Question 1

A 13-year-old girl is visiting the clinic for a sports physical.The nurse should remember to include which of the following in the examination?
A)Test for occult blood
B)The Valsalva maneuver
C)Internal palpation of the anus
D)Inspection of the perianal area

Accepted Answer

Inspect the perianal region of the school-aged child and adolescent during examination of the genitalia.Internal palpation is not performed routinely.

Question 2

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 most likely indicates:
A)pinworms.
B)chickenpox.
C)child abuse.
D)bacterial infection.

Accepted Answer

In children,pinworms are a common cause of intense itching and irritated anal skin.

Question 3

The nurse is examining only the rectal area of a woman and should place the woman in what position?
A)The lithotomy position
B)Lying in the prone position
C)Left lateral decubitus position
D)Bending over the table while standing

Accepted Answer

Place the female in lithotomy position if examining genitalia as well;use the left lateral decubitus position for the rectal area alone.

Question 4

A 46-year-old man requires assessment of his sigmoid colon.Which of the following is most appropriate for this examination?
A)A proctoscope
B)An ultrasound
C)A colonoscope
D)A rectal exam with an examining finger

Accepted Answer

The sigmoid colon is 40 cm long and is accessible to examination only through the colonoscope.

Question 5

During an examination,the nurse asks the patient to perform the Valsalva maneuver and notes that the patient has a moist,red,doughnut-shaped protrusion from the anus.The nurse knows that this would be consistent with:
A)a rectal polyp.
B)hemorrhoids.
C)a rectal fissure.
D)rectal prolapse.

Accepted Answer

In rectal prolapse,the rectal mucous membrane protrudes through the anus,appearing as a moist red doughnut with radiating lines.It occurs following a Valsalva maneuver,such as straining at stool,or with exercise.

Question 6

Which of the following statements about the anal canal is true?
A)The anal canal is about 2 cm long in the adult.
B)The anal canal slants backward toward the sacrum.
C)The anal canal contains hair and sebaceous glands.
D)The anal canal is the outlet for the gastrointestinal tract.

Accepted Answer

The anal canal is the outlet for the gastrointestinal tract,and it is about 3.8 cm long in the adult.

Question 7

During an assessment of the newborn,the nurse expects to see which finding when the anal area is slightly stroked?
A)A jerking of the legs
B)Flexion of the knees
C)A quick contraction of the sphincter
D)Relaxation of the external sphincter

Accepted Answer

To assess sphincter tone,check the anal reflex.Gently stroke the anal area and note a quick contraction of the sphincter.

Question 8

When testing stool for occult blood,the nurse is aware that a false-positive result may occur with:
A)absent bile pigment.
B)increased fat content.
C)increased ingestion of iron medication.
D)a large amount of red meat within the last 3 days.

Accepted Answer

When testing for occult blood,a false-positive finding may occur if the person has ingested significant amounts of red meat within 3 days of the test.

Question 9

During the assessment of an 18-month-old child,the mother expresses concern to the nurse about the infant's inability to toilet train.What would be the nurse's best response?
A)"Some children are just more difficult to train,so I wouldn't 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 there is a problem in your baby's development.We'll 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."

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 1¹/₂ to 2 years of age.Toilet training usually starts after age 2 years.

Question 10

A 60-year-old man has just been told he has benign prostatic hypertrophy.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?
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 hormone changes and not cancer."

Accepted Answer

The prostate gland commonly starts to enlarge during the middle adult years.This benign prostatic hypertrophy (BPH)is present in 1 out of 10 males at the age of 40 years and increases with age.It is thought that the hypertrophy is caused by hormonal imbalance that leads to the proliferation of benign adenomas.

Question 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 is sure to mention the need for a/an:
A)annual proctoscopy.
B)colonoscopy every 10 years.
C)fecal test for blood every 6 months.
D)digital rectal examinations every 2 years.

Accepted Answer

Early detection for cancer: digital rectal examination performed annually after age 50 years;fecal occult blood test annually after age 50 years;sigmoidoscopy every 5 years or colonoscopy every 10 years after age 50 years;PSA blood test annually for men over 50 years old,except black men beginning at age 45 years (American Cancer Society,2006).

Question 12

Which of the following techniques is correct for palpation of the rectum?
A)Flex the finger and insert slowly toward the umbilicus.
B)Instruct the patient first that this will be a painful procedure.
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.

Accepted Answer

Place the pad of your index finger gently against the anal verge.You will feel the sphincter tighten,then relax.As it relaxes,flex the tip of your finger and slowly insert it into the anal canal in a direction toward the umbilicus.Never approach the anus at right angles with your index finger extended.

Question 13

The nurse is caring for a newborn infant.Thirty hours after birth,the infant passes a dark green meconium stool.The nurse recognizes that this is important because:
A)this stool would indicate anal patency.
B)the dark green color could indicate occult blood in the stool.
C)meconium stool can be reflective of distress in the newborn.
D)the newborn should have passed the first stool within 12 hours after birth.

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.

Question 14

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 about the last 10 days.He denies taking any medications.The nurse is aware that these symptoms are most 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)increase in bile pigment from liver problems.

Accepted Answer

Black stools may be tarry due to occult blood (melena)from gastrointestinal bleeding or nontarry from ingestion of iron medications.

Question 15

While doing an assessment of the perianal area of a patient,the nurse notes the following: pigmentation of anus is darker than surrounding skin;anal opening closed;a skin sac that is shiny and blue.The patient mentioned that he has had pain with bowel movements and has noted some spots of blood occasionally.What would this assessment and history be most likely to indicate?
A)Anal fistula
B)Pilonidal cyst
C)Rectal prolapse
D)Thrombosed hemorrhoid

Accepted Answer

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

Question 16

Which of the following statements about 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.

Accepted Answer

The external sphincter surrounds the internal sphincter but also has a small section overriding the tip of the internal sphincter at the opening.It is under voluntary control.

Question 17

While performing a rectal examination,the nurse notes a firm,irregularly shaped mass.What should the nurse do next?
A)Continue with exam and note finding in chart.
B)Instruct patient to return for 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.

Accepted Answer

A firm or hard mass with irregular shape or rolled edges may signify carcinoma.Promptly report any mass that is discovered for further examination.

Question 18

A 70-year-old man is visiting the clinic for "difficulty in passing urine." In the history he indicates he has to urinate frequently,especially at night.He has burning when he urinates and has noticed pain in his back.Given this history,what might the nurse expect to find during the physical assessment?
A)Asymmetric,hard,fixed prostate gland
B)Occult blood and perianal pain to palpation
C)Symmetrically enlarged,soft prostate gland
D)A soft nodule protruding from rectal mucosa

Accepted Answer

Carcinoma of the prostate.S: Frequency,nocturia,hematuria,weak stream,hesitancy,pain or burning on urination,continuous pain in lower back,pelvis and thighs.O: A malignant neoplasm 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 19

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)Food poisoning
D)Fecal incontinence

Accepted Answer

Having painful bowel movements,known as dyschezia,may be due to a local condition (hemorrhoid or fissure)or constipation.

Question 20

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)polyp.
B)pruritus ani.
C)benign tumor.
D)pilonidal cyst.

Accepted Answer

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.

Quiz 25: Anus,rectum,and Prostate

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

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 most likely indicates:

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

A 46-year-old man requires assessment of his sigmoid colon.Which of the following is most appropriate for this examination?

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

Which of the following statements about the anal canal is true?

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

When testing stool for occult blood,the nurse is aware that a false-positive result may occur with:

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

A 60-year-old man has just been told he has benign prostatic hypertrophy.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?

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 is sure to mention the need for a/an:

Which of the following techniques is correct for palpation of the rectum?

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

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 about the last 10 days.He denies taking any medications.The nurse is aware that these symptoms are most indicative of:

Which of the following statements about the sphincters is correct?

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

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?

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: