Chapter 18: Breasts, Axillae, and
Regional Lymphatics
Physical Examination and Health Assessment, 8th Edition by
Carolyn Jarvis
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)
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)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. In performing an assessment of a womans 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)
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. Nonspecific
b. Ipsilateral axillary
c. Contralateral axillary
d. Inguinal andcervical
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)
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 dont seem to need a bra yet, but I have some
friends who do. What if I never get breasts? The nurses best response would be:
a. Dont 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, 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 girls feelings by using statements like dont 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 nurses 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 havent
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)
MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation
7. 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.
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 nurses 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.
Regional Lymphatics
Physical Examination and Health Assessment, 8th Edition by
Carolyn Jarvis
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)
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)
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. In performing an assessment of a womans 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)
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. Nonspecific
b. Ipsilateral axillary
c. Contralateral axillary
d. Inguinal andcervical
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)
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 dont seem to need a bra yet, but I have some
friends who do. What if I never get breasts? The nurses best response would be:
a. Dont 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, 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 girls feelings by using statements like dont 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 nurses 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 havent
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)
MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation
7. 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.
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 nurses 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.
