C HAPTER 15: T HE A NUS , R ECTUM , AND
P ROSTATE
MULTIPLE CHOICE
1. The nurse is examining onl y the rectal area of a woman and should place
the woman in what position?
a. Lithotom y
b. Prone
c. Left lateral decubitus
d. Bending over the table while standing
ANS: C
The nurse should place the female patient in the lithotom y position if
the genitalia are being examined as well. The left lateral decubitus
position is used for the rectal area alone.
DIF: Cognitive Level: Under standing (Comprehension) REF: p. 725
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
2. While performing an assessment of the perianal area of a patient, the
nurse notices that the pigmentation of anus is darker than the surroundi ng
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 occasionall y noted some spots of blood. What would this
assessment and history most likel y indicate ?
a. Thrombosed hemorrhoid
b. Anal fistula
c. Pilonidal cyst
d. Rectal prolapse
ANS: D
The anus normall y looks moist and hairless, with coarse folded skin
that is more pigmented than the perianal skin, and the anal opening is
tightl y closed. The shiny blue skin sac indicates a thrombosed
hemorrhoid.
DIF: Cognitive Level: Anal yzing (Anal ysis) REF: p. 726
MSC: Client Needs: Physiologic Integrit y: Physiologic
Adaptation
3. The nurse is preparing to palpate the rectum and should use which of these
techniques? The nurse should:
a. Flex the finger, and slowl y 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 directl y into the anus to overcome th e tight
sphincter.
ANS: A
The nurse should gentl y 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 needi ng to move
the bowels.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 726
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
4. While performing a rectal examination, the nurse notices a firm,
irregularl y shaped mass. W hat should the nurse do next?
a. Continue with the examination, and document 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 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 an irregular shape or rolled edges may signify
carcinoma. Any mass that is discovered should be promptl y reported
for further examination. The other re sponses are not correct.
DIF: Cognitive Level: Appl ying (Application) REF: p. 734 MSC:
Client Needs: Health Promotion and Maintenance
P ROSTATE
MULTIPLE CHOICE
1. The nurse is examining onl y the rectal area of a woman and should place
the woman in what position?
a. Lithotom y
b. Prone
c. Left lateral decubitus
d. Bending over the table while standing
ANS: C
The nurse should place the female patient in the lithotom y position if
the genitalia are being examined as well. The left lateral decubitus
position is used for the rectal area alone.
DIF: Cognitive Level: Under standing (Comprehension) REF: p. 725
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
2. While performing an assessment of the perianal area of a patient, the
nurse notices that the pigmentation of anus is darker than the surroundi ng
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 occasionall y noted some spots of blood. What would this
assessment and history most likel y indicate ?
a. Thrombosed hemorrhoid
b. Anal fistula
c. Pilonidal cyst
d. Rectal prolapse
ANS: D
The anus normall y looks moist and hairless, with coarse folded skin
that is more pigmented than the perianal skin, and the anal opening is
tightl y closed. The shiny blue skin sac indicates a thrombosed
hemorrhoid.
DIF: Cognitive Level: Anal yzing (Anal ysis) REF: p. 726
MSC: Client Needs: Physiologic Integrit y: Physiologic
Adaptation
3. The nurse is preparing to palpate the rectum and should use which of these
techniques? The nurse should:
a. Flex the finger, and slowl y 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 directl y into the anus to overcome th e tight
sphincter.
ANS: A
The nurse should gentl y 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 needi ng to move
the bowels.
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 726
MSC: Client Needs: Safe and Effective Care Environment:
Management of Care
4. While performing a rectal examination, the nurse notices a firm,
irregularl y shaped mass. W hat should the nurse do next?
a. Continue with the examination, and document 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 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 an irregular shape or rolled edges may signify
carcinoma. Any mass that is discovered should be promptl y reported
for further examination. The other re sponses are not correct.
DIF: Cognitive Level: Appl ying (Application) REF: p. 734 MSC:
Client Needs: Health Promotion and Maintenance
