Anus, Rectum, and prostate Flashcards
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 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 that 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.”
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.
- 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.
- 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.
- 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.
- 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).
- 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.
- 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.
- 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.
- 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.
