Chapter 25: Anus, Rectum, and Prostate My Nursing Test Banks

Chapter 25: Anus, Rectum, and Prostate

Jarvis: Physical Examination & Health Assessment, 7th Edition

MULTIPLE CHOICE

1. Which statement concerning the anal canal is true? The anal canal:

a.

Is approximately 2 cm long in the adult.

b.

Slants backward toward the sacrum.

c.

Contains hair and sebaceous glands.

d.

Is the outlet for the gastrointestinal tract.

ANS: D

The anal canal is the outlet for the gastrointestinal tract and is approximately 3.8 cm long in the adult. It is lined with a modified skin that does not contain hair or sebaceous glands, and it slants forward toward the umbilicus.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 721

MSC: Client Needs: General

2. Which statement concerning the sphincters is correct?

a.

The internal sphincter is under voluntary control.

b.

The external sphincter is under voluntary control.

c.

Both sphincters remain slightly relaxed at all times.

d.

The internal sphincter surrounds the external sphincter.

ANS: B

The external sphincter surrounds the internal sphincter but also has a small section overriding the tip of the internal sphincter at the opening. The external sphincter is under voluntary control. Except for the passing of feces and gas, the sphincters keep the anal canal tightly closed.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 721

MSC: Client Needs: General

3. The nurse is performing an examination of the anus and rectum. Which of these statements is correct and important to remember during this examination?

a.

The rectum is approximately 8 cm long.

b.

The anorectal junction cannot be palpated.

c.

Above the anal canal, the rectum turns anteriorly.

d.

No sensory nerves are in the anal canal or rectum.

ANS: B

The anal columns are folds of mucosa that extend vertically down from the rectum and end in the anorectal junction. This junction is not palpable but is visible on proctoscopy. The rectum is 12 cm long; just above the anal canal, the rectum dilates and turns posteriorly.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 721

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. The structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm is the:

a.

Cowper gland.

b.

Prostate gland.

c.

Median sulcus.

d.

Bulbourethral gland.

ANS: B

In men, the prostate gland secretes a thin milky alkaline fluid that enhances sperm viability. The Cowper glands (also known as bulbourethral glands) secrete a clear, viscid mucus. The median sulcus is a groove that divides the lobes of the prostate gland and does not secrete fluid.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 722

MSC: Client Needs: General

5. A 46-year-old man requires an assessment of his sigmoid colon. Which instrument or technique is most appropriate for this examination?

a.

Proctoscope

b.

Ultrasound

c.

Colonoscope

d.

Rectal examination with an examining finger

ANS: C

The sigmoid colon is 40 cm long, and the nurse knows that it is accessible to examination only with the colonoscope. The other responses are not appropriate for an examination of the entire sigmoid colon.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 722

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

6. The nurse is caring for a newborn infant. Thirty hours after birth, the infant passes a dark green meconium stool. The nurse recognizes this is important because the:

a.

Stool indicates anal patency.

b.

Dark green color indicates occult blood in the stool.

c.

Meconium stool can be reflective of distress in the newborn.

d.

Newborn should have passed the first stool within 12 hours after birth.

ANS: A

The first stool passed by the newborn is dark green meconium and occurs within 24 to 48 hours of birth, indicating anal patency. The other responses are not correct.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 723

MSC: Client Needs: Health Promotion and Maintenance

7. During the assessment of an 18-month-old infant, the mother expresses concern to the nurse about the infants inability to toilet train. What would be the nurses best response?

a.

Some children are just more difficult to train, so I wouldnt worry about it yet.

b.

Have you considered reading any of the books on toilet training? They can be very helpful.

c.

This could mean that there is a problem in your babys development. Well watch her closely for the next few months.

d.

The nerves that will allow your baby to have control over the passing of stools are not developed until at least 18 to 24 months of age.

ANS: D

The infant passes stools by reflex. Voluntary control of the external anal sphincter cannot occur until the nerves supplying the area have become fully myelinated, usually around 1 to 2 years of age. Toilet training usually starts after the age of 2 years.

DIF: Cognitive Level: Applying (Application) REF: p. 723

MSC: Client Needs: Health Promotion and Maintenance

8. A 60-year-old man has just been told that he has benign prostatic hypertrophy (BPH). He has a friend who just died from cancer of the prostate. He is concerned this will happen to him. How should the nurse respond?

a.

The swelling in your prostate is only temporary and will go away.

b.

We will treat you with chemotherapy so we can control the cancer.

c.

It would be very unusual for a man your age to have cancer of the prostate.

d.

The enlargement of your prostate is caused by hormonal changes, and not cancer.

ANS: D

The prostate gland commonly starts to enlarge during the middle adult years. BPH is present in 1 in 10 men at the age of 40 years and increases with age. It is believed that the hypertrophy is caused by hormonal imbalance that leads to the proliferation of benign adenomas. The other responses are not appropriate.

DIF: Cognitive Level: Applying (Application) REF: p. 723

MSC: Client Needs: Health Promotion and Maintenance

9. A 30-year-old woman is visiting the clinic because of pain in my bottom when I have a bowel movement. The nurse should assess for which problem?

a.

Pinworms

b.

Hemorrhoids

c.

Colon cancer

d.

Fecal incontinence

ANS: B

Having painful bowel movements, known as dyschezia, may be attributable to a local condition (hemorrhoid or fissure) or constipation. The other responses are not correct.

DIF: Cognitive Level: Applying (Application) REF: p. 723

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

10. A patient who is visiting the clinic complains of having stomach pains for 2 weeks and describes his stools as being soft and black for approximately the last 10 days. He denies taking any medications. The nurse is aware that these symptoms are mostly indicative of:

a.

Excessive fat caused by malabsorption.

b.

Increased iron intake, resulting from a change in diet.

c.

Occult blood, resulting from gastrointestinal bleeding.

d.

Absent bile pigment from liver problems.

ANS: C

Black stools may be tarry as a result of occult blood (melena) from gastrointestinal bleeding or nontarry from ingestion of iron medications (not diet). Excessive fat causes the stool to become frothy. The absence of bile pigment causes clay-colored stools.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 724

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

11. After completing an assessment of a 60-year-old man with a family history of colon cancer, the nurse discusses with him early detection measures for colon cancer. The nurse should mention the need for a(n):

a.

Annual proctoscopy.

b.

Colonoscopy every 10 years.

c.

Fecal test for blood every 6 months.

d.

DREs every 2 years.

ANS: B

Early detection measures for colon cancer include a DRE performed annually after age 50 years, an annual fecal occult blood test after age 50 years, a sigmoidoscopic examination every 5 years or a colonoscopy every 10 years after age 50 years, and a PSA blood test annually for men over 50 years old, except beginning at age 45 years for black men (American Cancer Society, 2006).

DIF: Cognitive Level: Applying (Application) REF: p. 725

MSC: Client Needs: Health Promotion and Maintenance

12. The mother of a 5-year-old girl tells the nurse that she has noticed her daughter scratching at her bottom a lot the last few days. During the assessment, the nurse finds redness and raised skin in the anal area. This finding most likely indicates:

a.

Pinworms.

b.

Chickenpox.

c.

Constipation.

d.

Bacterial infection.

ANS: A

In children, pinworms are a common cause of intense itching and irritated anal skin. The other options are not correct.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 725

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

13. The nurse is examining only the rectal area of a woman and should place the woman in what position?

a.

Lithotomy

b.

Prone

c.

Left lateral decubitus

d.

Bending over the table while standing

ANS: C

The nurse should place the female patient in the lithotomy position if the genitalia are being examined as well. The left lateral decubitus position is used for the rectal area alone.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 725

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

14. While performing an assessment of the perianal area of a patient, the nurse notices that the pigmentation of anus is darker than the surrounding skin, the anal opening is closed, and a skin sac that is shiny and blue is noted. The patient mentioned that he has had pain with bowel movements and has occasionally noted some spots of blood. What would this assessment and history most likely indicate?

a.

Anal fistula

b.

Pilonidal cyst

c.

Rectal prolapse

d.

Thrombosed hemorrhoid

ANS: D

The anus normally looks moist and hairless, with coarse folded skin that is more pigmented than the perianal skin, and the anal opening is tightly closed. The shiny blue skin sac indicates a thrombosed hemorrhoid.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 726

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

15. The nurse is preparing to palpate the rectum and should use which of these techniques? The nurse should:

a.

Flex the finger, and slowly insert it toward the umbilicus.

b.

First instruct the patient that this procedure will be painful.

c.

Insert an extended index finger at a right angle to the anus.

d.

Place the finger directly into the anus to overcome the tight sphincter.

ANS: A

The nurse should gently place the pad of the index finger against the anal verge. The nurse will feel the sphincter tighten and then relax. As it relaxes, the nurse should flex the tip of the finger and slowly insert it into the anal canal in a direction toward the umbilicus. The nurse should never approach the anus at right angles with the index finger extended; doing so would cause pain. The nurse should instruct the patient that palpation is not painful but may feel like needing to move the bowels.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 726

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

16. While performing a rectal examination, the nurse notices a firm, irregularly shaped mass. What should the nurse do next?

a.

Continue with the examination, and document the finding in the chart.

b.

Instruct the patient to return for a repeat assessment in 1 month.

c.

Tell the patient that a mass was felt, but it is nothing to worry about.

d.

Report the finding, and refer the patient to a specialist for further examination.

ANS: D

A firm or hard mass with an irregular shape or rolled edges may signify carcinoma. Any mass that is discovered should be promptly reported for further examination. The other responses are not correct.

DIF: Cognitive Level: Applying (Application) REF: p. 734

MSC: Client Needs: Health Promotion and Maintenance

17. During an assessment of the newborn, the nurse expects to see which finding when the anal area is slightly stroked?

a.

Jerking of the legs

b.

Flexion of the knees

c.

Quick contraction of the sphincter

d.

Relaxation of the external sphincter

ANS: C

To assess sphincter tone, the nurse should check the anal reflex by gently stroking the anal area and noticing a quick contraction of the sphincter. The other responses are not correct.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 729

MSC: Client Needs: Health Promotion and Maintenance

18. A 13-year-old girl is visiting the clinic for a sports physical examination. The nurse should remember to include which of these tests in the examination?

a.

Testing for occult blood

b.

Valsalva maneuver

c.

Internal palpation of the anus

d.

Inspection of the perianal area

ANS: D

The perianal region of the school-aged child and adolescent should be inspected during the examination of the genitalia. Internal palpation is not routinely performed at this age. Testing for occult blood and performing the Valsalva maneuver are also not necessary.

DIF: Cognitive Level: Applying (Application) REF: p. 729

MSC: Client Needs: Health Promotion and Maintenance

19. During an assessment of a 20-year-old man, the nurse finds a small palpable lesion with a tuft of hair located directly over the coccyx. The nurse knows that this lesion would most likely be a:

a.

Rectal polyp.

b.

Pruritus ani.

c.

Carcinoma.

d.

Pilonidal cyst.

ANS: D

A pilonidal cyst or sinus is a hair-containing cyst or sinus located in the midline over the coccyx or lower sacrum. It often opens as a dimple with a visible tuft of hair and, possibly, an erythematous halo. (See Table 25-1 for more information, and also for the description of a pruritus ani. See Table 25-2 for the descriptions of rectal polyps and carcinoma.)

DIF: Cognitive Level: Applying (Application) REF: p. 732

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

20. During an examination, the nurse asks the patient to perform the Valsalva maneuver and notices that the patient has a moist, red, doughnut-shaped protrusion from the anus. The nurse knows that this finding is consistent with a:

a.

Rectal polyp.

b.

Hemorrhoid.

c.

Rectal fissure.

d.

Rectal prolapse.

ANS: D

In rectal prolapse, the rectal mucous membrane protrudes through the anus, appearing as a moist red doughnut with radiating lines. It occurs after a Valsalva maneuver, such as straining at passing stool or with exercising (see Table 25-1). (See Table 25-2 for a description of rectal polyps and Table 25-1 for the descriptions of a rectal fissure and hemorrhoids.)

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 733

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

21. A 70-year-old man is visiting the clinic for difficulty in passing urine. In the health history, he indicates that he has to urinate frequently, especially at night. He has burning when he urinates and has noticed pain in his back. Considering this history, what might the nurse expect to find during the physical assessment?

a.

Asymmetric, hard, and fixed prostate gland

b.

Occult blood and perianal pain to palpation

c.

Symmetrically enlarged, soft prostate gland

d.

Soft nodule protruding from the rectal mucosa

ANS: A

Subjective symptoms of carcinoma of the prostate include frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination, and continuous pain in lower back, pelvis, and thighs. Objective symptoms of carcinoma of the prostate include a malignant neoplasm that often starts as a single hard nodule on the posterior surface, producing asymmetry and a change in consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stone hard and fixed.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 735

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

22. A 40-year-old black man is in the office for his annual physical examination. Which statement regarding the PSA blood test is true, according to the American Cancer Society? The PSA:

a.

Should be performed with this visit.

b.

Should be performed at age 45 years.

c.

Should be performed at age 50 years.

d.

Is only necessary if a family history of prostate cancer exists.

ANS: B

According to the American Cancer Society (2006), the PSA blood test should be performed annually for black men beginning at age 45 years and annually for all other men over age 50 years.

DIF: Cognitive Level: Applying (Application) REF: p. 725

MSC: Client Needs: Health Promotion and Maintenance

23. A 62-year-old man is experiencing fever, chills, malaise, urinary frequency, and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. These symptoms are most consistent with which condition?

a.

Prostatitis

b.

Polyps

c.

Carcinoma of the prostate

d.

BPH

ANS: A

The common presenting symptoms of prostatitis are fever, chills, malaise, and urinary frequency and urgency. The individual may also have dysuria, urethral discharge, and a dull aching pain in the perineal and rectal area. These symptoms are not consistent with polyps. (See Table 25-3 for the descriptions of carcinoma of the prostate and BPH.)

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 735

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

24. During a discussion for a mens health group, the nurse relates that the group with the highest incidence of prostate cancer is:

a.

Asian Americans.

b.

Blacks.

c.

American Indians.

d.

Hispanics.

ANS: B

According to the American Cancer Society (2010), black men have a higher rate of prostate cancer than other racial groups.

DIF: Cognitive Level: Remembering (Knowledge) REF: p. 723

MSC: Client Needs: Physiologic Integrity: Reduction of Risk Potential

25. Which characteristic of the prostate gland would the nurse recognize as an abnormal finding while palpating the prostate gland through the rectum?

a.

Palpable central groove

b.

Tenderness to palpation

c.

Heart shaped

d.

Elastic and rubbery consistency

ANS: B

The normal prostate gland should feel smooth, elastic, and rubbery; slightly movable; heart-shaped with a palpable central groove; and not be tender to palpation.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 728

MSC: Client Needs: Health Promotion and Maintenance

26. The nurse notices that a patient has had a pale, yellow, greasy stool, or steatorrhea, and recalls that this is caused by:

a.

Occult bleeding.

b.

Absent bile pigment.

c.

Increased fat content.

d.

Ingestion of bismuth preparations.

ANS: C

Steatorrhea (pale, yellow, greasy stool) is caused by increased fat content in the stools, as in malabsorption syndrome. Occult bleeding and ingestion of bismuth products cause a black stool, and absent bile pigment causes a gray-tan stool.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 729

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

27. During a health history of a patient who complains of chronic constipation, the patient asks the nurse about high-fiber foods. The nurse relates that an example of a high-fiber food would be:

a.

Broccoli.

b.

Hamburger.

c.

Iceberg lettuce.

d.

Yogurt.

ANS: A

High-fiber foods are either soluble type (e.g., beans, prunes, barley, broccoli) or insoluble type (e.g., cereals, wheat germ). The other examples are not considered high-fiber foods.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 724

MSC: Client Needs: Health Promotion and Maintenance

28. While assessing a patient who is hospitalized and bedridden, the nurse notices that the patient has been incontinent of stool. The stool is loose and gray-tan in color. The nurse recognizes that this finding indicates which of the following?

a.

Occult blood

b.

Inflammation

c.

Absent bile pigment

d.

Ingestion of iron preparations

ANS: C

The presence of gray-tan stool indicates absent bile pigment, which can occur with obstructive jaundice. The ingestion of iron preparations and the presence of occult blood turns the stools to a black color. Jellylike mucus shreds mixed in the stool would indicate inflammation.

DIF: Cognitive Level: Applying (Application) REF: p. 729

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

29. During a digital examination of the rectum, the nurse notices that the patient has hard feces in the rectum. The patient complains of feeling full, has a distended abdomen, and states that she has not had a bowel movement for several days. The nurse suspects which condition?

a.

Rectal polyp

b.

Fecal impaction

c.

Rectal abscess

d.

Rectal prolapse

ANS: B

A fecal impaction is a collection of hard, desiccated feces in the rectum. The obstruction often results from decreased bowel motility, in which more water is reabsorbed from the stool. (See Table 25-2 for the descriptions of rectal polyps and abscesses; See Table 25-1 for a description of rectal prolapse.)

DIF: Cognitive Level: Applying (Application) REF: p. 734

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

30. During the taking of a health history, the patient states, It really hurts back there, and sometimes it itches, too. I have even seen blood on the tissue when I have a bowel movement. Is there something there? The nurse should expect to see which of these upon examination of the anus?

a.

Rectal prolapse

b.

Internal hemorrhoid

c.

External hemorrhoid that has resolved

d.

External hemorrhoid that is thrombosed

ANS: D

These symptoms are consistent with an external hemorrhoid. An external hemorrhoid, when thrombosed, contains clotted blood and becomes a painful, swollen, shiny blue mass that itches and bleeds with defecation. When the external hemorrhoid resolves, it leaves a flabby, painless skin sac around the anal orifice. An internal hemorrhoid is not palpable but may appear as a red mucosal mass when the person performs a Valsalva maneuver. A rectal prolapse appears as a moist, red doughnut with radiating lines.

DIF: Cognitive Level: Applying (Application) REF: p. 732

MSC: Client Needs: Physiologic Integrity: Physiologic Adaptation

MULTIPLE RESPONSE

1. The nurse is performing a digital examination of a patients prostate gland and notices that a normal prostate gland includes which of the following characteristics? Select all that apply.

a.

1 cm protrusion into the rectum

b.

Heart-shaped with a palpable central groove

c.

Flat shape with no palpable groove

d.

Boggy with a soft consistency

e.

Smooth surface, elastic, and rubbery consistency

f.

Fixed mobility

ANS: A, B, E

The size of a normal prostate gland should be 2.5 cm long by 4 cm wide and should not protrude more than 1 cm into the rectum. The prostate should be heart-shaped, with a palpable central groove, a smooth surface, and elastic with a rubbery consistency. Abnormal findings include a flat shape with no palpable groove, boggy with a soft consistency, and fixed mobility.

DIF: Cognitive Level: Analyzing (Analysis) REF: p. 728

MSC: Client Needs: Health Promotion and Maintenance

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