Deck 23: Anus, rectum, and Prostate

Question 1

Perianal disease occurring in the early stages of Crohn's disease typically progresses to

A) rectal prolapse.
B) anal stricture.
C) prostatic infections.
D) prostate cancer.

Answer 1

anal stricture.

Question 2

Rectal prolapse is best assessed with the patient placed in which position?

A) lying on the stomach
B) squatting
C) knee-chest
D) Sims'

Answer 2

squatting

Question 3

The common signs of potential rectal abuse include all of the following,EXCEPT

A) bleeding anal mucosa.
B) anal cuts or tears.
C) bruising.
D) prolapsed hemorrhoids.

Answer 3

prolapsed hemorrhoids.

Question 4

Anal fissures are typically caused by

A) trauma.
B) sphincter spasms.
C) herpes simplex virus infection.
D) incomplete hemorrhoid resolution.

Question 5

Which statement is true of rectal polyps?

A) They can be either benign or malignant.
B) They are always attached to stalks.
C) They rarely occur in the U.S.population.
D) They are always accompanied by rectal bleeding.

Question 6

Anorectal abscesses are most commonly caused by infection of the

A) anal glands.
B) external sphincter.
C) hemorrhoids.
D) perianal skin.

Question 7

Which question is least likely to provide useful information for determining the cause of a patient's reported constipation?

A) "How long have you taken laxatives?"
B) "How much fluid do you drink in a day?"
C) "How much exercise do you typically get each day?"
D) "Do you have increased mucus and straining with your hard stools?"

Question 8

The location of the prostate gland is best described in which statement?

A) It lines the inner walls of the lower third of the bladder.
B) It encircles the spermatic cord.
C) It lies just below the bladder and encircles the urethra like a doughnut.
D) It encircles the vas deferens.

Question 9

After spreading your patient's buttocks with gloved hands to inspect the anal mucosa,you should instruct the patient to

A) take a deep breath, then breathe out slowly and relax.
B) flex both knees and hold tightly with both hands.
C) bear down as if moving the bowels.
D) cough several times.

Question 10

The component of prostatic fluid that maintains the osmotic equilibrium of the seminal fluid is

A) citrate.
B) prostatic acid phosphatase.
C) prostate-specific antigen.
D) zinc.

Question 11

Which of the following increases the risk for prostate cancer?

A) alcohol
B) cigarette smoking
C) use of illicit drugs
D) anal intercourse

Question 12

Your patient has requested a follow-up assessment of his pilonidal disease because of a recent onset of pruritus on his buttocks.To inspect the patient's perineum and sacrococcygeal area,you would position him

A) in the lithotomy position.
B) in the left lateral decubitus position.
C) bending over the examination table, with his legs spread apart.
D) supine, with legs spread apart.

Question 13

The stool of a patient with obstructive jaundice typically is

A) black and tarry.
B) pale yellow and greasy.
C) gray or tan.
D) brown, containing mucus.

Question 14

Upon inspection,you observe a 3 cm spherical bluish lump on your patient's anal mucosa.The overlying skin is mildly edematous.This is most likely a(n)

A) anal skin tag.
B) anal wart.
C) herpes simplex lesion.
D) thrombosed external hemorrhoid.

Question 15

Mucus,which provides lubrication for the passage of feces,is secreted by compression of the

A) anal orifice.
B) anal sinuses.
C) anoderm.
D) anal valves.

Question 16

Which lobes of the prostate gland are most accessible to examination?

A) anterior
B) posterior
C) lateral
D) median

Question 17

To facilitate the insertion of your gloved finger into the anal sphincter,you should instruct the patient to

A) take a deep breath and hold it.
B) take shallow breaths.
C) bear down.
D) tighten the sphincter.

Question 18

Which condition typically causes a mucoid or creamy rectal exudate occasionally accompanied by blood?

A) Crohn's disease
B) condyloma acuminatum
C) gonococcal proctitis
D) herpes simplex virus

Question 19

A hollow,fibrous tract leading from the anal canal to an opening in the perianal skin is called a(n)

A) scabies burrow.
B) anal fissure.
C) anorectal fistula.
D) pilonidal sinus.

Question 20

You are caring for a 60-year-old African American man,who is at risk for prostate cancer primarily because he:

A) is over the age of 45 and is African American.
B) has diabetes mellitus, arthritis, and prostatic disease.
C) reports that his uncle died from prostate cancer.
D) reports a history of recurrent bacterial prostatitis.

Question 21

For which of the following patients should the nurse order a prostate-specific antigen (PSA)?

A) 40-year-old Caucasian male with a high intake of dietary fat, oil, and sugar
B) 68-year-old African American male with no complaints
C) 45-year-old Hispanic male with prostatitis
D) 40-year-old Asian male whose brother has prostate cancer

Question 22

You observe on a patient's lower buttocks demarcated,erythematous,exudative patches rimmed with small,red-based pustules.You hypothesize that these lesions are most likely

A) fissures caused by Crohn's disease.
B) fistulas caused by bacterial organisms.
C) pruritus ani.
D) exudative patches caused by Candida albicans.

Question 23

A male patient presents to your office and you obtain a sexual history.Why would you consider performing an anal Pap smear?

A) He is heterosexual and always uses condoms.
B) He is not HIV infected but engages in oral intercourse.
C) He has a history of perianal condylomas.
D) He is not HIV infected and has had three female partners in the past year.

Question 24

A nurse practitioner is about to perform the advanced technique for an anal pap collection.Which of the following steps would be included? Select all that apply.

A) Inform the patient to avoid enemas and receptive anal intercourse for 24 hours prior to specimen collection.
B) Colonic preparation is not necessary, but the rectum should be emptied before obtaining the sample.
C) Moisten a Dacron-tipped swab with tap water and insert the swab about 4 inches into the anal canal.
D) Perform 1 to 2 spiral rotation movements of the swab against the walls of the rectum and anus as the swab encircles the anal canal during slow withdrawal of the swab.
E) Remove the swab and swirl it for 5 seconds in a container of liquid cytology fluid.
F) Perform a digital rectal examination after the anal Pap to rule out any masses.

Question 25

You are assigned to a 60-year-old African American patient who has diabetes and arthritis.Your patient is receiving treatment for a recurrent urinary tract infection and today has developed a sudden rise in temperature and complains of rectal pain.You prepare the patient for a prostatic examination.To perform prostatic palpation,you should insert your gloved finger into the anal sphincter with the

A) tip of the finger extended at a right angle to the perianal area.
B) ball of the finger toward the posterior rectal wall.
C) ball of the finger toward the left lateral rectal wall.
D) tip of the finger toward the anterior rectal wall.

Question 26

In the midline over your patient's sacral region,you observe several tiny openings.Which of the following are you most likely to find protruding from these openings?

A) hair
B) moles
C) scaly papules
D) skin tags

Question 27

Which of the following are true of the prostate? Select all that apply.

A) Drains into the urethra
B) Consists of glandular tissue and muscle
C) Is controlled by parasympathetic reflex signals
D) Is formed by skeletal muscle
E) Encircles the urethra like a doughnut
F) Produces semen

Question 28

You suspect that a patient has developed a prostatic abscess when palpation of his prostate reveals a gland that is

A) firm and hard.
B) firm and tender.
C) soft and enlarged.
D) nodular.

Question 29

Causes of pruritis ani include which of the following? Select all that apply.

A) Pinworms
B) Psoriasis
C) Eczema
D) Dermatitis
E) Hemorrhoids
F) Anal fissures

Question 30

Enlargement of the prostate in benign prostatic hypertrophy is primarily the result of changes related to aging and the effects of

A) dihydrotestosterone.
B) frequent sexual activity.
C) smoking.
D) overstimulation of alpha-1 adrenergic receptors.

Question 31

Rectal prolapse is associated with which of the following? Select all that apply.

A) Viral infection
B) Fecal incontinence
C) Neurological disease
D) Chronic straining at stool
E) Traumatic damage to the pelvis
F) Poor tone of the pelvic musculature

Question 32

Which etiology should the nurse suspect if a patient has the complaint of blood,pus,and mucus in the stool?

A) upper gastrointestinal (GI) bleeding
B) diverticulosis
C) iron ingestion
D) ulcerative colitis

Question 33

Rectal polyps are most often diagnosed by ____________________.

Question 34

Palpation of an anal carcinoma typically reveals a

A) tender, indurated mass.
B) hard mass.
C) rubbery, puttylike mass.
D) soft, painful mass.

Question 35

Which statement is correct in regard to performing a successful rectal examination?

A) Perform it at the end of the physical examination after a trusting relationship has been established.
B) Perform it at the beginning of the physical examination to minimize the patient's embarrassment.
C) Provide minimal explanations about what will be done to decrease the patient's anxiety.
D) Explain to the patient that you are just as nervous about this as she is.

Question 36

The function of the Houston's valves are to retain ____________________.

Question 37

Which of the following can cause diarrhea? Select all that apply.

A) Antibiotics
B) Fecal impaction
C) Irritable bowel syndrome
D) Weak abdominal muscles
E) Lactose intolerance
F) Inadequate fluid intake

Question 38

Because of the possibility of bacteremia,a rectal examination should be avoided in patients with

A) acute bacterial prostatitis.
B) fecal incontinence.
C) irritable bowel syndrome.
D) inflammatory bowel disease.

Question 39

Hemorrhoids result from ____________________ of the superior and inferior hemorrhoidal veins.

Question 40

Palpation of a patient's prostate reveals a small,smooth,nontender gland with a palpable median sulcus,which indicates

A) normal findings.
B) the early stage of benign prostatic hypertrophy.
C) increased risk for prostatic stones.
D) increased risk for prostatic cancer.