Rectum, anus, and prostate

Question 1

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

Answer 1

ANS: A
The nurse should place the pad of the index finger gently 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—this would cause pain. The nurse should instruct the patient that palpation is not painful but may feel like needing to move the bowels.

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?
A)
The rectum is about 8 cm long.
B)
The anorectal junction cannot be palpated.
C)
Above the anal canal, the rectum turns anteriorly.
D)
There are no sensory nerves in the anal canal or rectum.

Answer 2

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 it is visible on proctoscopy. The rectum is 12 cm long, and just above the anal canal, the rectum dilates and turns posteriorly.

Question 3

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 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 hormone changes and not cancer.”

Answer 3

ANS: D
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. The other responses are not appropriate.

Question 4

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)
digital rectal examinations every 2 years.

Answer 4

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

Question 5

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

Answer 5

ANS: C
The nurse should place the female patient in lithotomy position if examining genitalia as well; use the left lateral decubitus position for the rectal area alone.

Question 6

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 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.

Answer 6

ANS: D
A firm or hard mass with irregular shape or rolled edges may signify carcinoma. Promptly report any mass that is discovered for further examination. The other responses are not correct

Question 7

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

Answer 7

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 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 8

A 40-year-old black man is in the office for his annual physical. Which statement regarding the prostate-specific antigen (PSA) blood test is true, according to the American Cancer Society? The PSA:
A)
should be done with this visit.
B)
should be done at age 45 years.
C)
should be done at age 50 years.
D)
is only necessary if there is a family history of prostate cancer.

Answer 8

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

Question 9

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 of the following?
A)
Prostatitis
B)
A polyp
C)
Carcinoma of the prostate
D)
Benign prostatic hypertrophy (BPH)

Answer 9

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. See Table 25-3 for descriptions of carcinoma of the prostate and BPH. These are not the symptoms of a polyp.

Question 10

During a discussion for a men's health group, the nurse relates that the group with the highest incidence of prostate cancer is:
A)
Asian Americans.
B)
African-Americans.
C)
American Indians.
D)
Hispanics.

Answer 10

ANS: B
According to the American Cancer Society (2010), African-American men have a higher rate of prostate cancer than other racial groups.

Question 11

The nurse is palpating the prostate gland through the rectum and notices an abnormal finding if which of these is present?
A)
Palpable central groove
B)
Tenderness to palpation
C)
Heart shape
D)
Elastic and rubbery consistency

Answer 11

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

Question 12

The nurse is performing a digital examination of a patient’s prostate gland and notices that characteristics of a normal prostate gland include which of the following? Select all that apply.
A)
The gland protruding 1 cm into the rectum
B)
Heart-shaped with a palpable central groove
C)
Flat with no groove palpable
D)
Boggy and soft consistency
E)
Smooth surface, elastic, or rubbery consistency
F)
Fixed mobility

Answer 12

ANS: A, B, E
The size should be 2.5 cm long by 4 cm wide, and it 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, rubbery consistency. Abnormal findings include a flat shape with no palpable groove, boggy with a soft consistency, and fixed mobility.