NUR 301 Exam 3 Review AQAQA
1. A 52-year-old secretary comes to your office, complaining about accidentally leaking
urine when she coughs or sneezes. She says this has been going on for about a year
now. She relates that she has not had a period for 2 years. She denies any recent illness
or injuries. Her past medical history is significant for four spontaneous vaginal
deliveries. She is married and has four children. She denies alcohol, tobacco, or drug
use. During her pelvic examination you note some atrophic vaginal tissue, but the
remainder of her pelvic, abdominal, and rectal examinations are unremarkable.
Which type of urinary incontinence does she have?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence
Ans: A
Feedback:
Stress incontinence usually occurs when the intra-abdominal pressure goes up during
coughing, sneezing, or laughing. This is usually due to a weakness of the pelvic floor,
with inadequate muscle support of the bladder. Vaginal deliveries and pelvic surgery
are often associated with these symptoms. Usually female patients are postmenopausal
when stress incontinence begins. Kegel exercises are usually recommended to
strengthen the pelvic floor muscles.
1. A 72-year-old retired saleswoman comes to your office, complaining of a bloody
discharge from her left breast for 3 months. She denies any trauma to her breast. Her
past medical history includes high blood pressure and abdominal surgery for colon
cancer. Her aunt died of ovarian cancer and her father died of colon cancer. Her
mother died of a stroke. The patient denies tobacco, alcohol, or drug use. She is a
widow and has three healthy children. On examination her breasts are symmetric, with
no skin changes. You are able to express bloody discharge from her left nipple. You
feel no discrete masses, but her left axilla has a hard, 1-cm fixed node. The remainder
of her heart, lung, abdominal, and pelvic examinations are unremarkable.
What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast cancer
C) Galactorrhea
Ans: B
Feedback:
Nipple discharge in breast cancer is usually unilateral and can be clear or bloody.
Although a breast mass is not palpated, in this case a fixed lymph node is palpated.
Other forms of breast cancer can present as a chronic rash on the breast.
,NUR 301 Exam 3 Review AQAQA
2. A 44-year-old female comes to your clinic, complaining of severe dry skin in the area
over her right nipple. She denies any trauma to the area. She noticed the skin change
during a self-examination 2 months ago. She also admits that she had felt a lump under
the nipple but kept putting off making an appointment. She does admit to 6 months of
fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history
is significant for hypothyroidism. She does not have a history of eczema or allergies.
She denies any tobacco, alcohol, or drug use. On examination you find a middle-aged
woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-
like crust around her nipple. Underneath you palpate a nontender 2-cm mass. The
axilla contains only soft, moveable nodes. The left breast and axilla examination
findings are unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: B
Feedback:
This uncommon form of breast cancer starts as an eczema-like, scaly skin change
around the areola. The lesion may weep, crust, or erode. It can be associated with an
underlying mass, but the skin change can also be found alone. Any eczema-like area
around the nipple that does not respond to topical treatment needs to be evaluated for
breast cancer.
3. A 56-year-old female comes to your clinic, complaining of her left breast looking
unusual. She says that for 2 months the angle of the nipple has changed direction. She
does not do self-examinations, so she doesn't know if she has a lump. She has no history
of weight loss, weight gain, fever, or night sweats. Her past medical history is
significant for high blood pressure. She smokes two packs of cigarettes a day and has
three to four drinks per weekend night. Her paternal aunt died of breast cancer in her
forties. Her mother is healthy but her father died of prostate cancer. On examination
you find a middle-aged woman appearing older than her stated age. Inspection of her
left breast reveals a flattened nipple deviating toward the lateral side. On palpation the
nipple feels thickened. Lateral to the areola you palpate a nontender 4-cm mass. The
axilla contains several fixed nodes. The right breast and axilla examinations are
unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: A
,NUR 301 Exam 3 Review AQAQA
Feedback:
A retracted nipple is flattened or pulled inward or toward the medial, lateral, anterior, or
posterior side of the breast. The surrounding skin can be thickened. This is a relatively
late finding in breast cancer.
4. A 19-year-old female comes to your office, complaining of a clear discharge from her
right breast for 2 months. She states that she noticed it when she and her boyfriend were
“messing around” and he squeezed her nipple. She continues to have this discharge
anytime she squeezes that nipple. She denies any trauma to her breasts. Her past
medical history is unremarkable. She denies any pregnancies. Both of her parents are
healthy. She denies using tobacco or illegal drugs and drinks three to four beers a week.
On examination her breasts are symmetric with no skin changes. You are able to express
clear discharge from her right nipple. You feel no discrete masses and her axillae are
normal. The remainder of her heart, lung, abdominal, and pelvic examinations are
unremarkable. A urine pregnancy test is negative.
What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast cancer
C) Nonpuerperal galactorrhea
Ans: A
Feedback:
Nipple discharge in benign breast abnormalities tends to be clear and unilateral. The
discharge is usually not spontaneous. This patient needs to be told to stop compressing
her nipple. If the problem still persists after the patient has stopped compressing the
nipple, further workup is warranted.
5. A 23-year-old computer programmer comes to your office for an annual examination.
She has recently become sexually active and wants to be placed on birth control. Her
only complaint is that the skin in her armpits has become darker. She states it looks like
dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past
medical symptoms consist of acne and mild obesity. Her periods have been irregular
for 3 years. Her mother has type 2 diabetes and her father has high blood pressure. The
patient denies using tobacco but has four to five drinks on Friday and Saturday nights.
She denies any illegal drug use. On examination you see a mildly obese female who is
breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you
see dark, velvet-like skin. Her annual examination is otherwise unremarkable.
What disorder of the breast or axilla is she most likely to have?
A) Peau d'orange
B) Acanthosis nigricans
C) Hidradenitis suppurativa
, NUR 301 Exam 3 Review AQAQA
Ans: B
Feedback:
Acanthosis nigricans can be associated with an internal malignancy, but in most cases it
is a benign dermatologic condition associated with polycystic ovarian syndrome,
consisting of acne, hirsutism, obesity, irregular periods, infertility, ovarian cysts, and
early onset type 2 diabetes. It is also known to correlate with insulin resistance.
6. A 43-year-old store clerk comes to your office upset because she has found an enlarged
lymph node under her left arm. She states she found it yesterday when she was feeling
pain under her arm during movement. She states the lymph node is about an inch long
and is very painful. She checks her breasts monthly and gets a yearly mammogram (her
last was 2 months ago), and until now everything has been normal. She states she is so
upset because her mother died in her 50s of breast cancer. The patient does not smoke,
drink, or use illegal drugs. Her father is in good health. On examination you see a tense
female appearing her stated age. On visual inspection of her left axilla you see a tense
red area. There is no scarring around the axilla. Palpating this area, you feel a 2-cm
tender, movable lymph node underlying hot skin. Other shotty nodes are also in the
area. Visualization of both breasts is normal. Palpation of her right axilla and both
breasts is unremarkable. Examining her left arm, you see a scabbed-over superficial
laceration over her left hand. Upon your questioning, she remembers she cut her hand
gardening last week.
What disorder of the axilla is most likely responsible for her symptoms?
A) Breast cancer
B) Lymphadenopathy of infectious origin
C) Hidradenitis suppurativa
Ans: B
Feedback:
A lymph node enlarged because of infection is generally hot, tender, and red. Close
examination of the skin that drains to that lymph node region is advised. Often there will
be a cut or scratch over the involved arm that has an infectious agent. An example is cat
scratch disease.
1. A 52-year-old secretary comes to your office, complaining about accidentally leaking
urine when she coughs or sneezes. She says this has been going on for about a year
now. She relates that she has not had a period for 2 years. She denies any recent illness
or injuries. Her past medical history is significant for four spontaneous vaginal
deliveries. She is married and has four children. She denies alcohol, tobacco, or drug
use. During her pelvic examination you note some atrophic vaginal tissue, but the
remainder of her pelvic, abdominal, and rectal examinations are unremarkable.
Which type of urinary incontinence does she have?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence
Ans: A
Feedback:
Stress incontinence usually occurs when the intra-abdominal pressure goes up during
coughing, sneezing, or laughing. This is usually due to a weakness of the pelvic floor,
with inadequate muscle support of the bladder. Vaginal deliveries and pelvic surgery
are often associated with these symptoms. Usually female patients are postmenopausal
when stress incontinence begins. Kegel exercises are usually recommended to
strengthen the pelvic floor muscles.
1. A 72-year-old retired saleswoman comes to your office, complaining of a bloody
discharge from her left breast for 3 months. She denies any trauma to her breast. Her
past medical history includes high blood pressure and abdominal surgery for colon
cancer. Her aunt died of ovarian cancer and her father died of colon cancer. Her
mother died of a stroke. The patient denies tobacco, alcohol, or drug use. She is a
widow and has three healthy children. On examination her breasts are symmetric, with
no skin changes. You are able to express bloody discharge from her left nipple. You
feel no discrete masses, but her left axilla has a hard, 1-cm fixed node. The remainder
of her heart, lung, abdominal, and pelvic examinations are unremarkable.
What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast cancer
C) Galactorrhea
Ans: B
Feedback:
Nipple discharge in breast cancer is usually unilateral and can be clear or bloody.
Although a breast mass is not palpated, in this case a fixed lymph node is palpated.
Other forms of breast cancer can present as a chronic rash on the breast.
,NUR 301 Exam 3 Review AQAQA
2. A 44-year-old female comes to your clinic, complaining of severe dry skin in the area
over her right nipple. She denies any trauma to the area. She noticed the skin change
during a self-examination 2 months ago. She also admits that she had felt a lump under
the nipple but kept putting off making an appointment. She does admit to 6 months of
fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history
is significant for hypothyroidism. She does not have a history of eczema or allergies.
She denies any tobacco, alcohol, or drug use. On examination you find a middle-aged
woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-
like crust around her nipple. Underneath you palpate a nontender 2-cm mass. The
axilla contains only soft, moveable nodes. The left breast and axilla examination
findings are unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: B
Feedback:
This uncommon form of breast cancer starts as an eczema-like, scaly skin change
around the areola. The lesion may weep, crust, or erode. It can be associated with an
underlying mass, but the skin change can also be found alone. Any eczema-like area
around the nipple that does not respond to topical treatment needs to be evaluated for
breast cancer.
3. A 56-year-old female comes to your clinic, complaining of her left breast looking
unusual. She says that for 2 months the angle of the nipple has changed direction. She
does not do self-examinations, so she doesn't know if she has a lump. She has no history
of weight loss, weight gain, fever, or night sweats. Her past medical history is
significant for high blood pressure. She smokes two packs of cigarettes a day and has
three to four drinks per weekend night. Her paternal aunt died of breast cancer in her
forties. Her mother is healthy but her father died of prostate cancer. On examination
you find a middle-aged woman appearing older than her stated age. Inspection of her
left breast reveals a flattened nipple deviating toward the lateral side. On palpation the
nipple feels thickened. Lateral to the areola you palpate a nontender 4-cm mass. The
axilla contains several fixed nodes. The right breast and axilla examinations are
unremarkable.
What visible skin change of the breast does she have?
A) Nipple retraction
B) Paget's disease
C) Peau d'orange sign
Ans: A
,NUR 301 Exam 3 Review AQAQA
Feedback:
A retracted nipple is flattened or pulled inward or toward the medial, lateral, anterior, or
posterior side of the breast. The surrounding skin can be thickened. This is a relatively
late finding in breast cancer.
4. A 19-year-old female comes to your office, complaining of a clear discharge from her
right breast for 2 months. She states that she noticed it when she and her boyfriend were
“messing around” and he squeezed her nipple. She continues to have this discharge
anytime she squeezes that nipple. She denies any trauma to her breasts. Her past
medical history is unremarkable. She denies any pregnancies. Both of her parents are
healthy. She denies using tobacco or illegal drugs and drinks three to four beers a week.
On examination her breasts are symmetric with no skin changes. You are able to express
clear discharge from her right nipple. You feel no discrete masses and her axillae are
normal. The remainder of her heart, lung, abdominal, and pelvic examinations are
unremarkable. A urine pregnancy test is negative.
What cause of nipple discharge is the most likely in her circumstance?
A) Benign breast abnormality
B) Breast cancer
C) Nonpuerperal galactorrhea
Ans: A
Feedback:
Nipple discharge in benign breast abnormalities tends to be clear and unilateral. The
discharge is usually not spontaneous. This patient needs to be told to stop compressing
her nipple. If the problem still persists after the patient has stopped compressing the
nipple, further workup is warranted.
5. A 23-year-old computer programmer comes to your office for an annual examination.
She has recently become sexually active and wants to be placed on birth control. Her
only complaint is that the skin in her armpits has become darker. She states it looks like
dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past
medical symptoms consist of acne and mild obesity. Her periods have been irregular
for 3 years. Her mother has type 2 diabetes and her father has high blood pressure. The
patient denies using tobacco but has four to five drinks on Friday and Saturday nights.
She denies any illegal drug use. On examination you see a mildly obese female who is
breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you
see dark, velvet-like skin. Her annual examination is otherwise unremarkable.
What disorder of the breast or axilla is she most likely to have?
A) Peau d'orange
B) Acanthosis nigricans
C) Hidradenitis suppurativa
, NUR 301 Exam 3 Review AQAQA
Ans: B
Feedback:
Acanthosis nigricans can be associated with an internal malignancy, but in most cases it
is a benign dermatologic condition associated with polycystic ovarian syndrome,
consisting of acne, hirsutism, obesity, irregular periods, infertility, ovarian cysts, and
early onset type 2 diabetes. It is also known to correlate with insulin resistance.
6. A 43-year-old store clerk comes to your office upset because she has found an enlarged
lymph node under her left arm. She states she found it yesterday when she was feeling
pain under her arm during movement. She states the lymph node is about an inch long
and is very painful. She checks her breasts monthly and gets a yearly mammogram (her
last was 2 months ago), and until now everything has been normal. She states she is so
upset because her mother died in her 50s of breast cancer. The patient does not smoke,
drink, or use illegal drugs. Her father is in good health. On examination you see a tense
female appearing her stated age. On visual inspection of her left axilla you see a tense
red area. There is no scarring around the axilla. Palpating this area, you feel a 2-cm
tender, movable lymph node underlying hot skin. Other shotty nodes are also in the
area. Visualization of both breasts is normal. Palpation of her right axilla and both
breasts is unremarkable. Examining her left arm, you see a scabbed-over superficial
laceration over her left hand. Upon your questioning, she remembers she cut her hand
gardening last week.
What disorder of the axilla is most likely responsible for her symptoms?
A) Breast cancer
B) Lymphadenopathy of infectious origin
C) Hidradenitis suppurativa
Ans: B
Feedback:
A lymph node enlarged because of infection is generally hot, tender, and red. Close
examination of the skin that drains to that lymph node region is advised. Often there will
be a cut or scratch over the involved arm that has an infectious agent. An example is cat
scratch disease.
