Question 1

Which statement concerning the anal canal is true?

Accepted Answer

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.

Question 2

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

Accepted Answer

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.

Question 3

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?

Accepted Answer

Having painful bowel movements, known as dyschezia, may be attributable to a local condition (hemorrhoid or fissure) or constipation. Pinworms cause acute pain, itching, and a papular rash. Colon cancer often presents with occult blood in the stool. Fecal incontinence is leaking of solid or liquid stool involuntarily.

Question 4

What structure secretes a thin, milky alkaline fluid to enhance the viability of sperm?

Accepted Answer

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.

Question 5

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

Accepted Answer

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.

Question 6

The nurse is caring for a newborn infant. Thirty hours after birth, the infant passes a dark green meconium stool. What is the importance of this finding?

Accepted Answer

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.

Question 7

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. What does this finding indicate?

Accepted Answer

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. Carcinoma, or a malignant neoplasm, in the colon or rectum is typically asymptomatic. Rectal polyps are protruding growths from the rectal mucous membrane and are fairly common. They are difficult to palpate and found on examination with a scope. Pruritus ani is intense itching and burning in the perineum and has several causes such as soaps, fecal soiling or hemorrhoids, sexually transmitted infections, and pinworm manifestations in children.

Question 8

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

Accepted Answer

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.
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Question 9

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. What does this finding likely indicate?

Accepted Answer

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

Question 10

A patient who is visiting the clinic reports 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. What do these symptoms suggest?

Accepted Answer

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.

Question 11

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

Accepted Answer

The left lateral decubitus position is used when examining only the rectal area. If the genitalia are also going to be examined, the nurse should place the female patient in the lithotomy.

Question 12

Which statement concerning the sphincters is correct?

Accepted Answer

The external sphincter not only 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.

Question 13

While performing an assessment of the perianal area of a patient, the nurse notices that the pigmentation of the 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 does this assessment and history most likely indicate?

Accepted Answer

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.

Question 14

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 and is concerned this will happen to him. How should the nurse respond?

Accepted Answer

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.

Question 15

After completing an assessment of a 60-year-old white male with a family history of colon cancer, the nurse discusses with him early detection measures for colon cancer. What should the nurse include in the instructions?

Accepted Answer

Early detection measures for colon cancer include an annual fecal occult blood test after age 50 years (after age 45 for African Americans), a colonoscopy every 10 years after age 50, and a PSA blood test annually for men over 50 years old (45 years for African Americans).

Question 16

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

Accepted Answer

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.

Question 17

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?

Accepted Answer

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.

Question 18

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

Accepted Answer

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

Question 19

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?

Accepted Answer

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.

Question 20

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

Accepted Answer

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.

Quiz 26: Anus, Rectum, and Prostate