When assessing lymph nodes associated with the breast, which findings should the nurse consider abnormal? (Select all that apply.)

Rationale: A. Lymph nodes that are freely moveable under the skin are typically normal. Mobility indicates that the node is not infiltrated by fibrotic tissue or malignant cells. Moveable nodes may shift slightly during palpation and are usually soft or rubbery. B. Smooth lymph nodes are generally normal. Irregular, nodular, or spiculated nodes are more concerning for pathology. Smoothness alone does not indicate abnormality. C. Non-tender lymph nodes are often normal, particularly if they are small and soft. Tenderness is usually associated with acute infections, such as localized cellulitis or mastitis. Therefore, non-tender nodes in isolation are not considered abnormal. D. Hard lymph nodes are abnormal. Hardness suggests that the node may be infiltrated with malignant cells or fibrotic tissue, which can occur in breast cancer metastasis or chronic infections. Hard nodes are less compressible and may be associated with an irregular surface. E. Fixed, immobile lymph nodes are also abnormal. Normal nodes are freely movable; when nodes are adherent to surrounding tissues, it can indicate malignancy, fibrosis, or metastatic spread. Fixed nodes do not shift easily with palpation and require prompt medical evaluation.