Description
Physical Examination and Health Assessment 2nd Canadian Edition Jarvis Test Bank
ISBN: 9781926648729
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Jarvis: Physical Examination & Health Assessment, 2nd Canadian Edition
Chapter 23: Anus, Rectum and Prostate
Test Bank
MULTIPLE CHOICE
- 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. |
ANS: D
The anal canal is the outlet for the gastrointestinal tract, and it is about 3.8 cm long in the adult.
DIF: Knowledge REF: Page 583
- Which of the following statements about the sphincters is true?
| 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. It is under voluntary control.
DIF: Knowledge REF: Page 583
- The nurse is performing an examination of the anus and rectum. Which of the following is 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. |
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.
DIF: Knowledge REF: Page 584
- The structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm is the:
| a. | Cowper’s gland. |
| b. | prostate gland. |
| c. | median sulcus. |
| d. | seminal vesicle. |
ANS: B
In men, the prostate gland lies in front of the anterior wall of the rectum. It surrounds the bladder neck and the urethra, and it secretes a thin, milky alkaline fluid that aids sperm viability.
DIF: Knowledge REF: Page 584
- 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 |
ANS: C
The sigmoid colon is 40 cm long and is accessible to examination only through the colonoscope.
DIF: Comprehension REF: Page 585
- 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 colour 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. |
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.
DIF: Comprehension REF: Page 585
- During the assessment of an 18-month-old, 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.” |
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 1½ to 2 years of age. Toilet training usually starts after 2 years of age.
DIF: Application REF: Page 585
- A 60-year-old man has just been told he has benign prostatic hypertrophy (BPH). He has a friend who just died from prostate cancer 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 prostate cancer.” |
| d. | “The enlargement of your prostate is caused by hormone changes and not cancer.” |
ANS: D
The prostate gland commonly starts to enlarge during the middle adult years. This 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.
DIF: Application REF: Page 585
- A 30-year-old woman is visiting the clinic for a complaint 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 |
ANS: B
Having painful bowel movements, known as dyschezia, may be due to a local condition (hemorrhoid or fissure) or constipation.
DIF: Application REF: Page 586
- 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. |
ANS: C
Black stools may be tarry due to occult blood (melena) from gastrointestinal bleeding or nontarry from ingestion of iron medications.
DIF: Analysis REF: Page 586
- After completing an assessment of a 60-year-old man with a family history of colon cancer, the nurse discusses early detection measures for colon cancer with him. The nurse is sure to mention the need for a(n):
| a. | annual proctoscopy. |
| b. | colonoscopy every 5 years. |
| c. | fecal test for blood every 2 years. |
| d. | digital rectal examination (DRE) every 2 years. |
ANS: B
Early detection for colon cancer includes a fecal occult blood test (FOBT) at least every 2 years after 50 years of age for both men and women; a positive FOBT may be followed up by a flexible sigmoidoscopy. With a family history, a colonoscopy should be performed every 5 years beginning at 40 years of age or 10 years younger than the youngest diagnosis of polyp or cancer in the family, whichever comes first.
DIF: Application REF: Page 587, Table 23-1
- 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. |
ANS: A
In children, pinworms are a common cause of intense itching and irritated anal skin.
DIF: Analysis REF: Page 587
- The nurse is examining only the rectal area of a woman. In what position should the woman be placed?
| a. | The lithotomy position |
| b. | Lying in the prone position |
| c. | The left lateral decubitus position |
| d. | Bending over the table while standing |
ANS: C
Place the female in the lithotomy position if examining genitalia as well; use the left lateral decubitus position for the rectal area alone.
DIF: Comprehension REF: Page 589
- While doing an assessment of the perianal area of a patient, the nurse notes that the pigmentation of the anus is darker than the surrounding skin, that the anal opening is closed, and that a shiny, blue skin sac is present. The patient mentions that he has had pain with bowel movements and has noted some occasional 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. The anal opening is tightly closed. The shiny blue skin sac indicates a thrombosed hemorrhoid.
DIF: Analysis REF: Page 589
- Which of the following techniques is correct for palpation of the rectum?
| a. | Flex the finger, and insert it slowly toward the umbilicus. |
| b. | First instruct the patient 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. |
ANS: A
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.
DIF: Comprehension REF: Page 590
- While performing a rectal examination, the nurse notes a firm, irregularly shaped mass. What should the nurse do next?
| a. | Continue with the exam, and note the finding in the chart. |
| b. | Instruct the patient to return for a repeat assessment in 1 month. |
| c. | Tell the patient that a mass was felt, but that it is nothing to worry about. |
| d. | Report the finding, and refer the patient to a specialist for further examination. |
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.
DIF: Application REF: Page 592
- 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. |
ANS: D
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.
DIF: Comprehension REF: Page 593
- 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 |
ANS: C
To assess sphincter tone, check the anal reflex. Gently stroke the anal area and note a quick contraction of the sphincter.
DIF: Comprehension REF: Page 590
- During an assessment of a 20-year-old man, the nurse finds a small, palpable lesion containing a tuft of hair and located directly over the coccyx. The nurse knows that this lesion would most likely be a:
| a. | polyp. |
| b. | pruritus ani. |
| c. | benign tumour. |
| d. | pilonidal cyst. |
ANS: D
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.
DIF: Application REF: Page 594, Table 23-2
- During an examination, the nurse asks the patient to perform the Valsalva manoeuvre 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. |
ANS: D
In rectal prolapse, the rectal mucous membrane protrudes through the anus, appearing as a moist red doughnut shape with radiating lines. It occurs following a Valsalva manoeuvre, such as straining at stool, or with exercise.
DIF: Comprehension REF: Pages: 589; 595, Table 23-2
- 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 experiences 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. | Asymmetrical hard, fixed prostate gland |
| b. | Occult blood and perianal pain with palpation |
| c. | Symmetrically enlarged, soft prostate gland |
| d. | A soft nodule protruding from rectal mucosa |
ANS: A
Subjective data for carcinoma of the prostate: frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination, and continuous pain in lower back, pelvis, and thighs. Objective data: 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.
DIF: Analysis REF: Page 597, Table 23-4
- A 40-year-old male of African descent is in the office for his annual physical. Which statement is true regarding screening for prostate cancer, according to the Canadian Cancer Society?
| a. | DRE is more effective than prostate-specific antigen (PSA) in finding prostate cancer. |
| b. | Ancestry is a factor in determining when PSA testing begins. |
| c. | PSA will be done at 50 years of age if there is a family history. |
| d. | BPH increases an individual’s risk for prostate cancer. |
ANS: B
According to the Canadian Cancer Society (2010), males of African descent and/or those with a family history of prostate cancer should consider starting testing at an earlier age than the recommended 50 years of age. It is recommended that DRE and PSA are done together. BPH does not increase the risk for developing prostate cancer.
DIF: Application REF: Page 588
- A 62-year-old man is experiencing fever, chills, malaise, and 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. | Urinary tract infection |
| c. | Carcinoma of the prostate |
| d. | BPH |
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.
DIF: Analysis REF: Page 597, Table 23-4
- Which of the following is an abnormal finding upon palpation of the prostate gland through the rectum?
| a. | Palpable central groove |
| b. | Tenderness to palpation |
| c. | Heart shape |
| d. | Elastic and rubbery consistency |
ANS: B
The normal prostate gland should feel smooth, elastic, and rubbery. It is slightly movable, is heart-shaped with a palpable central groove, and is nontender to palpation.
DIF: Analysis REF: Page 592
- The nurse notes that a patient has had a pale, yellow, greasy stool, or steatorrhea, and recalls that this is caused by:
| a. | occult bleeding. |
| b. | absent bile pigment. |
| c. | increased fat content. |
| d. | ingestion of bismuth preparations. |
ANS: C
Steatorrhea (pale, yellow, greasy stool) is caused by increased fat content in the stool, as in malabsorption syndrome.
DIF: Comprehension REF: Page 593
- During a health history of a patient who complains of chronic constipation, she asks the nurse about high-fibre foods. The nurse relates that an example of a high-fibre food would be:
| a. | broccoli. |
| b. | hamburger. |
| c. | iceberg lettuce. |
| d. | white dinner rolls. |
ANS: A
High-fibre foods of the soluble type (beans, prunes, barley, broccoli) have been shown to lower cholesterol, and those of the insoluble type (cereals, wheat germ) reduce the risk of colon cancer.
DIF: Comprehension REF: Page 586
- While assessing a hospitalized, bedridden patient, the nurse notes that the patient has been incontinent of stool. The stool is loose and grey-tan in colour. The nurse recognizes that this finding indicates which of the following?
| a. | Occult blood |
| b. | Inflammation |
| c. | Absent bile pigment |
| d. | Ingestion of iron preparations |
ANS: C
The presence of grey-tan (clay-coloured) stool indicates absent bile pigment, which can occur with obstructive jaundice.
DIF: Application REF: Page 586
- During a DRE, the nurse notes that the patient has hard feces in the rectum. The patient complains of feeling “full,” has a distended abdomen, and states that she has not had a bowel movement “for several days.” The nurse suspects which condition?
| a. | Rectal polyp |
| b. | Fecal impaction |
| c. | Rectal abscess |
| d. | Rectal prolapse |
ANS: B
A fecal impaction is a collection of hard, desiccated feces in the rectum. The obstruction often results from decreased bowel motility, in which more water is reabsorbed from the stool.
DIF: Application REF: Page 596, Table 23-3
MULTIPLE RESPONSE
- The nurse is performing a digital examination of a patient’s prostate gland and notes a normal prostate gland includes the following characteristics: (Select all that apply.)
| a. | The gland is protruding 1 cm into the rectum. |
| b. | The gland is heart-shaped, with a palpable central groove. |
| c. | The gland is flat, with no palpable groove. |
| d. | The gland has a boggy and soft consistency. |
| e. | The gland has a smooth surface and an elastic or rubbery consistency. |
| f. | The gland has fixed mobility. |
ANS: A, B, E
The gland should be 2.5 cm long by 4 cm wide, and it should not protrude more than 1 cm into the rectum. It should be heart-shaped with a palpable central groove and should have a smooth surface and elastic, rubbery consistency.
DIF: Analysis REF: Page 592
