3102 EAQ: Chapter 25- Anus, Rectum, Prostate

During a physical assessment, which finding would be considered abnormal? The prostate is tender to palpation with the central groove obliterated. The prostate is rubbery, smooth, and movable through the rectal wall. The cervix is palpable as a small round mass through the anterior wall of the rectum. The tissue surrounding the anal opening is more pigmented and coarse than the adjacent skin.

1 A normal prostate gland is nontender to palpation. An enlarged, firm, smooth prostate gland with the central groove obliterated suggests benign prostatic hypertrophy. A rubbery, smooth, and movable prostate gland is a normal finding. A hard or boggy, soft, fluctuant, and nodular prostate indicates abnormality. From the anterior wall of the rectum, the normal cervix is palpated as a round mass. The shape of an abnormal cervix may change. The anus normally looks moist and hairless, with coarse, folded skin that is more pigmented than the perianal skin. Increased pigmentation is not an abnormality.

A 15-year-old patient is brought to the clinic complaining of tenderness over the lower sacrum. On inspection, the nurse finds an edematous, erythematous, hairy area over the coccyx. Which condition is most likely affecting the patient? Pilonidal cyst Anal fissure Rectal tenesmus Perirectal abscess

1 A pilonidal cyst is a hair-containing cyst or sinus located in the midline over the coccyx or the lower sacrum. It often opens as a dimple with a visible tuft of hair and an erythematous halo. Although pilonidal cyst is a congenital disorder, the lesion is first diagnosed between the ages of 15 and 30. An anal fissure is a painful longitudinal tear in the superficial mucosa at the anal margin. Rectal tenesmus is a feeling of incomplete defecation, even if the rectum contains no bowel residue. A localized cavity of pus from infection in a pararectal space causes perirectal abscess. This infection usually extends from an anal crypt and is characterized by a persistent throbbing rectal pain.

A patient reports to the nurse, "I have itching and pain during defecation." Upon examination, the nurse finds flabby skin sacs around the anus. What should the nurse conclude from these findings? The patient has hemorrhoids. The patient has an anal fissure. The patient has a pilonidal cyst. The patient has a rectal prolapse.

1 An increase in the portal venous pressure may result in hemorrhoids. When thrombosed, hemorrhoids may appear as painful, swollen, shiny blue masses in the anal region that itch and bleed with defecation. When this condition resolves, it leaves flabby skin sacs around the anal orifice. Anal fissures refer to linear splits in the anal region. Pilonidal cysts are tufts of hair containing cysts over the coccyx. Rectal prolapse refers to the protrusion of rectal mucous membrane through the anus. Fissures, pilonidal cysts, and rectal prolapse do not appear as flabby skin sacs around the anus.

The nurse is caring for a patient with celiac disease. Which sign or symptom is the nurse likely to find in the patient? Passage of frothy stools Passage of gray tan stools Passage of black, tarry stools Passage of jelly mucous stools

1 Celiac disease is a small intestine disorder. Patients with celiac disease pass frothy stools due to the impaired absorption of fat and other nutrients in the intestine. Patients with obstructive jaundice pass gray tan stools due to an obstruction in the biliary tract preventing bile from draining into the small intestine. Patients with upper gastrointestinal bleeding pass black, tarry stools due to bleeding. Patients with inflammatory conditions pass jelly mucous stools due to the increased secretion of prostaglandins in the gastrointestinal tract.

The nurse is caring for a patient with cystic fibrosis. While reviewing the laboratory reports, the nurse finds increased levels of fat in the feces. Based on this, what does the nurse expect the stool to look like? Frothy stool Clay-colored stool Lumpy or hard stool Bright red-colored stool

1 Cystic fibrosis leads to the malabsorption of fats, which results in the presence of fat in the feces. This condition is also called steatorrhea. Steatorrhea may give a frothy appearance to the stools. Cystic fibrosis may not result in clay-colored stools. Biliary cirrhosis, gallstones, and alcoholic or viral hepatitis may result in clay-colored stools due to the absence of bile pigment.Cystic fibrosis will not cause upper gastrointestinal bleeding or rectal bleeding in the patient. Therefore, the patient will not have black-colored or bright red-colored stools. Lumpy or hard stools happen as a result of constipation.Bright red stools indicate rectal bleeding.

A student nurse is discussing the anatomy of the anal canal with a study group after class. Which statement made by the student nurse needs correction? "The anal canal contains the valves of Houston." "The sphincter helps keep the anal canal tight." "The anal canal is surrounded by two sphincters." "The internal sphincter is involuntary in function."

1 The anal canal is the terminal part of the large intestine. It is situated between the rectum and the anus. A valve of Houston is a group of three semilunar transverse folds present in the rectum, but not in the anal canal. Two concentric layers of muscles called sphincters surround the anal canal. The sphincters always keep the anal canal tight except during the passage of feces and gas. The internal sphincter has involuntary functioning, whereas the external sphincter of the anal canal has voluntary control.

While examining the feces of a patient, the nurse notices that the feces are soft and brown in color. What does the nurse infer from this finding? This is a normal assessment finding. There is inflammation inside the colon. An obstruction is present in the biliary tract. Upper gastrointestinal bleeding has occurred.

1 The normal and healthy patient passes soft and brown-colored stools. Presence of jelly mucus in the stool indicates the presence of inflammation. Clay-colored stools indicate a biliary obstruction in the patient. The patient with upper gastrointestinal bleeding may pass black, tarry stools.

How would the nurse describe abnormalities observed during an anal examination? The nurse describes the abnormality in terms of clock position. The nurse describes the abnormality in relation to the pilonidal area. The nurse describes the abnormality in relation to the perianal area. The nurse describes the abnormality starting from the anal opening and working outward.

1 The nurse describes any abnormality in clock-face terms, with the 12 o'clock position as the anterior point toward the symphysis pubis and the 6 o'clock position toward the coccyx. The pilonidal area is the region of the buttock crease or the natal cleft of the buttocks. This area is not included during normal anal inspection. The perianal area is located around the anus and includes anal area located outside the rectal opening. Anal inspection does not cover this area.

A patient reports intense itching around the perineum. While assessing, the nurse sees dull grayish pink, thickened excoriated skin around the anus. Which treatment strategy would be most beneficial for the patient? Instruct the patient to use topical steroid cream. Administer intravenous analgesics to the patient. Administer several Botox injections to the patient. Instruct the patient to use nitroglycerin ointment.

1 The presence of dull grayish pink, excoriated skin around the anus indicates a fungal infection. Pruritus ani manifests as intense itching around the perineum. Topical steroid creams help relieve itching and discomfort that occurs from pruritus ani. Analgesics help relieve pain, but the patient with pruritus ani may not have pain. Botox injections and nitroglycerin ointment help in the treatment of fissures.

The nurse is examining the genitals of a child who is a victim of sexual abuse. Which findings is the nurse likely to observe in the child? Anal abrasions Perianal tears Coccygeal dimple Anal flabby papules Shiny, blue anal sac

1, 2 Due to trauma and forceful insertion of a penis or other object into the anus or vagina, a child who has been sexually abused may have anal abrasions and perianal tears. The presence of a dimple at the tip of coccyx indicates that the child has a pilonidal cyst, which is a common congenital disorder. It is not caused by sexual abuse. The presence of flabby papules indicates that the child has hemorrhoids due to varicose veins. The presence of a shiny, blue skin sac indicates that the child has a thrombosed hemorrhoid caused by the formation of a clot.

Which symptoms would the nurse observe in a patient with prostatitis? Fever Chills Dysuria Nocturia Hematuria

1, 2, 3 Prostatitis is a swelling and irritation of the prostate gland. Prostatitis may occur because of a bacterial infection. The patient may have fever and chills due to the infection. Dysuria refers to painful urination caused by a urinary tract infection that is a result of prostatitis. Prostatitis will not cause nocturia in the patient. Nocturia is the condition in which the body produces excessive urine during the night, and the person needs to wake up at night to pass the urine. Hematuria is the occurrence of red blood cells in the urine. Prostatitis will not cause bleeding in the urinary tract that leads to hematuria. Nocturia and hematuria are signs of carcinoma.

The nurse is caring for a patient who reports having frequent urination, blood in the urine, and continuous pelvic pain. Upon reviewing the patient's diagnostic tests, the nurse finds that the patient has prostate cancer. Which findings enabled the nurse to make such a conclusion? Swollen, asymmetric prostate gland Stony hard, irregular nodules in the prostate Presence of obliterations in the median sulcus Presence of elastic and rubbery prostate gland Prostate gland of 2.5 cm in length and 4 cm in width.

1, 2, 3 The patient with prostate carcinoma may experience urinary frequency, urinary hesitancy, blood in the urine, painful urination, and continuous pain in the lower back, pelvis, and thighs. The prostate gland becomes swollen and asymmetric due to extracellular growth in the patient with prostate cancer. Due to the presence of nodules, the prostate gland becomes stony hard and fixed. In the patient with prostate cancer, the median sulcus of the prostate gland is obliterated because of the loss of symmetry. Due to the growth of a tumor, the consistency of the prostate gland is decreased and it becomes less elastic. In healthy patients, the prostate gland is approximately 2.5 cm long and 4 cm wide. In a patient with prostate cancer, the size of the prostate gland will be more than 2.5 cm in length and 4 cm in width due to extracellular growth

Which signs and symptoms does the nurse expect to find in a patient with prostate cancer? Pain during urination Weak stream of urine Fever, chills and malaise Presence of blood in the urine Dull, achy pain in the anal region

1, 2, 4 Prostate cancer is associated with the formation of a malignant tumor in the prostate gland. The size of the prostate gland increases because of the tumor and compresses the urethra. This may obstruct the urine flow and may result in painful urination and a weak stream of urine. An enlarged prostate gland may damage the blood vessels of the urinary tract and may cause blood in the urine, resulting in hematuria. Fever, chills, and malaise are caused by inflammation of the prostate gland, but not by prostate cancer. A dull achy pain in the perianal or the anal regions is associated with inflammation of the prostate gland; it is not related to prostate cancer.

Which conditions can cause pruritus ani? Crohn's disease Diabetes mellitus Chronic liver disease Prolapsed hemorrhoids Cardiovascular disorders

1, 2, 4 Pruritus ani is a fungal infection associated with intense perianal itching. Crohn's disease is an inflammatory bowel disease that may impair skin integrity and cause pruritus ani. The patient with diabetes mellitus may have severe itching and increased risk of infection. Prolapsed hemorrhoids may cause irritation of the anal mucosa and intense itching, resulting in pruritus ani. Cardiovascular disorders and chronic liver disorders do not decrease immunity and do not increase the risk of infection.

Which conditions increase a patient's risk for hemorrhoids? Obesity Pregnancy Celiac disease Crohn's disease Chronic liver disease

1, 2, 5 Hemorrhoids are flabby papules in the anal region that are caused by a varicose vein of the hemorrhoid plexus. The patient with obesity has excessive adipose tissue, which increases the risk of varicose vein formation and may result in hemorrhoids. During pregnancy, the uterus grows and exerts pressure on the rectum and may reduce the blood flow to the rectal blood vessels. This may increase the risk of varicose veins and result in hemorrhoids in the patient. Chronic liver disease may cause a dual blood supply to the rectum and may result in hemorrhoids. Celiac disease and Crohn's disease do not cause varicose veins of the hemorrhoid plexus and do not cause hemorrhoids. Celiac disease interferes with bowel movements and increases the risk of diarrhea. Crohn's disease increases peristalsis and may cause diarrhea.

The nurse is caring for a patient who has BRCA2 mutations and weight loss. The patient reports blood in the stools, abdominal pain, and a change in bowel habits to the nurse. Which tests would be indicated based on this patient's signs and symptoms? Colonoscopy Microscopic tape test Fecal occult blood testing Fecal immunochemical test Blood test for prostate-specific antigen

1, 3, 4 BRCA2 mutations increase the risk of breast, prostate, and pancreatic cancers. Unexplained weight loss, presence of blood in the stool, pain, and a change in bowel habits are the symptoms of colorectal cancer. An early sign of colon or colorectal cancer is bleeding. A colonoscopy screens for colorectal cancer by directly examining the rectum and the colon with a scope. A positive result from a fecal occult blood test helps determine bleeding in the digestive tract. A fecal immunochemical test helps detect bleeding in the lower digestive tract. A microscopic tape test helps screen for an infection in the patient. BRCA2 mutations may not lead to infections; therefore, the patient may not need a microscopic tape test for the assessment. Elevated prostate-specific antigen (PSA) levels indicate prostate gland complications such as prostatitis, prostate cancer, or enlargement of the prostate gland. Prostate complications will not cause a change in bowel habits. Therefore, the patient may not need a blood test for assessing PSA levels.

The nurse suspects that a patient has Crohn's disease after examining a stool specimen. What other signs and symptoms should the nurse look for in the patient? Severe pain in the gastrointestinal tract Palpable cyst noted in the lower sacrum Stool passing through skin near the anus Itching around the anal sphincter opening Protrusion of rectal walls through the anus

1, 3, 4 Crohn's disease is a type of inflammatory bowel disease. Pruritus ani, or itching around the anus, may occur in the patient with inflammatory bowel disease, due to inflammation. The patient may have pain in the gastrointestinal tract due to inflammation. The presence of an abnormal passage from the inner anus or rectum to the skin surrounding the anus indicates an anorectal fistula. It is caused by local abscess or inflammation. Therefore, it may occur in the patient with Crohn's disease. Inflammation will not lead to the formation of a cyst in the patient. Therefore, the patient will not have a palpable cyst in the lower sacrum. Inflammation of the gastrointestinal tract may not weaken the walls of the rectum. Therefore, the patient will not have rectal prolapse or protruded rectal walls.

Which conditions put patients at higher risk of developing hemorrhoids? Pregnancy Renal disorders Chronic constipation Ischemic heart disease Chronic hepatic disease

1, 3, 5 Hemorrhoids are painless, flabby papules caused by a varicose vein of the hemorrhoidal plexus. All hemorrhoids result from increased portal venous pressure. Portal venous pressure increases when one strains at passing stool. Patients with chronic liver disease, chronic constipation, obesity, or pregnancy have a higher risk of developing hemorrhoids. Such patients generally strain at stool. Patients with ischemic heart disease or patients with poor renal functioning are not at a higher risk of developing hemorrhoids, because these patients do not routinely strain at stool as a result of their illness.

After interacting with the mother of a 2-year-old child, the nurse suspects that the child has a risk of developing gastrointestinal disorders. Which statement made by the mother would lead the nurse to this conclusion? "I found my child eating raw eggs yesterday!" "My child drinks cow's milk at least twice a day." "I make sure my child gets some dietary roughage." "We eat raw shellfish at home several times a week." "I feed my child corn and vegetable soup during the week."

1, 4 Raw or undercooked food irritates the gastrointestinal lining and increases the risk of gastrointestinal (GI) disorders in a child. Therefore, when a child is fed raw shellfish and eggs the risk of GI disorders increases. Cow's milk provides calcium and protein required for the proper growth and development of the child. Roughage adds bulk to the food and helps eliminate undigested food from the body. Corn and vegetable soup help provide carbohydrates and protein that are essential for the growth of the child. Therefore, cow's milk, food rich in roughage, corn, and vegetable soup do not increase the risk of GI disorders in the child.

While caring for a patient, the nurse discovers bright red blood in the patient's stool and a visible anal tear. The patient reports severe pain and a burning sensation around the anus. Which interventions should the nurse include in the patient's care plan to relieve the signs and symptoms? Instruct the patient to increase fluid intake. Instruct the patient to consume foods rich in iron. Instruct the patient to avoid the intake of broccoli. Instruct the patient to include warm soaking baths. Instruct the patient to apply nitroglycerin ointment.

1, 4, 5 Bright red blood in the stool and a visible tear on the anus indicate that the patient has a fissure. The patient should increase fluid intake, because this intervention helps prevent constipation, which can aggravate the patient's condition. Warm baths provide relief and comfort from the pain caused by the anal fissure. The nurse instructs the patient to apply nitroglycerin ointment, because it helps in healing. Iron-rich foods do not help soften the stools; therefore, they will not provide comfort to the patient with an anal fissure. Broccoli is a fiber-rich food and it helps prevent constipation. Therefore, the nurse might instruct the patient to increase the intake of broccoli.

Which medical conditions may lead to the absence of bile pigment in the stool? Gallstones Cystic fibrosis Celiac disease Viral hepatitis Biliary cirrhosis

1, 4, 5 Clay-colored stools indicate the absence of bile pigment. Gallstones may cause an obstruction to the passage of bile pigments into the intestine, resulting in clay-colored stools. Viral hepatitis refers to a viral infection that causes inflammation of the liver, resulting in reduced bile production. Therefore, the patient with viral hepatitis may have clay-colored stools. Biliary cirrhosis refers to the inflammation of the bile ducts. This may lead to the absence of bile pigment in the stools. Cystic fibrosis may affect the digestion of fats, resulting in steatorrhea and frothy stools, but it is not responsible for clay-colored stools. Celiac disease is an autoimmune disorder that damages the intestinal lining. This condition may affect the passage of bile, but does not lead to the absence of bile pigments in the stool.

The nurse is assessing an 8-month-old child and sees that the child has a secondary infection due to a diaper rash. Which findings support the nurse's conclusion? Presence of pustules Presence of anal abrasion Presence of perianal tears Presence of rectal bleeding Presence of reddened skin

1, 5 Diaper rash is common in children younger than 1 year. This may be caused by tight diapers, overexposure to urine, and allergic reactions. Pustules are lesions filled with pus present under the dermal layer of the skin. The child with diaper rash has pustules and reddened skin near the buttocks and anus. The child who is sexually abused has anal abrasions and perianal tears. Rectal bleeding indicates that the child may have a fissure or constipation.

A hospitalized geriatric patient with rheumatoid arthritis reports severe abdominal pain and difficulty during defecation. After doing a digital rectal examination, the nurse finds a fecal mass in the patient's colon. Which medication does the nurse suspect to be the cause of this finding? Ibuprofen (Motrin) Morphine (Roxanol) Celecoxib (Celebrex) Prednisolone (Orapred)

2 A fecal impaction refers to a blockage of the colon by hard, immovable, desiccated stool. This appears as a fecal mass during the digital rectal examination. Opiates such as morphine (Roxanol) are effective in relieving severe pain in the patient with rheumatoid arthritis. However, these medications may reduce intestinal motility, resulting in a fecal impaction. Ibuprofen (Motrin) is a nonsteroidal antiinflammatory medication that helps relieve pain. However, this medication does not decrease peristalsis and does not cause a fecal impaction in the patient. Celecoxib (Celebrex) helps relieve the pain associated with musculoskeletal disorders. This medication does not decrease the intestinal motility; therefore, it should not cause a fecal impaction in the patient. Prednisolone (Orapred) is an oral corticosteroid, which does not have any impact on bowel movements.

The nurse, while palpating the rectum, feels small nodules in the center. These nodules are firm and nontender. Which disorder does the nurse suspect? Rectal polyps Early carcinoma Ischiorectal abscess Internal hemorrhoids

2 A malignant neoplasm in the rectum is asymptomatic. An early lesion may be a single firm nodule. The nurse may palpate an ulcerated center with rolled edges. An abscess is a localized cavity of pus from infection. An ischiorectal abscess occurs in the pararectal space. It is deep and tender to bidigital palpation. It occurs laterally between the anus and ischial tuberosity and is rare. Polyps are abnormal growths rising from the lining of the colon or the rectum that protrude into the lumen. Polyps are soft and movable masses and are not firm. Hemorrhoidal tissue lies within the anal canal and perianal area and consists of blood vessels, connective tissue, and a small amount of muscle. Bleeding during bowel movements is the most common sign of hemorrhoids.

While doing a digital rectal exam for a 50-year old patient, the nurse finds that the patient has rectal lesions that are irregular and appear to be cauliflower-shaped. What is the priority nursing intervention in this condition? Acquire a prescription for a urinalysis test. Instruct the patient to consult an oncologist. Instruct the patient to take warm sitz baths. Suggest to the patient that fiber intake be increased.

2 A patient who is 50 years old has an increased risk of prostate carcinoma. The presence of irregular cauliflower-shaped lesions in the rectum indicates that the patient most likely has cancer, because most of these lesions are malignant. Therefore, the nurse would recommend the patient consult an oncologist immediately. Intake of fiber-rich food helps alleviate the risk of constipation, but not cancer. Warm sitz baths help relieve pain caused by hemorrhoids. The nurse should suggest that the patient undergo a colonoscopy and a fecal occult test to diagnose the illness accurately. Urinalysis does not help detect the formation of tumors in the patient.

While doing the anal examination of a child, the nurse finds that the child's anal region is swollen, moist, and dull grayish-pink in color. Which test should the nurse expect to be prescribed for the child to diagnose the illness? Sigmoidoscopy Microscopic tape test Fecal occult blood test Fecal immunochemical test

2 A swollen, moist, and dull grayish-pink colored anal region indicates that the patient has pruritus ani. It is an infection of the perianal region and is caused by pinworm infection in children. It can be diagnosed by the microscopic tape test. During this test, a piece of transparent tape is applied on the patient's anal region so that the eggs of the pinworm deposited on the anus adhere to the tape and can be seen under a microscope. Sigmoidoscopy, fecal occult blood test, and fecal immunochemical test help diagnose colon cancer.

While palpating the anus of a patient, the nurse notes increased muscle tone. What should the nurse infer from this finding? The patient has a polyp. The patient has anxiety. The patient has carcinoma. The patient has a rectal prolapse.

2 Anxiety is a feeling of being worried, followed by nervousness and an impaired physical state. When a patient is anxious, the sensory receptors become more active and this results in increased muscle tone. A polyp is the outgrowth of the tissue projecting from the mucous membrane and it is soft and has a movable mass. The patient with carcinoma has a hard tissue mass with rolled edges. Rectal prolapse occurs when the rectum protrudes out through the anal opening. It appears as a red, doughnut-like mass with circular folds.

The health care provider instructs the nurse to administer a bismuth preparation to the patient for the treatment of diarrhea. Which statement should the nurse make before administering the bismuth preparation to the patient? "You may have pale yellow stools from bismuth preparations." "You may have black stools as a result of bismuth preparations." "You may have red stools because of the bismuth preparations." "You may have greasy stools from taking bismuth preparations."

2 Bismuth preparations may form black, insoluble metabolites in the stomach, so the patient may pass black-colored stools. Therefore, to reduce the patient's anxiety, the nurse would inform the patient that the bismuth preparation will cause a black discoloration of the stools. Red discoloration of the stools is caused by bleeding in the patient with colon cancer. Pale yellow and greasy stools indicate the presence of fat content in the stool. It occurs because of malabsorption syndrome, not the intake of the bismuth preparation. p. 729

A patient with diabetes mellitus has perianal itching and red, raised, thickened, excoriated skin around the anus. The patient's anus is swollen, moist, and dull grayish-pink in color. The microscopic tape test report indicates the presence of translucent eggs. What do these findings indicate? The patient has a fissure. The patient has pruritus ani. The patient has hemorrhoids. The patient has a pilonidal cyst.

2 Patients with diabetes mellitus are highly susceptible to infection. The presence of red, raised, thickened, excoriated skin around the anus indicates that the patient has pruritus ani. It is a pinworm infection and can be diagnosed by the microscopic tape test. Due to the presence of translucent eggs, the patient may have perianal itching. A fissure is not associated with a swollen, moist, and dull grayish-pink-colored anus. It is associated with a painful longitudinal tear in the superficial mucosa at the anal margin. Hemorrhoids are associated with less bleeding and flabby papules at the anal region. A pilonidal cyst is associated with inflammation and a tuft of hair at the tip of the coccyx.

Which characteristic feature does the nurse observe in a patient with a pilonidal cyst? Linear splits noted in the anal region Hair containing cysts over the coccyx Flabby skin sacs around the anal orifice Hard mass palpated in the rectal wall

2 Pilonidal cyst is a congenital disorder, characterized by the presence of a tuft of hair containing cysts over the coccyx. Sinus tract is observed in advanced cases of pilonidal cyst. Fissures are characterized by the presence of linear splits in the anal region. Hemorrhoids are characterized by the presence of flabby skin sacs in the anal region. Carcinoma is characterized by the presence of a hard mass with rolled edges in the rectal wall.

Which statement precisely describes the internal anal sphincter? It surrounds the external anal sphincter and is always open. It is under involuntary control by the autonomic nervous system. It is under voluntary control by the parasympathetic nervous system. It is made of folds of the mucosa and ends at the anorectal junction.

2 The anal canal is surrounded by two concentric layers of muscle known as the sphincters. The internal sphincter is under involuntary control by the autonomic nervous system. The autonomic nervous system is a part of the peripheral nervous system that acts as a control system. It functions largely below the level of consciousness to control the visceral functions. The external sphincter surrounds the internal sphincter. Except for the passing of feces and gas, the sphincters keep the anal canal tightly closed. The external sphincter is under voluntary control. It is not under the control of the parasympathetic nervous system. The anal columns are made of mucosal folds. These extend vertically down from the rectum and end in the anorectal junction.

The nurse is assessing a patient who reports bleeding during defecation. The nurse asks the patient to do the Valsalva maneuver and sees a red mucosal mass inside the anus. What could be the cause of this condition in the patient? Passage of irritant diarrheal stool Increase in portal venous pressure Weakened pelvic support muscles Result of a local abscess near the anus

2 When a patient does the Valsalva maneuver, internal hemorrhoids may appear as a red mucosal mass. The patient with hemorrhoids may have bright red bleeding. An increase in the portal venous pressure during defecation may cause hemorrhoids in the patient. Passage of irritant diarrheal stools will not increase the pressure in the portal veins; therefore, it may cause anal fissure, but not hemorrhoids, in the patient. Weakening of pelvic support muscles may result in rectal prolapse. The presence of a local abscess around the anus may lead to inflammation, resulting in anorectal fistula, not hemorrhoids.

The nurse is caring for a patient who is taking iron supplements. Which finding should the nurse expect in the patient? Clay-colored stool Black, nontarry stool Pale-yellow greasy stool Bright red-colored stool

2 When patients take iron supplements, the stool may become black and nontarry. Biliary cirrhosis, gallstone, and alcoholic or viral hepatitis may cause clay-colored stool due to the absence of bile pigment. Steatorrhea or fecal fat may result in pale-yellow, greasy stool in the patient. Bright red-colored stools usually indicate rectal bleeding.

Which nursing interventions should the nurse implement in a patient to reduce the risk of prostate cancer? Teach the patient to include dairy products in the diet. Teach the patient to refrain from eating processed meat. Teach the patient to increase the daily intake of fiber. Teach the patient to eat many fresh vegetables and fruits. Advise the patient to have a colonoscopy every 10 years.

2, 3, 4 Animal products such as processed meat increase the levels of insulin-like growth factor-1(IGF-1) in the blood, which increases the risk of prostate cancer. Therefore, the patient should limit the intake of processed meat. A high-fiber diet is rich in a carbohydrate called inositol hexaphosphate, which promotes the development of prostate cancer. Vegetables and fruits have cancer-fighting properties. Dairy products increase the risk of prostate cancer, so the nurse should instruct the patient to limit dairy products. A colonoscopy screens for colon cancer, colorectal cancer, and polyps.

What are the symptoms of colorectal cancer? Dysuria Anemia Weight loss Blood in stools Swelling of extremities

2, 3, 4 Colorectal cancer is associated with the loss of blood. As a result, the patient may have iron deficiency that results in anemia. Colorectal cancer impairs bowel motility and reduces the appetite, resulting in weight loss. Colorectal cancer may be associated with damage to the blood vessels and may result in bloody stools. Dysuria is a symptom of prostatitis. Colorectal cancer does not cause retention of fluid in the limbs and does not cause swelling of extremities.

While doing a digital rectal examination on a patient, the nurse finds symmetric enlargement of the prostate gland. Which signs and symptoms would the nurse expect to find in the patient? Fever Nocturia Urinary frequency Urethral discharge Straining to urinate

2, 3, 5 A symmetric enlargement of the prostate gland indicates that the patient has benign prostatic hypertrophy. A hormonal imbalance causes hypertrophy and leads to the proliferation of benign adenomas. The enlarged prostate obstructs the urethra and reduces the urine output. Due to the obstruction of the urethra, the patient may have a frequent sensation of urination, which may result in nocturia and urinary frequency. Due to the obstruction of the urinary tract, the patient may have difficulty with urination. A fever and urethral discharge are symptoms of prostatitis. Benign prostatic hypertrophy is not associated with an increase in the body temperature or with urethral discharge.

A patient with hypothyroidism has a fecal impaction. Which treatment strategies would be beneficial for the patient? Prescribing opioids Prescribing enemas Prescribing laxatives Prescribing analgesics Prescribing suppositories

2, 3, 5 The patient with hypothyroidism may have reduced gastric motility, which may block the colon by hard, desiccated, immovable stool in the rectum. This may result in a fecal impaction and constipation in the patient. Laxatives increase the gastric mobility, prevent constipation, and prevent fecal impactions. Enemas and suppositories soften the stool and enhance its elimination from the rectum. Therefore, to prevent constipation and to treat fecal impaction, the health care provider would prescribe laxatives, enemas, and suppositories for the patient. Opioids decrease gastric mobility and increase the risk of constipation in the patient. Analgesics help alleviate pain but do not enhance gastric motility and do not prevent constipation.

The nurse is caring for a patient who has a longitudinal tear at the anal margin. The patient reports having pain during defecation and bright-red blood in the stool. The health care provider has prescribed stool softeners and topical analgesics. Which other treatment strategies should the nurse expect to be prescribed for the patient to enhance healing? Antacids Botox injection Anticholinergics Opioid analgesics Topical nitroglycerine ointment (Nitro-Bid)

2, 5 The presence of a longitudinal tear in the superficial mucosa at the anal margin indicates that the patient has a fissure. It may cause severe pain during defecation and bright-red stools. To ease defecation and alleviate pain, the health care provider would prescribe stool softeners and analgesics. Diarrhea may cause irritation to the anal mucosa and worsen the patient's condition. Therefore, the health care provider prescribes a Botox injection to the patient. Topical nitroglycerine ointment (Nitro-Bid) aids in healing anal fissures. It reduces muscles spasm in the rectal sphincter and increases the blood flow to the rectum. Therefore, the nurse expects that adding these medications to the patient's prescription will enhance the healing process. Antacids help reduce acidity, but do not alleviate pain and soften stools. Anticholinergics and opioids decrease gastric motility and increase the risk of constipation in the patient. These may worsen the patient's condition; hence, these should not be prescribed to the patient.

The nurse assesses the prostate gland of an adult patient and documents the findings. What should the nurse infer from these findings? The patient has prostatitis. The patient has prostate cancer. The patient has normal development. The patient has benign prostatic hypertrophy.

3 A normal prostate gland size is about 2.5 cm long by 4 cm wide and is heart-shaped with a palpable central groove. The normal prostate gland is smooth, slightly movable, nontender, elastic, and rubbery. These findings indicate that the patient has normal development. The patient with prostatitis will present with swelling and a tender prostate gland. Carcinoma of the prostate is characterized by the presence of an irregular, fixed, and stone-hard nodule. Benign prostatic hypertrophy is characterized by the presence of an enlarged, firm, smooth gland with a central groove.

Which position would be suitable to assess the rectal area and genitalia in a female patient? Supine Standing Lithotomy Left lateral decubitus

3 The female patient should be placed in the lithotomy position to best examine the genitalia and the rectal area. In the supine position, the head, spine, hips, and legs are parallel so the nurse may not be able to examine the rectal region of the patient in this position. The standing and left lateral decubitus positions are suitable for assessing the rectal area in the male patient. The nurse may select the lateral decubitus position to examine only the rectal area in a female patient. p. 725

What is the approximate length of the rectum in an adult patient? 2.5 cm 4 cm 12 cm 16 cm

3 The rectum is the distal portion of the large intestine extending from the sigmoid colon and is approximately 12 cm long. The prostate gland is 2.5 cm long and 4 cm in diameter. The combined length of the anal canal and the rectum is about 16 cm in the adult.

Which statement accurately describes the sigmoid colon? It originates at the ascending colon. It contains the zona hemorrhoidalis. It is approximately 40 cm in length. It is palpable with the bimanual technique.

3 The sigmoid colon is an S-shaped structure that is approximately 40 cm long. Bimanual palpation is a method used for the examination of the pelvic organs of a woman. The sigmoid colon is accessible to examination only with a colonoscope. The sigmoid colon extends from the iliac flexure of the descending colon, not the ascending colon. Zona hemorrhoidalis is the part of the anal canal that contains the rectal venous plexus. The anal canal extends from the sigmoid colon.

Which conditions can cause frothy stools? Gallstones Rectal cancer Celiac disease Cystic fibrosis Chronic pancreatitis

3, 4, 5 Frothy stools occur because of fat malabsorption. Celiac disease is a digestive and autoimmune disorder in which the body cannot properly absorb nutrients, and this condition may result in frothy stools. Cystic fibrosis is an inherited disease that affects the digestive system. It is associated with the impaired absorption of fat and may result in frothy stools. Chronic pancreatitis is inflammation of the pancreas, which is associated with the impaired absorption of fat due to reduced pancreatic enzymes. This may result in frothy stools. Gallstones may cause clay-colored stools because of the absence of bile pigments. Red blood in stools may appear in the patient with rectal cancer due to growth through the intestinal lining.

Which foods should the nurse include in the patient's diet to reduce the risk of colon cancer? Eggs Meat Prunes Cereals Wheat germ

3, 4, 5 Prunes are high-fiber foods that help maintain proper bowel movement and prevent the risk of stool impaction. Cereals and wheat germ are insoluble fiber foods that add bulk to the stools and allow smoother passage. Smooth passage of stools helps reduce the contact time of toxins with the colon, thereby reducing the risk of colon cancer. Eggs and meat do not add bulk to the stools and do not enhance peristalsis. Therefore, they may not reduce the risk of colon cancer in the patient.

Which patients are most susceptible to developing a fecal impaction? A patient with colitis A patient with Crohn's disease A patient with hypothyroidism A patient with giardial infection A patient with a spinal cord injury

3, 5 A fecal impaction refers to a blockage in the colon by hard, immovable, desiccated stools. This may happen as a result of decreased peristalsis resulting in decreased bowel motility. Hypothyroidism slows down the process of digestion and peristalsis. This in turn increases the risk of fecal impaction in the patient. Lack of mobility in the patient with a spinal cord injury may result in decreased peristaltic movements of the intestine. Therefore, the patient with a spinal cord injury is at risk for a fecal impaction. Colitis may lead to diarrhea, but does not cause constipation and fecal impaction. Giardiasis is a parasitic intestinal infection that may lead to diarrhea. Crohn's disease is a type of inflammatory bowel disease that may decrease the absorption of water and nutrients in the intestine. Thus, it may lead to diarrhea.

The diagnostic reports of a patient indicate the presence of a symmetric, nontender prostate gland. The patient has a positive hematest and has no lesions in the perianal area. What do these findings indicate? The patient has an anorectal fistula. The patient has developed prostatitis. The patient has benign prostatic hypertrophy. The patient has upper gastrointestinal bleeding.

4 A fecal occult blood test is used to determine the presence of blood in the stool. The patient with upper gastrointestinal bleeding may have a positive hematest due to the presence of blood in the stools. Therefore, the patient may have upper gastrointestinal bleeding. The patient with an anorectal fistula will present with an abnormal opening near the anus. As a result, the patient does not have a fistula. The patient with prostatitis will have an asymmetrical and tender prostate gland due to inflammation. Here, the patient has a symmetric, nontender prostate gland, so the nurse would not conclude the patient has prostatitis. The patient with benign prostatic hypertrophy may have a symmetric, nontender enlargement of the prostate gland. Because the patient does not have enlargement of the prostate gland, the nurse would not conclude that the patient has benign prostatic hypertrophy.

A patient reports itching and constant pain around the anus. The nurse assesses the patient and notes purulent discharge from a red, raised tract opening near the anus. How should the nurse document this finding? Pruritus ani Pilonidal cyst Hemorrhoids Anorectal fistula

4 An anorectal fistula refers to an abnormal passageway that has developed between the anal canal and the perianal skin. Stool passes through this abnormal opening. This appears as a red, raised tract opening near the anus, and the patient may have purulent discharge when pressure is applied. An anorectal fistula causes occlusion of the anal tract and swelling in the anal area; therefore, the patient may have pain in the anal region. Pruritus ani refers to intense itching in the perineal region. However, the patient with pruritus ani would not have a red, raised tract opening near the anus. A hair-containing cyst over the coccyx or the lower sacrum indicates a pilonidal cyst. Painless bleeding during bowel movements, itching, and swelling in the anal region are symptoms of hemorrhoids. The patient with hemorrhoids should not have purulent discharge.

Which condition is associated with melena? Anorectal fistula Hemorrhoidal bleeding Ingestion of iron tablets Upper gastrointestinal bleeding

4 Melena is a condition in which the patient passes black, tarry stools. Black, tarry stool with distinct malodor indicates upper gastrointestinal bleeding with blood partially digested. If there is more than 50 mL of blood from the upper gastrointestinal tract, the patient has melena. Hemorrhoidal tissue lies within the anal canal and the perianal area and consists of blood vessels, connective tissue, and a small amount of muscle. Hemorrhoids are swollen veins in the lower rectum. Painless bleeding during bowel movements and small amounts of bright red blood on the toilet tissue or in the toilet bowl indicate hemorrhoidal bleeding. Anorectal fistula is caused by a chronically inflamed gastrointestinal tract. It may drain serosanguineous or purulent matter when pressure is applied. If the patient passes black, non-tarry stool, then it is due to the ingestion of iron medications (such as tablets). Non-tarry stools do not have the appearance of tar.

At what age does a child develop voluntary control over the external anal sphincter? At 6 months At 12 months At 14 months At 18 months

4 Myelination of the nerves of the anal region is completed by the age of 1½ to 2 years, or 18 to 24 months. Myelinated spinal nerves effectively transmit the nerve impulse that helps in controlling anal sphincters. At 6 months, 12 months, and 14 months, these nerves remain unmyelinated. Therefore, the child cannot control the external anal sphincter.

Which finding would the nurse observe in a patient with prolapsed hemorrhoids? Bowel movements that are clay-colored stool Noticeable tufts of hair around the coccyx area Presence of a longitudinal tear at the anal margins Soiled underwear with excess mucoid discharge

4 Prolapsed hemorrhoids may cause the leakage of mucoid discharge from the anus. Clay-colored stools may occur with biliary cirrhosis, gallstones, and alcoholic or viral hepatitis. A pilonidal cyst refers to the presence of tufts of hair containing cysts over the coccyx. Anal fissures are the painful longitudinal tears in the superficial mucosa at the anal margins.

A patient presents with fever, chills, painful urination, and severe pain in the rectum. After reviewing the patient's diagnostic reports, the nurse suspects the patient has inflammation of the prostate gland. Which findings support this conclusion? Obliterated median sulcus Stone-hard and fixed prostate gland Smooth, firm, rubbery prostatic surface Slightly swollen and asymmetric prostate gland

4 Prostatitis is an inflammation of the prostate gland. It is associated with fever, chills, malaise, urinary frequency and urgency, painful urination, and severe pain in the perineal and rectal areas. Due to inflammation, the prostate gland swells and may have a slightly asymmetric appearance. Therefore, the nurse would observe a slightly swollen and asymmetric prostate gland in the patient's diagnostic reports. Prostatitis is not associated with formation of tumors and would not result in obliteration of the median sulcus of the prostate gland. A stone-hard and fixed prostate gland indicates that the patient has carcinoma. The presence of a smooth, firm, and rubbery prostatic surface indicates that the patient has benign prostatic hypertrophy.

Which condition is caused by mutations in the BRCA2 gene? Pruritus ani Hemorrhoids Rectal abscess Prostate cancer

4 The BRCA2 gene is a tumor suppressor gene. Mutations in this gene may result in prostate cancer. Pruritus ani is caused by pinworm infections, prolapsed hemorrhoids, anal fissure, dermatitis, and chronic diarrhea, but not by BRCA2 gene mutations. Hemorrhoids are caused by increased pressure in the rectal region and reduced blood supply to the rectum and anus. An abscess is caused by infections in the pararectal space.

The nurse is evaluating a student nurse who is palpating the anus of a patient. Which action of the student nurse indicates the need for correction? Asking the patient to tighten the muscles near the anus Assuring the patient that palpation is not usually painful Pressing the examining finger toward the perianal tissue Approaching the anus at a right angle with the index finger

4 The nurse should not approach the anus at a right angle with the index finger extended, because it causes pain and will not promote the relaxation of the sphincter. Instead, the nurse should ask the patient to tighten the muscles to assess sphincter tone. Patients often feel discomfort and have fear while the nurse is palpating the anus, so the nurse should assure patients that palpation is not usually painful. Pressing the examining finger toward the perianal tissue highlights any swelling or tenderness.

A patient reports black, tarry stools with a distinct malodor. For which complication does the nurse screen in this patient? Steatorrhea Rectal bleeding Obstructive jaundice Upper gastrointestinal bleeding

4 The patient with upper gastrointestinal bleeding will have black, tarry stools, because blood is passing through the digestive system. Steatorrhea will cause pale-yellow, greasy stools in the patient due to the presence of fecal fat. Bright red blood on the stool surface indicates rectal bleeding. Gray and tan stools are signs of obstructive jaundice.

The nurse is assessing a patient who reports persistent, throbbing rectal pain. On examining the patient's anus, the nurse finds a localized cavity of pus, which is red, hot, swollen, indurate, and tender. What should the nurse infer from these findings? The patient has hemorrhoids. The patient has an anal fissure. The patient has a pilonidal cyst. The patient has a perianal abscess.

4 The presence of a localized cavity of pus at the anus indicates that the patient has a perianal abscess. It is caused by an infection, and the patient may have a persistent throbbing rectal pain. Due to the accumulation of pus, it appears red, hot, swollen, indurated, and tender. Hemorrhoids are painless, flabby papules. When filled with a blood clot, these become painful and appear as shiny, blue masses and bleed with defecation. A longitudinal tear at the anal margin characterizes a fissure. It is painful and is associated with blood in the stool. It may occur due to trauma. A pilonidal cyst is characterized by the presence of a hair-containing cyst or sinus on the coccyx or the lower sacrum.

The nurse notices that the patient has a tuft of hair in the sacrococcygeal area and a tightly closed anal opening. The nurse also finds that the patient's prostate surface is rubbery and the prostate gland is slightly movable. Which finding indicates that the patient is at risk for rectal disorders? Rubbery prostate surface Tightly closed anal opening Slightly movable prostate gland Tuft of hair in the sacrococcygeal area

4 The sacrococcygeal area is smooth and even in healthy patients. The presence of a dimple or visible tuft of hair in the sacrococcygeal area indicates that the patient has a pilonidal cyst. The presence of a tightly closed anal opening is a normal finding. The prostate surface should be smooth and rubbery. A hard prostate surface may indicate a complication in the patient. The prostate gland is slightly movable. If it is fixed, then it indicates that the patient has prostate disorders.