drainage of the breast.
While teaching breast self-examination (BSE) to a premenopausal client, which instruction is most accurate for timing and technique?
Perform BSE every day to detect subtle changes.
Perform BSE a few days after your period ends; use the pads of the three middle fingers in small circular motions while supine.
Only perform BSE if you feel pain or see changes in your breast.
Perform BSE standing with arms at sides only; lying down is unnecessary.
A 35-year-old woman with a family history of early-onset breast cancer asks about risk related to age at first childbirth. Which statement is most correct?
Having your first child after age 30 slightly increases lifetime breast cancer risk compared with having one earlier.
Age at first childbirth has no influence on breast cancer risk.
Having any children eliminates breast cancer risk.
First childbirth before age 18 greatly increases risk compared with nulliparous women.
You palpate an axillary lymph node that is 2.5 cm, hard, fixed to underlying tissue, and non-tender in a 60-year-old patient with a suspicious breast mass. Which interpretation is most appropriate?
This node likely represents a benign reactive node; advise follow-up in 6 months.
Hard, fixed, non-tender node increases concern for metastatic involvement and requires urgent further evaluation.
Fixed nodes are typical in elderly clients and rarely clinically significant.
Swollen nodes of this size are pathognomonic for fungal infection.
A client with newly diagnosed breast carcinoma asks what “ER/PR positive” means and why it matters. The best nurse explanation is:
The tumor grows faster because estrogen and progesterone are always harmful.
The tumor’s cells have receptors for estrogen and/or progesterone, meaning hormone therapy may be an effective treatment option.
ER/PR positivity means the tumor originated outside the breast.
ER/PR positivity always indicates a higher grade (more aggressive) tumor.
During inspection you note subtle skin puckering and one area that looks like “orange peel” (peau d’orange). Which action is most appropriate by the nurse?
Document as benign fibrocystic change and advise warm compresses.
Immediately prepare patient for antibiotics for cellulitis.
Recognize these as signs suspicious for malignancy and report promptly for diagnostic workup.
Reassure the patient that peau d’orange only occurs after radiation therapy.
A male patient presents with unilateral breast enlargement and mild nipple tenderness. He reports current use of spironolactone and recent weight gain. What is the most likely nursing conclusion?
This presentation most likely indicates male breast carcinoma and should be treated with chemotherapy.
Gynecomastia from medication or hormonal imbalance is likely; evaluate medications, endocrine causes, and consider imaging if a suspicious mass persists.
Normal aging change in men — no further evaluation needed.
Always treat immediately with anti-estrogen therapy.
A patient had a unilateral mastectomy with axillary lymph node dissection. Which nursing instruction is most critical to include in discharge teaching to reduce long-term complications?
Avoid ipsilateral arm blood pressure measurements, venipuncture, and heavy lifting to reduce risk of lymphedema.
Use the affected arm freely; there is no increased risk from any activities.
Encourage tight clothing on the affected side to reduce swelling.
Start vigorous weightlifting the day after discharge to strengthen the arm.
A 42-year-old woman with dense breasts on mammogram is concerned about screening. Which statement is most appropriate?
Dense breasts do not affect cancer risk or mammogram accuracy.
Dense breast tissue can both increase risk and reduce mammogram sensitivity; additional imaging (ultrasound or MRI) may be recommended depending on risk.
Dense breasts automatically indicate breast cancer and require immediate biopsy.
You should stop mammograms and rely solely on monthly BSE.
You assess a client who reports a single-side bloody nipple discharge and an eczematous, scaly lesion on the nipple. Which condition is highest on your differential and requires prompt referral?
Paget disease of the breast (associated with underlying malignancy).
Benign intraductal papilloma that never requires further workup.
Simple contact dermatitis from soap.
Normal physiologic discharge — no action needed.
Which findings on breast inspection/palpation are more suggestive of breast malignancy than benign conditions? (SATA)
A single, firm, irregular, nonmobile mass.
Multiple, bilateral, soft, tender lumps that vary with the menstrual cycle.
Skin dimpling or retraction over a mass.
Nipple retraction or bloody nipple discharge.
Mobile, smooth, rubbery lump that is tender and regular.
When teaching a patient how to perform BSE, which instructions should the nurse include? (SATA)
Perform BSE a few days after menses when breasts are least tender.
Use the pads of the three middle fingers and a systematic pattern to cover entire breast including axilla.
Only perform BSE if you have a family history of breast cancer.
Demonstrate technique and ask the patient to return-demonstrate (teach-back).
Delay seeking clinical evaluation if you find a lump until it becomes painful.
A client has multiple risk factors for breast cancer. Which of the following are recognized risk factors? (SATA)
Early menarche and late menopause.
First full-term pregnancy before age 20.
BRCA1 or BRCA2 gene mutation in a first-degree relative.
Excessive alcohol use.
Having several children and prolonged breastfeeding throughout reproductive years.
