ATI Health Assess 2.0: Rectum and Genitourinary

A nurse is providing teaching about the prevention of sexually transmitted infections (STIs) to a 19 year old client who is sexually active and reports having multiple partners. Which of the following client responses demonstrates an understanding of the teaching? a.) I should plan on getting tested each year for sexually transmitted infections b.) Taking my birth control pills will prevent me from getting an infection c.) Because I am at a low risk for HIV, I only need to get tested every other year d.) Since I got Hepatitis B vaccine, I am protected from sexually transmitted infections.

- "I should plan on getting tested each year for sexually transmitted infections." It is recommended that all sexually active females who are under the age of 25 receive a yearly screening for chlamydia, gonorrhea, and syphilis infections. - "Taking my birth control pills daily will prevent me from getting an infection." Birth control pills will not prevent the exchange of bodily fluids, which can lead to the transmission of an STI. Condoms provide a physical barrier and prevent the transmission of STIs. - "Because I am at a low risk for HIV, I only need to get tested every other year." It is recommended that clients who have a low risk of contracting HIV/AIDS get tested at least once as part of their routine health care. Clients who are at a high risk should be tested annually. High-risk clients include individuals who have multiple sexual partners, men who have sex with men, past or present use of injectable substances, and clients whose sexual partners have HIV, are bisexual, or have a history of using injectable substances. - "Since I got the Hepatitis B vaccine, I am protected from sexually transmitted infections." Hepatitis B is a viral infection that can be spread through contact with blood, semen, and bodily fluids. While the vaccine can prevent development of the infection if exposed to the virus, it does not provide protection against other STIs.

A nurse is collecting a health history from a client. Which the following client statements requires further investigation? a.) I urinate a lot when I get up int he morning b.) I have a bowel movement every morning after breakfast c.) I have noticed that it burns when I urinate d.) I empty my bladder several times a day

- "I urinate a lot when I get up in the morning." This is an expected response and does not require further investigation. Reports of awakening at night to void would require further investigation. - "I have a bowel movement every morning after breakfast." This is an expected response and does not require further investigation. Reports of constipation, diarrhea, or changes in the color or consistency of the stool would require further investigation. - "I have noticed that it burns when I urinate." A burning sensation when voiding can be an indication of a urinary tract infection (UTI). Other manifestations of a UTI can include an urgent sensation to void and changes in the appearance of the urine, such as blood, cloudiness, or a foul odor. - "I empty my bladder several times a day." This is an expected response and does not require further investigation. Reports of increased frequency or urgency of voiding would require further investigation.

A nurse is providing education to a male client about health promotion screenings. Which of the following information should the nurse include in the teaching? a.) a digital rectal examination can detect enlargement of the prostate gland. b.) the prostate-specific antigen (PSA) test evaluates semen for the presence of cancer cells c.) testicular self-examination should be performed when the client is sitting in a cool environment d.) a client who has an average risk for colorectal cancer should have a colonoscopy every 2 years.

- A digital rectal examination can detect enlargement of the prostate gland. A digital rectal examination can assess the size of the prostate gland and the presence of any tenderness or nodules. - The prostate-specific antigen (PSA) test evaluates semen for the presence of cancer cells. The PSA test is a blood test that detects the presence of a small protein that is produced only in the prostate gland. An elevation of this protein can be due to cancer, infection, noncancerous growth, or recent ejaculation. Clients should be instructed to abstain from ejaculation for 2 days prior to the PSA blood test. - Testicular self-examination should be performed when the client is sitting in a cool environment. Testicular self-examination is best performed when the client is in a standing position and after a warm bath or shower. This allows the scrotal skin to be warm and relaxed to better examine the testicles. - A client who has an average risk for colorectal cancer should have a colonoscopy every 2 years. It is recommended that a colonoscopy be performed once every 10 years, beginning at age 50 for clients who have no manifestations of colorectal cancer and no first-degree relatives who have had colorectal cancer.

A nurse is inserting a urinary catheter for a female adolescent. Which of the following findings should the nurse report to the provider? a.) a membrane at the vaginal opening b.) an area of tenderness on the labia majora c.) lack of pubic hair on the medial thigh d.) labia minora is a darker skin tone than overall coloring

- A membrane at the vaginal opening The hymen is a membrane that can partially occlude the opening of the vagina. The presence of a hymenal membrane is an expected finding and does not need to be reported to the provider. - An area of tenderness on the labia majora A palpable, fluid-filled area with swelling, tenderness, or other manifestations of inflammation on the labia majora could be a Bartholin gland abscess and should be reported to the provider. - Lack of pubic hair on the medial thigh A lack of pubic hair on the medial thigh is an expected finding in an adolescent. This finding does not need to be reported to the provider. - Labia minora is a darker skin tone than overall coloring Darker coloring of the labia minora and the posterior labia majora is an expected finding in a female client. This finding does not need to be reported to the provider.

A nurse is providing a bed bath for an older adult client who is immobile. Which of the following findings should the nurse report to the provider? a.) a pendulous scrotal sac b.) an inability to retract the foreskin c.) sparse pubic hair d.) left testicle is positioned lower than the right one

- A pendulous scrotal sac In an older adult client, it is an expected finding for the scrotal sac to become more pendulous as the testes decrease in size. - An inability to retract the foreskin The prepuce, or foreskin, should be retractable in an uncircumcised male. Phimosis, a narrowed opening of the foreskin, is an unexpected finding and should be reported to the provider. - Sparse pubic hair In an older adult client, it is an expected finding for the pubic hair to become thinner and grayer in color. - Left testicle is positioned lower than the right one This is an expected finding in an older adult client due to the increased length of the left spermatic cord.

A nurse is inspecting a client's rectal area and noted the presence of bulging red tissue that encompasses the entire anal opening. Which of the following should the nurse suspect? a.) anal fissure b.) rectal prolapse c.) external hemorrhoid d.) pilondial sinus

- Anal fissure An anal fissure is a painful tear in the superficial mucosa in the rectal area. Fissures can occur as a result of constipation, trauma, and obesity. - Rectal prolapse A rectal prolapse appears as a moist, red, circular protrusion of the rectal mucus membranes through the anal opening. This can occur due to straining if the client has weak pelvic muscular support. - External hemorrhoid An external hemorrhoid is a dilated vein that is covered in anal skin. They are usually soft and painless unless they become irritated or thrombosed from a lack of blood flow due to a blood clot. When that occurs, the hemorrhoid becomes swollen, painful, and bluish in color. - Pilonidal sinus A pilonidal sinus is an opening along the spinal tract in the sacral or coccyx area. It could contain hair or have an erythemic ring surrounding the opening.

A nurse is providing education to a female client who has expressed a desire to use a natural method of contraception. Which of the following methods should the nurse recommend? (select all that apply) a.) condoms b.) withdrawal c.) fertility track with periodic abstinence d.) spermicidal sponge e.) tubal ligation

- Condoms is incorrect. A condom is a barrier method of contraception and also protects against the transmission of sexually transmitted infections. - Withdrawal is correct. Withdrawing the penis from the vagina prior to ejaculation is considered a natural method of contraception. - Fertility tracking with periodic abstinence is correct. Fertility tracking involves an understanding of the reproductive cycle and monitoring for subtle clues that are present during fertile times. This is a natural method of contraception. - Spermicidal sponge is incorrect. A contraceptive sponge containing spermicide is considered a pharmacological method of birth control. - Tubal ligation is incorrect. A tubal ligation is a permanent surgical option of contraception. The procedure involves cutting or tying the fallopian tubes.

A nurse is preparing to assess a client's genitalia. Which of the following actions should the nurse plan to take? a.) ensure the client has a full bladder b.) use a firm, deliberate touch when palpating c.) apply sterile gloves prior to touching the genitalia d.) remove the drape from the lower half of the cleint's body.

- Ensure the client has a full bladder. The client should empty their bladder prior to an examination of the genitalia to decrease discomfort during palpation. - Use a firm, deliberate touch when palpating. The nurse should use a gentle, firm, deliberate touch when palpating a client's genitals. - Apply sterile gloves prior to touching the genitalia. The nurse should apply clean gloves prior to inspecting a client's genitalia. - Remove the drape from the lower half of the client's body. The nurse should expose only the body part that is currently being inspected. Maintaining privacy and keeping other body parts covered during the examination can assist in decreasing the unease that clients often experience when having their genitalia examined.

A nurse is preparing to assess a client for the presence of a hernia. Which of the following areas should nurse plan to inspect? (select all that apply) a.) femoral area b.) inguinal area c.) rectal area d.) length of the shaft e.) the circumference of the glans

- Femoral area is correct. The nurse should inspect the bilateral areas of the femoral canal for the presence of any bulges, swelling, or asymmetry that can indicate the occurrence of a femoral hernia. A femoral hernia occurs when loops of bowel descend through the femoral canal; it can present a surgical emergency. - Inguinal area is correct. The nurse should inspect the bilateral areas below the symphysis pubis, on either side of the penile shaft, for the presence of any bulges, swelling, or asymmetry that can indicate the occurrence of an inguinal hernia. An inguinal hernia occurs when loops of bowel descend through the inguinal canal. - Rectal area is incorrect. This is not an area the nurse should inspect for a hernia. A hernia occurs when loops of bowel descend through the femoral or inguinal canals. - Length of the shaft is incorrect. This is not an area the nurse should inspect for a hernia. - The circumference of the glans is incorrect. This is not an area the nurse should inspect for a hernia.

A nurse is caring for a male client who reports the presence of yellow discharge from the meatus and burning with urination. Which of the following infections should the nurse suspect? a.) Human papillomavirus (HPV) b.) Urinary tract infection (UTI) c.) Syphillis d.) gonorrhea

- Human papillomavirus (HPV) An HPV infection will cause the development of genital warts. They present as painless, soft, fleshy growths on the penile shaft or at the base of the glans. - Urinary tract infection (UTI) Manifestations of a UTI include dysuria, frequency, urgency, and suprapubic pain. If untreated, fever and hematuria can occur. There is no meatus discharge associated with a UTI. - Syphilis A syphilis infection presents as a single small ulceration on the penis. While it begins as a papule, it then changes to become an ulcerated area with yellow serous drainage. - Gonorrhea The reported manifestation of yellow discharge from the meatus and dysuria are associated with a gonorrhea infection. The edges of the meatus can also appear inflamed and edematous.

A nurse is caring for an older adult client who has an enlarged prostate and reports difficulty voiding. Which of the following actions should the nurse take? (select all that apply) a.) perform a bladder scan within 60 minutes of the client voiding b.) ensure that the client's intake is significantly greater than output c.) inspect the client's suprapubic area for distention d.) notify the provider if the bladder scan residual volume is greater than 100ml e.) ask the client if they are experiencing pain or a burning sensation when voiding

- Perform a bladder scan within 60 min of the client voiding is incorrect. A bladder scan should be performed within 5 to 15 min of the client voiding to determine the amount of urine left after the client empties their bladder. - Ensure that the client's intake is significantly greater than output is incorrect. Urine output is an indicator of kidney and bladder function, as well as fluid and electrolyte balance. A urine output that is significantly less than the client's intake requires further investigation. - Inspect the client's suprapubic area for distention is correct. Clients who have an enlarged prostate can experience difficulty or an inability to pass urine due to an obstruction at the bladder outlet. A full bladder can be noted by inspecting the suprapubic area for distention and when the client reports lower abdominal discomfort. - Notify the provider if the bladder scan residual volume is greater than 100 mL is correct. A post-void residual is expected to be less than 100 mL. The nurse should notify the provider if the volume is greater than 100 mL. - Ask the client if they are experiencing pain or a burning sensation when voiding is correct. Clients who have difficulty emptying their bladder can develop a urinary tract infection (UTI) due to urinary stasis. Manifestations of a UTI can include a burning sensation when voiding, frequent voiding of small volumes, urgency, suprapubic pain, fever, and bloody urine.

A nurse is preparing to assist the provider with an assessment of a female client's genitourinary system. Which of the following actions should the nurse plan to take? a.) position the client supine with the head of the bed elevated b.) avoid conversation while the provider is performing the assessment c.) instruct the client to position their knees inward d.) position the client's arms above their head

- Position the client supine with the head of the bed elevated. The client should be positioned supine with the head of the bed elevated 45° or with their head on a pillow so that the provider can maintain eye contact with the client throughout the examination. - Avoid conversation while the provider is performing the assessment. Communicating with the client throughout the examination helps to establish a dialogue and can decrease the client's level of unease during the procedure. Each step of the examination should be explained to the client prior to proceeding. - Instruct the client to position their knees inward. The client should be positioned with their thighs flexed and abducted so that the provider can inspect and perform the internal assessment. - Position the client's arms above their head. The client should be positioned with their arms at their sides or folded across their chest. Placing the client's arms above their head will tighten the abdominal muscles and affect the examination.

A nurse is conducting a healthy interview with a client about their urinary system. The nurse should recognize that which of the following client reports could indicate the presence of declining kidney function? (select all that apply) a.) recent weight gain b.) hematuria c.) shortness of breath d.) swelling in the ankles e.) difficulty starting a urine system

- Recent weight gain is correct. If kidney function declines, the body is less able to excrete fluid, leading to extracellular volume overload. This alteration in fluid balance can result in weight gain, edema, and shortness of breath. - Hematuria is incorrect. The presence of blood in the urine is associated with cancer of the bladder or prostate, or an infection in the kidneys or bladder. Hematuria is not associated with kidney failure. - Shortness of breath is correct. If kidney function declines, the body is less able to excrete fluid, leading to extracellular volume overload. This alteration in fluid balance can result in weight gain, edema, and shortness of breath. - Swelling in the ankles is correct. If kidney function declines, the body is less able to excrete fluid, leading to extracellular volume overload. This alteration in fluid balance can result in weight gain, edema, and shortness of breath. - Difficulty starting a urine stream is incorrect. Difficulty initiating a urine stream is associated with an obstruction at the bladder outlet, such as from an enlarged prostate.

A nurse is inspecting the genitalia of an older adult female client. For which of the following findings should the nurse notify the provider? a.) sparse pubic hair b.) atrophy of the mons pubis c.) dry vaginal membranes d.) labial ulcerations

- Sparse pubic hair With menopause, the ovaries stop producing estrogen, which leads to physical changes in the appearance of the reproductive tract. These expected changes include thinning of the pubic hair and atrophy of the mons pubis, labia, and clitoris. As the vaginal lining atrophies, it becomes thinner and drier. - Atrophy of the mons pubis With menopause, the ovaries stop producing estrogen, which leads to physical changes in the appearance of the reproductive tract. These expected changes include thinning of the pubic hair and atrophy of the mons pubis, labia, and clitoris. As the vaginal lining atrophies, it becomes thinner and drier. - Dry vaginal membranes With menopause, the ovaries stop producing estrogen, which leads to physical changes in the appearance of the reproductive tract. These expected changes include thinning of the pubic hair and atrophy of the mons pubis, labia, and clitoris. As the vaginal lining atrophies, it becomes thinner and drier. - Labial ulceration Redness, swelling, or ulcerations in the genital area are always unexpected findings and should be reported to the provider.

A nurse is preparing to assist with a prostate examination. Which of the following actions should the nurse plan to take? a.) supply sterile gloves for the provider b.) provide the supplies for a specimen culture c.) position the client standing, facing the examination table d.) darken the lighting in the room.

- Supply sterile gloves for the provider. The provider should use clean gloves and lubricant when examining a client's prostate gland. - Provide the supplies for a specimen culture. An examination of the prostate is performed by palpating the gland and noting symmetry, size, texture, mobility, and the presence of any tenderness. There is no specimen collection for culture included in this assessment. - Position the client standing, facing the examination table. An ambulatory client can be positioned standing with the examination table supporting their upper body. Alternately, the provider might prefer the client to be positioned on their left side with the hip and knee flexed to stabilize their position and enable adequate visualization of the area. - Darken the lighting in the room. The nurse should ensure that there is adequate lighting to allow the provider to visualize the anus and perianal area.

A nurse is providing education to a young adult about the human papillomavirus (HPV) vaccine. Which of the following information should the nurse include in the teaching? a.) the HPV vaccine is only recommended for female clients b.) an HPV infection can lead to the development of cancer c.) the HPV vaccine should be administered before age 18 to be effective d.) immunization to prevent an HPV infection requires a single injection

- The HPV vaccine is only recommended for female clients. The HPV vaccine is recommended to be administered to all clients beginning between ages 9 to 11 years. - An HPV infection can lead to the development of cancer. HPV infections are associated with the development of genital, rectal, and oropharyngeal cancers. - The HPV vaccine should be administered before age 18 to be effective. Current recommendations for the administration of the HPV vaccine include adults up to age 26 years. However, guidelines are now expanding to include some adults up to age 45. - Immunization to prevent an HPV infection requires a single injection. The HPV vaccine is a series of two or three injections over a 6-month period. Young adolescents only require two injections, while older adolescents and adults require a three-injection series to achieve immunity against the virus.

A nurse is inspecting the genitals of an adult male client. Which of the following should the nurse identify as expected findings? (select all that apply) a.) visible dorsal vein on the underside of the penile shaft b.) bilateral pea-sized (1cm), soft testes c.) Meatus located on the dorsal side of the glans d.) absence of public hair on the penile shaft e.) testes that are easily moveable during palpation

- Visible dorsal vein on the underside of the penile shaft is correct. The dorsal vein might be visible on the penile shaft. This is an expected finding. - Bilateral pea-sized (1 cm), soft testes is incorrect. It is expected that the testes are oval, firm, larger than 3.5 cm in diameter, and the same size bilaterally. Small, soft testes indicate atrophy. This is not an expected finding. - Meatus located on the dorsal side of the glans is incorrect. The meatus, or urethral opening, is expected to be located in the center of the glans. A meatus located on the top of the dorsal side of the glans or penile shaft is termed an epispadias. This is not an expected finding. - Absence of pubic hair on the penile shaft is correct. Pubic hair is expected to be present only at the base of the penis. This is an expected finding. - Testes that are easily movable during palpation is correct. It is an expected finding that the testes are freely movable. Testes that are not movable should be reported to the provider.