Jarvis HA Chapter 25, Anus, Rectum, and Prostate Q&A

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? Select all that apply. "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."

"I found my child eating raw eggs yesterday!" "We eat raw shellfish at home several times a week." 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.

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."

"The anal canal contains the valves of Houston." 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.

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."

"You may have black stools as a result of bismuth preparations." 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.

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

12 cm 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.

A geriatric patient with anemia is admitted to the hospital. The patient is receiving iron supplements and reports abdominal pain and difficulty passing stool. Which is the best nursing intervention for the patient? Administer an enema to the patient. Stop administering iron supplements. Include warm soaking baths every day. Encourage proper hygienic practices.

Administer an enema to the patient.

What population has the highest incidence of benign prostatic hypertrophy?

African Americans

What are the symptoms of colorectal cancer? Select all that apply. Dysuria Anemia Weight loss Blood in stools Swelling of extremities

Anemia Weight loss Blood in stools

Which conditions can cause frothy stools? Select all that apply. Gallstones Rectal cancer Celiac disease Cystic fibrosis Chronic pancreatitis

Celiac disease Cystic fibrosis Chronic pancreatitis

What finding in the prostate gland suggests prostate cancer?

Diffuse hardness

Which complications are associated with constipation? Select all that apply. Fissure Pruritus ani Hemorrhoids Pilonidal cyst Fecal impaction

Fissure Hemorrhoids Fecal Impaction

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

Gallstones Viral hepatitis Biliary cirrhosis

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

Hair containing cysts over the coccyx 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.

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.

Instruct the patient to consult an oncologist. 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.

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.

It is under involuntary control by the autonomic nervous system.

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

Lithotomy 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.

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)

Morphine (Roxanol) 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 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

Passage of frothy stools 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.

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

Pilonidal cyst 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 with hypothyroidism has a fecal impaction. Which treatment strategies would be beneficial for the patient? Select all that apply. Prescribing opioids Prescribing enemas Prescribing laxatives Prescribing analgesics Prescribing suppositories

Prescribing enemas Prescribing laxatives Prescribing suppositories

Which structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm?

Prostate Gland

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

Prostate cancer 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.

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

Prunes Cereals Wheat germ

The nurse is caring for an adult patient with a history of diabetes mellitus. The patient complains of perianal itching. The nurse finds the perianal skin to be dull grayish-pink in color and cracked. What does the nurse conclude from these signs and symptoms? Pilonidal cyst Anal fissure Pruritus ani Rectal tenesmus

Pruritus ani Pruritus ani is a persistent itch around the anus. Pruritus ani is seen in patients with systemic diseases such as diabetes mellitus or inflammatory bowel disease. Inspection shows red, raised, thickened excoriated skin around the anus. The area is swollen and moist, but with a fungal infection, it appears dull grayish-pink. Rectal tenesmus is a feeling of incomplete defecation, even if the rectum contains no bowel residue. The pilonidal cyst is a hair-containing cyst or sinus located in the midline over the coccyx or lower sacrum. An anal fissure is a painful longitudinal tear in the superficial mucosa at the anal margin.

Which finding does the nurse expect to see in the patient with a rectal prolapse? Small, round openings in the anal area Rounded tissue located near the anus A hard, irregular mass close to the anus Presence of tufts of hair over the coccyx

Rounded tissue located near the anus A rectal prolapse occurs when the rectum protrudes out through the anal opening. It appears as a red, circular mass with radiating folds. A fistula is characterized by small, round openings in the anal region. A patient with carcinoma may have a hard, irregular mass with rolled edges in the anal region. A pilonidal cyst is characterized by the presence of a tuft of hair containing cysts over the coccyx.

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

Slightly swollen and asymmetric prostate gland

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

Soiled underwear with excess mucoid discharge 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 states that he has frothy, foul-smelling stools that float on the surface of the water in the toilet bowl. What type of stool is this patient describing?

Steatorrhea

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.

The nurse describes the abnormality in terms of clock position. 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.

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.

The patient has a perianal abscess. 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.

While examining a patient's genitals, the nurse finds that the patient has a swollen, shiny, blue mass below the anorectal junction. What does the nurse conclude from these findings? The patient has developed a fissure. The patient has an anorectal fistula. The patient has developed a pilonidal cyst. The patient has a thrombosed hemorrhoid.

The patient has a thrombosed hemorrhoid.

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.

The patient has anxiety. 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

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.

The patient has hemorrhoids. 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 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.

The patient has upper gastrointestinal bleeding. 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 frequent urination, pain, and burning during urination. The nurse finds an elevated prostate-specific antigen (PSA) level in the patient's laboratory reports. While palpating the prostate, the nurse finds a hard, fixed nodule on the posterior surface of the prostate gland. What complication should the nurse suspect in the patient? The patient may have prostatitis. The patient may have prostate cancer. The patient may have a prostate infection. The patient may have benign prostatic hypertrophy.

The patient may have prostate cancer. Urinary frequency, pain, and a burning sensation during urination are symptoms of prostate cancer. An elevated PSA level also indicates prostate gland complications such as prostatitis, prostate cancer, or enlargement of the gland. A combination of an elevated PSA level and a hard, fixed nodule are characteristic findings of prostate cancer. A swollen, asymmetric gland indicates prostatitis. The patient with a prostate gland infection will not have elevated PSA levels in the blood. The patient with an infection may have an elevated white blood cell count. A smooth, rubbery prostate surface is indicative of benign prostatic hypertrophy.

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.

The prostate is tender to palpation with the central groove obliterated. 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 newborn infant has a dark green stool 2 days after birth. How should you interpret this?

This type of stool would indicate anal patency

The nurse is preparing to palpate the anus and rectum of a patient during an examination. In which direction should the nurse insert the finger into the anus? Toward the coccyx Toward the bladder Toward the umbilicus Toward the symphysis pubis

Toward the umbilicus The correct technique of palpating the anus and the rectum is to flex the tip of the finger and slowly insert it into the anal canal in a direction toward the umbilicus. The nurse should describe the anal 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. Therefore, the symphysis pubis and the coccyx are used to describe anal abnormalities and are not used as points of reference for palpating the anus and the rectum. The nurse should not direct the finger toward the bladder during anal palpation because it may cause the sphincter to tighten and is painful.

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

Tuft of hair in the sacrococcygeal area

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

Upper gastrointestinal bleeding

The nurse instructs a student nurse to palpate the rectum of an infant to evaluate for hemorrhoids. Which action done by the student nurse needs correction? Lubricating the finger before insertion Placing the infant in the supine position Flexing the infant's legs during palpation Using the middle finger for rectal palpation

Using the middle finger for rectal palpation While performing rectal palpation of an infant, the nurse should use the fifth finger, because it is small and most comfortable for the infant. The nurse should not use the middle finger for rectal palpation, because it is bigger in size and may cause pain and trauma. Placing the infant in the supine position helps the nurse examine the infant's rectum without discomfort. Lubricating the finger reduces friction and facilitates its insertion into the infant's rectum with ease. Flexing the infant's legs helps the nurse palpate the infant's rectum with ease.

The gastrocolic reflex is:

a peristaltic wave

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

at 18 months 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.

Normal stool is described as:

brown in color and soft in consistency

What symptoms suggest benign prostatic hypertrophy?

difficulty initiating urination and weak stream

Foods that may be beneficial to reduce the risk for colon cancer include:

foods high in fiber

What is true regarding the bullbourethral gland?

it can be palpated during an examination of a male patient

best description of the anal canal

outlet of the gastrointestinal tract; about 3.8 cm long in the adult

What is the correct technique to assess patency of the anal sphincter?

palpate the anus with a gloved finger to elicit sphincter control

A patient states that he is frequently constipated, and when he has a bowel movement he has rectal bleeding and pain. He does not feel any mass at his anal opening. The examiner completes a rectal examination and explains that:

the symptoms are consistent with internal hemorrhoids