Chapter 26: Assessing Male Genitalia and Rectum

Which client should a nurse recognize has the highest risk to develop prostate cancer? a) 65-year-old Caucasian male whose father had prostate cancer at age 55 b) 70-year-old Asian male who is not circumcised and eat a low fat diet c) 60-year-old male who works in a tire and rubber manufacturing plant d) 35-year-old African American male with a diet high in fat

a) 65-year-old Caucasian male whose father had prostate cancer at age 55 Age, African American race, and having a bother or father who was diagnosed with prostate cancer before the age of 60 are the greatest risk factors. Therefore, the older male with a first-degree relative has the highest risk.

A nurse is assessing a client who is uncircumcised. The nurse understands that this client is at greater risk for which of the following conditions? Select all that apply. a) Cancer of the glans penis b) Colorectal cancer c) Prostate cancer d) Testicular cancer e) HIV/AIDS

a) Cancer of the glans penis, e) HIV/AIDS Cancer of the glans penis occurs primarily in uncircumcised men. Also, being uncircumcised is a risk factor for HIV/AIDS in sexually active men. There is no association between lack of circumcision and prostate, testicular, or colorectal cancers.

A nurse examines the external genitalia of a client and observes that the scrotum is underdeveloped and the testis cannot be palpated. How should the nurse document this condition? a) Cryptorchidism b) Orchitis c) Epididymitis d) Hydrocele

a) Cryptorchidism The nurse should document this condition as cryptorchidism, a condition in which the scrotum appears underdeveloped and the testis cannot be palpated. Cryptorchidism is the failure of one or both testicles to descend into the scrotum. Orchitis is the inflammation of the testes, associated frequently with mumps; the scrotum appears enlarged and reddened. Epididymitis is an infection of the epididymis; the scrotum appears enlarged, reddened, and swollen, and a tender epididymis is palpated. Hydrocele appears as a swelling in the scrotum and is usually painless.

When assessing a client during the physical examination of the genitalia, the nurse palpates the scrotal contents. Which finding should the nurse recognize as an indication that a varicocele is present? a) Palpable and tortuous veins b) Beaded or thickened cord c) Left testicle is slightly lower than the right d) Smooth, nontender cord

a) Palpable and tortuous veins The presence of palpable and tortuous veins indicates varicocele. A beaded or thickened cord indicates infection or cysts. A smooth, nontender, and ropelike cord is a normal finding. In most men, one testicle hangs lower than the other in 65% of males, the left hangs lower than the right.

During the physical assessment of a client's genitalia, the nurse notes an abnormal mass or swelling. The nurse performs transillumination by shining a light from the back of the scrotum through the mass. In which condition should the nurse see a red glow? a) Spermatocele b) Varicocele c) Hernia d) Tumor

a) Spermatocele When transilluminating the scrotal contents, a red glow is seen in swellings or masses that contain serous fluid such as spermatocele and hydrocele. Swellings or masses such as tumors, hernias, and varicocele that are solid or filled with blood do not light up with a red glow.

On inspection of a client's penis, the nurse observes a small, silvery-white papule. Which of the following conditions should the nurse suspect in this client? a) Syphilitic chancre b) Cancer of the glans penis c) Herpes progenitalis d) Hypospadias

a) Syphilitic chancre Syphilitic chancre initially is a small, silvery-white papule that develops a red, oval ulceration. Herpes progenitalis is characterized by clusters of pimple-like, clear vesicles that erupt and become ulcers. Cancer of the glans penis appears as a hardened nodule or ulcer on the glans. Hypospadias is a condition in which the urethral meatus is located underneath the glans (ventral side).

After discovering an abnormal mass in the scrotum, a nurse performs transillumination of the client's testicles and observes no red glow within the scrotal sac. The nurse recognizes that this client may be experiencing what type of condition? a) Testicular tumor b) Hydrocele c) Spermatocele d) Testicular torsion

a) Testicular tumor A testicular tumor will not transilluminate when a light is shined from the back of the scrotum. A hydrocele or a spermatocele will transilluminate because it is a collection of fluid in the scrotum. Testicular torsion is a very painful condition that is caused by twisting of the spermatic cord and is a medical emergency; it does not involve an abnormal mass.

During the physical examination of the genitalia for an uncircumcised client, the nurse asks the client to retract foreskin of the penis. The nurse observes that the foreskin is tight and cannot be retracted. How should the nurse document this condition? a. phimosis b. hypospadias c. paraphimosis d. epispadias

a. Phimosis This condition should be documented as phimosis; wherein, the client's foreskin is so tight that it cannot be retracted. A foreskin that once retracted and can not be returned to cover the glans is called paraphimosis. Epispadias is the displacement of the urinary meatus to the dorsal surface of the penis. Hypospadias is the displacement of the urinary meatus to the ventral surface of the penis.

How should a nurse proceed with palpation of the anus to best facilitate the exam without causing the client undo discomfort? a) Use the fingertips of one hand because they are the smallest part of the finger b) Ask the client to bear down and place the lubricated finger on the anal opening c) Spread the gluteal folds with the hands and attempt to visualize the anal opening d) Use gentle but firm force to push past the sphincter into the anal canal

b) Ask the client to bear down and place the lubricated finger on the anal opening The nurse should lubricate the index finger of the gloved hand and ask the client to bear down. As the client bears down, place the pad of the index finger on the anal opening. When the sphincter relaxes, insert the finger with the pad facing down. Do not use the fingertip because this may cause the sphincter to tighten and this will cause pain when placed into the rectum. Spread the gluteal folds with the hands and attempt to visualize the anal opening is necessary if the client reports severe pain in order to see if there is a lesion present.

A 55-year-old client presents to the health care clinic with reports of decreased bowel movements with the passing of hard, dry stool for the past 2 weeks. The client states that he has noticed a small amount of bleeding from the rectum and on the stool. He states he has had trouble with his bowels all his adult life. He admits to drinking a lot of coffee and works in a high-stress job. The nurse observes a large external hemorrhoid upon examination of the anus. Which nursing diagnoses can be confirmed with this data? Select all that apply. a) Risk for Impaired Skin Integrity b) Constipation c) Acute pain d) Readiness for Enhanced Bowel Elimination e) Ineffective Health Maintenance

b) Constipation, e) Ineffective Health Maintenance, a) Risk for Impaired Skin Integrity Constipation can be confirmed because of the decrease in bowel elimination and the passage of hard, dry stools, as can Ineffective Health Maintenance related to insufficient knowledge of stress-reducing behaviors. Risk for Impaired Skin Integrity related to the presence of a large hemorrhoid, which could cause irritation and skin breakdown if it became thrombosed, may also be confirmed. There is no indication of acute pain or Readiness for Enhanced Bowel Elimination.

A nurse examining a client's external genitalia notices that his scrotum and testes draw up and he shivers. This phenomenon is known as which of the following? a) Vasovagal reflex b) Cremasteric reflex c) Rooting reflex d) Patellar reflex

b) Cremasteric reflex The scrotum can maintain temperature control because the cremaster muscle is sensitive to changes in temperature. The muscle contracts when too cold, raising the scrotum and testes upward toward the body for warmth (cremasteric reflex). This accounts for the wrinkled appearance of the scrotal skin. The patellar reflex occurs when a physician strikes the patellar tendon of the knee and the leg jerks. The rooting reflex occurs in infants when they turn their heads toward anything that strokes the cheek or mouth. The vasovagal reflex is a contraction of muscles in the gastrointestinal tract in response to distension of the tract following consumption of food and drink.

A male in college presents to the health clinic with complaints of fever, malaise, and swelling of the sides of the neck. A blood test confirms the presence of mumps. The nurse should educate the client to report which changes of his genitalia to the health care provider? a) Red rash on the penis b) Feelings of heaviness and pain in the scrotum c) Clear vesicles that erupt from ulcers d) Silvery lesion on the glans

b) Feelings of heaviness and pain in the scrotum Mumps may cause the onset of orchitis in males, which presents as a heaviness and swelling of the scrotum. The other symptoms listed are not associated with mumps, but with other conditions.

A client reports the new onset of mucous in the stool. How should the nurse document this in the client's history? a) Change in bowel habits b) Steatorrhea c) Fecal incontinence d) Diarrhea

b) Steatorrhea The proper term for mucus in the stool is steatorrhea, which indicates the presence of excessive fat in the stool. Diarrhea is an increase in the frequency of loose stool. Change in bowel habits is not specific to the problem the client reported. Fecal incontinence is the inappropriate release or inability to control the bowels.

During the assessment of a client, the nurse recognizes that which of the client's lifestyle practices may predispose to the development of an inguinal hernia? a) Exposure to radiation b) Strenuous activity c) Erectile dysfunction d) Stress and inhibition

b) Strenuous activity Strenuous activity and heavy lifting may predispose a client to the development of an inguinal hernia. Exposure to radiation and certain chemicals increases the risk of developing cancer. Erectile dysfunction occurs frequently in adult males and may be attributed to various factors, some of which include the use of alcohol, diabetes, or depression. Fear can cause stress and inhibition and decrease sexual satisfaction.

A nurse is performing palpation of a client's prostate gland. Which of the following indicates proper procedure? a) Turn the hand fully clockwise so that the tip of the index finger faces the client's umbilicus b) Turn the hand fully counterclockwise so that the pad of the index finger faces the client's umbilicus c) Turn the hand fully counterclockwise so that the pad of the finger faces the client's side d) Turn the hand fully clockwise so that the tip of the finger faces the client's lumbar region

b) Turn the hand fully counterclockwise so that the pad of the index finger faces the client's umbilicus The prostate can be palpated on the anterior surface of the rectum by turning the hand fully counterclockwise so that the pad of the index finger faces toward the client's umbilicus

On palpating a client's scrotum and testes, the nurse notes that the testes appear to be of normal shape and size. Which of the following would indicate a normal length for testes? a) 6 cm b) 3 cm c) 4.5 cm d) 1.5 cm

c) 4.5 cm Testes are ovoid, approximately 3.5 to 5 cm long, 2.5 cm wide, and 2.5 cm deep, and equal bilaterally in size and shape.

A client is concerned about his risk for developing testicular cancer. Which of the following should the nurse mention as a risk factor for this type of cancer? a) Being uncircumcised b) Smoking c) Cryptorchidism d) Sedentary lifestyle

c) Cryptorchidism Cryptorchidism increases the risk of testicular cancer. Being uncircumcised increases the risk for cancer of the glans penis, but not testicular cancer. A sedentary lifestyle increases the risk for colorectal cancer, not testicular cancer. Smoking is not associated with an increased risk for testicular cance

A male client presents to the health care clinic with reports of pain with ejaculation. The nurse should be prepared to inspect which part of the anatomy to determine the likely cause of the client's pain? a) Prostate b) Urethral meatus c) Epididymis d) Glans penis

c) Epididymis Painful ejaculation is often a sign of infection or inflammation within the epididymis. The prostate, if enlarged, may cause difficulty with urination. A discharge from the urethral meatus may be present with an infection. The glans penis is the base of the penis, where the urethral opening is located.

Upon inspection of the glans, a nurse observes the urethral opening present on the dorsal side of the penis. How should the nurse document this finding? a) Hydrocele b) Hypospadias c) Epispadias d) Normal variation

c) Epispadias Epispadias is the displacement of the urinary meatus to the dorsal (top) of the glans penis. Hypospadias is the displacement of the urinary meatus to the ventral (bottom) of the glans penis. A hyrocele is a collection of fluid in the scrotum, outside the tunica vaginalis.

A nurse examines the anal area of a client and observes the presence of a varicose vein. How should the nurse document this finding? a) Perianal abscess b) Anorectal fistula c) External hemorrhoid d) Anal fissure

c) External hemorrhoid Hemorrhoids are usually painless papules caused by varicose veins, either external or internal. If the hemorrhoid becomes thrombosed is can become painful and swollen. A perianal abscess is a cavity of pus caused by infection in the skin around the anal opening. An anal fissure is a split in the tissue of the anal canal caused by trauma. An anorectal fistula is a small, round opening in the skin that surrounds the anal opening. It suggests an inflammatory tract from the anus or rectum out to the skin.

Which position should a nurse assist a client to assume to ensure comfort during the examination of the anus, rectum, and prostate of a male client? a) Lithotomy b) Knee-chest c) Left lateral d) Standing

c) Left lateral The most frequently used position for examination of the anus, rectum, and prostate is the left lateral as it is usually more comfortable for the client. Besides, this position allows adequate inspection and palpation of the anus, rectum, and prostate. The client's torso and legs should be draped during the examination to lessen the feeling of vulnerability. Lithotomy position is logical for the female client who is already in that position for the vaginal examination. In the knee-chest position the client stands and bends over the table. Some examiners find it easy to examine the client when the client is standing and bending over the examination table with his hips flexed, this position may not be comfortable for all clients.

A nurse recognizes that which finding is normal upon palpation of the prostate? a) Swollen and tender b) Hard, fixed, irregular nodules c) Nontender and rubbery d) Enlarged, smooth, firm, slightly elastic

c) Nontender and rubbery The prostate is normally nontender and rubbery. A swollen and tender prostate may indicate acute prostatitis. An enlarged smooth, firm, slightly elastic prostate that may not have a median sulcus suggests benign prostatic hypertrophy. A hard area on the prostate or hard, fixed, irregular nodules on the prostate suggest cancer.

On inspecting a client's external genitalia, a nurse notes that he is uncircumcised. This means that which of the following covers the glans of the penis? a) Corpus cavernosa b) Corpus spongiosum c) Prepuce d) Urethral meatus

c) Prepuce If the man has not been circumcised, a hood-like fold of skin called the foreskin, or prepuce, covers the glans. In the center of the corpus spongiosum is the urethra, which travels through the shaft and opens as a slit at the tip of the glans as the urethral meatus. The shaft of the penis is composed of three cylindrical masses of vascular erectile tissue that are bound together by fibrous tissue—two corpora cavernosa on the dorsal side and the corpus spongiosum on the ventral side.

A nurse prepares a male client for a physical assessment of the external genitalia. Which instruction is appropriate for the nurse to give the client before the examination? a) Ask the client to not empty the bladder before the examination b) Explain that he may need to lie supine c) Reassure him that it is not unusual to have an erection during the examination d) Request that the client avoid talking

c) Reassure him that it is not unusual to have an erection during the examination The nurse should reassure the client that it is not unusual to have an erection during the examination; this will avoid unnecessary embarrassment in the client. The nurse should ask the client to empty the bladder before the examination so that he will be comfortable during the examination. The client should be informed that he may need to stand for most of the examination. The nurse should encourage the client to ask questions during the examination, and, at the same time, ease the client's anxiety by explaining in detail the significance of each portion of the examination.

A nurse educates a young male client on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Which of the following should the nurse identify as potential risk factors? Select all that apply. a) Mixing of sex and alcohol or drugs b) Previous treatment for a sexually transmitted disease c) Sharing intravenous needles d) Using water-based lubricant with latex-based condoms e) Indulging in anal intercourse with men

c) Sharing intravenous needles, a) Mixing of sex and alcohol or drugs, e) Indulging in anal intercourse with men The nurse should tell the client that using intravenous drugs by sharing needles, mixing sex and alcohol or drugs, and indulging in anal intercourse with men are potential risk factors for HIV/AIDS. A water-based lubricant is the only lubricant that should be used with a condom. Oil-based or petroleum-based lubricants can weaken the condom, causing it to tear. The presence of a sexually transmitted disease is a risk factor, but having one previously that was treated is not.

How should a nurse ask a client to position himself to best facilitate palpation of the left inguinal hernia and inguinal nodes? a) Side lying with the left leg slightly raised b) Bend the left leg and place it on a stool to expose the inguinal canal c) Stand with the weight shifted to the right leg d) Stand with the weight evenly distributed and knees relaxed

c) Stand with the weight shifted to the right leg To facilitate examination of the left inguinal canal and the inguinal nodes, the nurse should instruct the client to shift the weight to the right leg. This relaxes the inguinal area and facilitates palpation of the inguinal canal through the spermatic cord.

What information should nurse include in the teaching plan for a client considering a vasectomy? a) increases the amount of ejaculate b) protects from sexually transmitted infection c) offers permanent birth control d) May causes urinary incontinenc

c) offers permanent birth control Vasectomy is a method of permanent birth control which results in decreased, not increased, amounts of ejaculate. Vasectomy offers no protection from sexually transmitted infections (STIs). Prostatectomy, not vasectomy, causes urinary incontinence.

A nurse observes that the mucosa of the rectum and the rectal wall of a female client protrudes out through the anal opening. It appears as a red, doughnut-like mass with radiating folds. How should the nurse document this condition of the rectum? a) cancer b) shelf c) prolapse d) Rectal polyps

c) prolapse The nurse should document this condition as rectal prolapse. Soft structures like nodules that may be present in the muscular anal ring are called rectal polyps. They are rather common and occur in varying size and number. If cancer metastasizes to the peritoneal cavity, it may be felt as a nodular, hard, shelf-like structure called rectal shelf that protrudes onto the anterior surface of the rectum in the area of the rectouterine pouch in women. Rectal cancer may feel like a firm nodule, an ulcerated nodule with rolled edges, or, as it grows, a large, irregularly shaped, fixed, hard nodul

A client asks the nurse when a colonoscopy is recommended. Which advise by the nurse provides the most appropriate advice? a) "A colonoscopy should be done every year starting at age 65" b) "Either a fecal occult blood test or a colonoscopy is acceptable" c) "Your doctor will decide what schedule is best for you" d) "A flexible sigmoidoscopy should be done every five years starting at age 50"

d) "A flexible sigmoidoscopy should be done every five years starting at age 50" Beginning at age 50, men and women should have a fecal occult blood test or a flexible sigmoidoscopy every five (5) years. Both of these are preferred over either one separately. All screening should start at age 50, not 60 years of age. Health care providers should adhere to the screening guidelines not make their own decisions.

During the physical assessment of the anus for a client, the nurse observes a small opening in the skin that surrounds the anal opening. How should the nurse document this finding? a) Anal fissure b) Perianal abscess c) Pinworm infection d) Anorectal fistula

d) Anorectal fistula A small opening in the skin that surrounds the anal opening is indicative of an anorectal fistula. Perianal abscess is a painful mass that appears red and hard. Redness and excoriation may occur from scratching an area infected with fungi or pinworms. A swollen skin tag on the anal margin may indicate an anal fissure.

A 55-year-old male presents to the health care clinic with reports of difficulty starting the urine stream, dribbling frequently, and getting up several times a night to urinate. He has decreased his fluid intake to try to control the nighttime urination. The nurse assesses a temperature of 101.5°F oral, dry skin and mucous membranes, and suprapubic tenderness. Which nursing diagnosis can the nurse confirm from this data? a) Readiness for Enhanced Self-Health Management b) Ineffective Health Maintenance c) Sexual Dysfunction d) Disturbed Sleep Pattern

d) Disturbed Sleep Pattern The nursing diagnosis of Disturbed Sleep Patterns related to frequent awakenings and frequent voiding meets the major defining characteristics for this nursing diagnosis. There is no evidence to support diagnoses of Sexual Dysfunction, Readiness for Enhanced Self-Health Management, or Ineffective Health Maintenance

A client presents to the health care clinic with reports of black stool. The client denies the ingestion of iron supplements or taking Pepto-Bismol. The nurse recognizes that the black stools could be an indication of what disease process? a) Lack of bile pigment b) Cancer of the colon c) Increased fat content d) Gastrointestinal bleeding

d) Gastrointestinal bleeding Black stools may indicate gastrointestinal bleeding in this client who has not been receiving iron supplements or taking Pepto-Bismol. Clay-colored stool results from the lack of bile pigment. Yellow stool suggests increased fat content or steatorrhea. Cancer of the rectum or colon may be indicated by blood detected in the stool.

During a health assessment interview, a nurse learns that the client has a family history of colorectal cancer. What information should the nurse give the client about reducing the risk for colorectal cancer? Select all that apply. a) Consume foods with adequate folic acid b) Limit exposure to cadmium and sheet metal work c) Avoid taking vitamin A supplements d) Get regular exercise for at least 30 minutes every day e) Fecal occult blood test (FOBT) should be done yearly

d) Get regular exercise for at least 30 minutes every day, e) Fecal occult blood test (FOBT) should be done yearly, a) Consume foods with adequate folic acid The nurse should ask the client to get regular exercise for at least 30 minutes every day, have a fecal occult blood test (FOBT) every year, and include foods with adequate folic acid in the diet. The nurse informs clients who are likely to have prostate cancer to limit exposure to cadmium and sheet metal work and to avoid taking vitamin A supplements.

What documentation in a client's history should a nurse recognize as an indication that the client has a normal prostate? a) Rubbery with two lobes, left slightly larger than the right b) Nontender, firm, and slightly tender to palpation c) Slightly tender to palpation but smooth and rubbery d) Heart-shaped, smooth, with two distinct lobes

d) Heart-shaped, smooth, with two distinct lobes The normal prostate should be nontender and rubbery. Two lobes are divided by a median sulcus. The lobes are smooth, 2.5 cm long, and heart-shaped.

When performing the physical assessment of a client, the nurse notes the presence of a small cyst that contains hair, which is located midline in the sacrococcygeal area and has a palpable sinus tract. How should the nurse document this finding? a) Perianal abscess b) Anal fissure c) External hemorrhoid d) Pilonidal cyst

d) Pilonidal cyst A pilonidal cyst is a congenital disorder characterized by a small dimple or cyst/sinus that contains hair. External hemorrhoids are usually painless papules below the anorectal junction, caused by varicose veins. Anal fissures are splits in the tissue of the anal canal caused by trauma. Perianal abscess is a cavity of pus, caused by infection in the skin around the anal opening.

Upon inspection and palpation of the scrotum, the nurse discovers a mass. The nurse asks the client to lie down, and the bulge remains. On auscultation, the nurse finds bowel sounds. The nurse should document this finding as which type of hernia? a) Incarcerated b) Femoral c) Strangulated d) Scrotal

d) Scrotal The nurse should document this finding as scrotal hernia if the bulge remains when the client lies down and bowel sounds can be auscultated over it. If the mass in the scrotum cannot be pushed into the abdomen, it could be an incarcerated hernia. A hernia is strangulated if the blood supply is cut off. A bulge or mass on the front of the thigh in the femoral canal area is a femoral hernia

How should the testis feel to the nurse's fingers when performing palpation of the scrotal contents? Select all that apply. a) Firm b) Soft c) Hard d) Smooth e) Left larger than right f) Rubbery

d) Smooth, a) Firm, f) Rubbery The testis should feel smooth, firm, rubbery, mobile, free of nodules, and rather tender to palpation. A hard testicle may be a sign of testicular cancer. The left side of the scrotal sac hangs lower than the right, but the testicles are equal in size.

What care should a nurse take when performing the hands-on assessment of the anus, rectum, and prostate? Select all that apply. a) Examine the genitalia after examining the anus, rectum, and prostate b) Examine the upper rectum and sigmoid using the finger c) Use gentle movements with the finger and ensure adequate lubrication d) Listen and watch for signs of discomfort and tensing muscles e) Explain each step of the examination and encourage the client to relax

e) Explain each step of the examination and encourage the client to relax, c) Use gentle movements with the finger and ensure adequate lubrication, d) Listen and watch for signs of discomfort and tensing muscles The nurse should explain each step of the examination and encourage the client to relax, use gentle movements with the finger and ensure adequate lubrication, and listen and watch for signs of discomfort and tensing muscles. It is important for the nurse to ensure that the client is comfortable at all times during the examination. It is best to examine the anus, rectum, and prostate at the end of the genitalia examination. The examiner will be able to examine the rectum only up to a certain point using the finger; if an examination of the upper rectum and sigmoid colon is necessary, a proctosigmoidoscopy should be performed.