Chapter 25: Assessing the Anus, Rectum, Prostate, and Male Genitalia

Which elements of genital hair should be assessed on inspection? Select all that apply. Abundance Coarseness Color Distribution Presence of parasites

Abundance The abundance of the genital hair should be assessed on inspection. It should be abundant in the genital region and scant on the scrotum. Coarseness The coarseness of the genital hair should be assessed on palpation, not inspection. Color The color of the genital hair should be assessed on inspection. Color may range from dark to gray, depending on the age of the patient. Distribution The distribution of the genital hair should be assessed on inspection. A patient is expected to have genital hair in the pubic region but not on the penis. Presence of parasites The nurse should inspect the genital hair for the presence of parasites.

The "anal wink" is characterized by what reaction when light pressure is applied to the anal opening? Anal bleeding Anal contraction Anal prolapse Anal relaxation

Anal bleeding The "anal wink" is characterized by anal contraction, not bleeding, when the examiner lightly touches the anal opening. Anal contraction When the examiner lightly touches the anal opening, it contracts, producing the "anal wink." Anal prolapse Anal prolapse differs from the "anal wink," which is anal contraction. Anal relaxation The "anal wink" is characterized by anal contraction, not relaxation, when the examiner lightly touches the anal opening.

Identify the structures to palpate during the adult rectal examination. Select all that apply. Anal ring Prostate Rectal wall Sphincter Urethral meatus

Anal ring Prostate Rectal wall Sphincter

How can the examiner determine whether a bulge in the groin is a hernia? Select all that apply. Ask the patient to bear down Ask the patient to take a deep breath Auscultate the femoral area Inspect the abdomen Push contents back into the inguinal canal

Ask the patient to bear down Push contents back into the inguinal canal

The penile shaft should be palpated for which elements? Select all that apply. Color Hair distribution Induration Presence of lice Tenderness

Color Color is assessed on inspection, not palpation. Hair distribution Hair distribution is assessed on inspection, not palpation, and the penile shaft is not expected to have hair. Induration The penile shaft should be palpated for induration, which is an abnormal finding. Presence of lice The penile shaft is not expected to have hair and therefore would not have lice. Tenderness The penile shaft should be palpated for tenderness, which is an abnormal finding.

On examination of the urethral meatus, which elements should be assessed? Select all that apply. Color Discharge Location Orifice size Texture

Color Discharge Location Orifice size

Which elements of the scrotum should the examiner assess on inspection? Select all that apply. Color Presence of cysts Presence of edema Symmetry Texture

Color Presence of cysts Presence of edema Symmetry

When assessing the sphincter, which elements should be evaluated? Color Hair Moisture Tone

Color The examiner should not evaluate the color of the sphincter, because the sphincter is palpated, not inspected. Hair The sphincter is a muscle and would not be expected to have hair. Moisture The examiner should not evaluate the moisture of the sphincter, because this is not part of the male genitalia and prostate examination. Tone When assessing the sphincter, the examiner should evaluate the external sphincter tone. A lax sphincter could indicate a neurologic deficit, whereas an extremely tight sphincter may be the result of scarring.

Which elements of the prostate gland should be assessed on palpation? Select all that apply. Consistency Contour Hair texture Movability Tenderness

Consistency The examiner should assess the consistency of the prostate gland on palpation. Rubberiness, bogginess, fluctuant softness, or nodularity is unexpected and may indication a problem. Contour The examiner should assess the contour of the prostate gland on palpation. Hair texture The prostate should not have hair; therefore, the hair texture of the prostate gland should not be assessed. Movability The examiner should assess the movability of the prostate gland on palpation. The prostate is expected to be slightly movable. Tenderness The examiner should assess the tenderness of the prostate gland on palpation. Tenderness is an abnormal finding and may indicate a problem, such as inflammation.

Which elements of the penis should the examiner assess when inspecting the genitalia of a male infant? Select all that apply. Cremasteric reflex Foreskin Prostate Urethra Urinary stream

Cremasteric reflex The presence of cremasteric reflex would be assessed on palpation. Foreskin The foreskin of the infant's penis would be retracted slightly—just enough to assess whether the urethra is visible. Prostate Assessment of the prostate is not part of the assessment of the penis. Urethra The placement of the urethra should be assessed and is expected to be located at the tip of the penis. Urinary stream The urinary stream of the infant should be assessed.

Which age-specific abnormalities should the examiner inspect for when assessing the genitalia of a male infant? Select all that apply. Displaced urethra Hernia Incomplete development Sexual ambiguity Testicular descent

Displaced urethra The examiner should inspect the genitalia of a male infant for urethral placement, which should be ventral to the tip of the glans. Hernia A hernia should be assessed on palpation of male infant genitalia, not inspection. Incomplete development The examiner should inspect the genitalia of a male infant for incomplete development, which may suggest conditions of abnormal testicular development (e.g., Klinefelter syndrome). Sexual ambiguity The examiner should inspect the genitalia of a male infant for sexual ambiguity. An enlarged clitoris (clitoromegaly) may be mistaken for a small penis and should be distinguished. Testicular descent The examiner should palpate, not inspect, the genitalia of a male infant for testicular descent.

Which features should be inspected when assessing the anus? Select all that apply. Fissures Fistulae Hemorrhoids Skin lesions Skin tags Sphincter tone

Fissures Fictulae Hemorrhoids Skin lesions Skin tags

Which elements of the penis should be assessed on palpation? Select all that apply. Color Foreskin retraction Spermatic cord Tenderness Texture

Foreskin retraction Spermatic cord Tenderness Texture

In which area do femoral hernias occur? Fossa ovalis Inguinal canal Penis shaft Scrotum

Fossa ovalis

When evaluating a patient for hernias, which areas should be inspected? Select all that apply. Fossa ovalis Glans penis Inguinal canal Penile shaft Prostate

Fossa ovalis While the patient is straining, the region of the fossa ovalis, or the saphenous opening, should be inspected to assess for femoral hernia. Glans penis Hernias would not be visible on the glans penis; therefore, the examiner should not inspect the penile shaft when evaluating for hernias. Inguinal canal The area of the inguinal canal should be inspected when evaluating for hernias. Penile shaft Hernias would not be visible on the penile shaft; therefore, the examiner should not inspect the penile shaft when evaluating for hernias. Prostate Hernias do not occur in the prostate; therefore, the prostate should not be assessed when evaluating for hernias. Moreover, the prostate is palpated, not inspected.

Where should the examiner insert a gloved finger when checking for a hernia? Glans penis Inguinal canal Prostate Rectum

Glans penis The examiner should not insert a gloved finger into the glans penis to check for a hernia, because hernias do not occur in the penis. Inguinal canal The examiner should insert a gloved finger into the scrotum and carry it up into the inguinal canal to check for a hernia. Prostate The examiner should not insert a gloved finger into the prostate to check for a hernia, because hernias do not occur in the prostate. Rectum The examiner should not insert a gloved finger into the rectum to check for a hernia, because hernias cannot be assessed from the rectum.

A hernia is described as indirect if swelling is identified in which area? Hesselbach triangle Inguinal canal Scrotum Shaft

Inguinal canal

Which elements are included in assessment of the urethral meatus of an infant? Select all that apply. Inspecting the placement of urethra Inspecting the shape of urethral opening Palpating the penile shaft Pressing the glans between the thumb and the forefinger Retracting the foreskin to see the urethra

Inspecting the placement of urethra Inspecting the shape of urethral opening Retracting the foreskin to see urethra

Which components are included in assessment of the anus and rectum in infants? Select all that apply. Insertion of a finger 0.20 in. (0.5 cm) into the rectum to assess patency Inspection of the buttocks for redness or bruising Inspection of the pilonidal area for tufts of hair Lightly touching the anus to assess contraction Palpation of the testes

Inspection of the buttocks for redness or bruising Inspection of the pilonidal area for tufts of hair Lightly touching the anus to assess contraction

Which elements should be assessed when palpating the anal ring? Select all that apply. Color Irregularities Nodules Texture Tone

Irregularities Nodules Texture Tone

How should the adult patient be positioned for a prostate and rectal examination? Select all that apply. Knees to chest Left lateral with hips and knees flexed Lying on the stomach Standing with hips flexed 90 degrees Supine

Knees to chest To begin the prostate and rectal examination, the patient may be positioned knees to chest, allowing the examiner access to the prostate. Left lateral with hips and knees flexed To begin the prostate and rectal examination, the patient may be positioned left lateral with hips and knees flexed, allowing the examiner access to the prostate. Lying on the stomach The patient should not be lying on the stomach to begin a prostate examination, because this position would not facilitate access to the prostate. Standing with hips flexed 90 degrees To begin the prostate and rectal examination, the patient may be positioned with hips flexed and with upper body supported by the table, allowing the examiner access to the prostate. Supine The patient should not be positioned in the supine position to begin a prostate examination, because this position would not facilitate access to the prostate.

In which manner should an infant be positioned when performing a rectal and anal examination? Left lateral Prone Supine With the mother holding the infant

Left lateral The infant should be positioned supine, not in the left lateral position, to assess the anus and rectum. Prone The infant should be positioned supine, not prone, to assess the anus and rectum. Supine The anus and rectum of the infant should be assessed with the infant positioned on his back. Flex the knees and hips on the abdomen with one hand and use the other gloved hand for examination. With the mother holding the infant The infant should be positioned supine to assess the anus and rectum, not with the mother holding the infant.

Which elements of the infant scrotum should the examiner assess? Select all that apply. Moisture Shape Size Symmetry Testicles

Moisture The examiner should not assess the infant scrotum for moisture. Shape The examiner should assess the shape of the scrotum. A full-term baby should have a loose and pendulous scrotum. Size The examiner should assess the size of the scrotum. A full-term baby should have a loose scrotum. Symmetry The scrotum of an infant, including testicles, should be symmetrical. Testicles The examiner should assess for the presence of testicles. If testicles are not palpable, it suggests undescended testicles.

Assessment of the Rectum and Prostate Palpation

Palpate the prostate for the following: Contour Size Consistency Movability Tenderness Protrusion into the rectum Symmetry of lobes Presence of the median sulcus Nodules

The patency of the infant anus can be determined by which type of assessment? Insertion of a finger into the rectum Inspection for rectal prolapse Passage of meconium Rectal inspection

Passage of meconium

Which element of the rectum can be readily identified through bidigital palpation? Fistulae Perianal abscess Prostate Rectal prolapse

Perianal abscess

What is the correct order of the steps for introducing a finger into the rectum? Position the patient with the hips flexed. Wait for the external sphincter to relax. Press the pad of a finger against the anal opening. Slip a fingertip into the anal canal.

Position the patient with the hips flexed. Press the pad of a finger against the anal opening. Wait for the external sphincter to relax. Slip a fingertip into the anal canal.

Which aspect of the prostate gland can be palpated? Anterior wall Floor Lateral wall Posterior wall

Posterior wall

Which structure should the examiner palpate to detect the testicles in an infant? Fossa ovalis Glans penis Inguinal canal Scrotum

Scrotum

Which elements should be noted on palpation when assessing the sacrococcygeal and perianal areas? Mobility Pilonidal dimpling Tenderness Tufts of hair

Tenderness

How can the examiner determine whether a scrotal mass, found on palpation, is filled with fluid or solid? Palpate harder Pierce with a syringe Squeeze the mass Transilluminate the mass

Transilluminate the mass