Chapter 25, Male Genitourinary System: Assessing the Anus, Rectum, Prostate, and Male Genitalia- Sherpath

Question 1 of 18

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What is the correct order of the steps for introducing a finger into the rectum?

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

To introduce a finger into the rectum, the examiner positions the patient in the flexed-hip position. Next, the examiner presses the pad of a finger against the anal opening. Once the external sphincter relaxes, the examiner slips a fingertip into the anal canal.

Question 2 of 18

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Identify the structures to palpate during the adult rectal examination.

• Correct
  • Anal ringThe anal ring should be palpated for nodules or other irregularities during the rectal examination.
• Correct
  • ProstateThe prostate should be palpated during the rectal examination. The prostate gland should feel small and smooth.
• Correct
  • Rectal wallThe rectal wall should be palpated during the rectal examination to assess for tenderness, nodularity, and masses.
• Correct
  • SphincterThe sphincter should be palpated during the rectal examination. The examiner should note an even tone when asking the patient to tighten the sphincter.
• • Urethral meatusThe urethral meatus should not be palpated as part of the rectal examination.

Question 3 of 18

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Which features should be inspected when assessing the anus?

• Correct
  • FissuresThe anus should be inspected for fissures, which are an abnormal finding.
• Correct
  • FistulaeThe anus should be inspected for fistulae, which are an abnormal finding.
• Correct
  • HemorrhoidsThe anus should be inspected for external hemorrhoids, which are an abnormal finding.
• Correct
  • Skin lesionsThe anus should be inspected for skin lesions, which are abnormal findings and may indicate abuse or a sexually transmitted infection.
• Correct
  • Skin tagsThe anus should be inspected for skin tags, which are abnormal findings.
• • Sphincter toneThe anus should be palpated, not inspected, to assess sphincter tone.

Question 4 of 18

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Which aspect of the prostate gland can be palpated?

• • Anterior wallThe anterior wall of the prostate cannot be palpated, because it is not accessible through the rectum.
• • FloorThe prostate does not have a “floor” to be palpated.
• • Lateral wallThe lateral wall of the prostate cannot be palpated, because it is not accessible through the rectum.
• Correct
  • Posterior wallThe posterior surface of the prostate gland can be palpated through the anterior rectal wall.

Question 5 of 18

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Which elements should be assessed when palpating the anal ring?

• • ColorColor is inspected, not palpated.
• Correct
  • IrregularitiesThe anal ring should be palpated to assess for irregularities, such as masses.
• Correct
  • NodulesThe anal ring should be palpated to assess for nodules, which are an abnormal finding.
• Correct
  • TextureThe anal ring should be palpated to assess texture. The anal ring should feel smooth.
• Correct
  • ToneThe anal ring should be palpated to assess tone. Even pressure should be exerted when asking the patient to tighten the ring.

Question 6 of 18

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Which element of the rectum can be readily identified through bidigital palpation?

• • FistulaeFistulae can be identified as the patient bears down during a rectal examination and do not require bidigital palpation.
• Correct
  • Perianal abscessBidigital palpation is particularly useful for detecting a perianal abscess.
• • ProstateThe prostate is not identified using bidigital palpation.
• • Rectal prolapseRectal prolapse can be identified as the patient bears down during a rectal examination and does not require bidigital palpation.

Question 7 of 18

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Which elements should be noted on palpation when assessing the sacrococcygeal and perianal areas?

• • MobilityThe examiner should palpate the prostate, not the sacrococcygeal and perianal areas, for mobility.
• • Pilonidal dimplingThe examiner should inspect, not palpate, the sacrococcygeal and perianal areas for pilonidal dimpling.
• Correct
  • TendernessOn palpation, the examiner should assess the sacrococcygeal and perianal areas for tenderness, which is an abnormal finding and may indicate a problem such as an abscess, fistula, or cyst.
• • Tufts of hairThe examiner should inspect, not palpate, the sacrococcygeal and perianal areas for tufts of hair.

Question 8 of 18

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The patency of the infant anus can be determined by which type of assessment?

• • Insertion of a finger into the rectumThe patency of the infant anus should be assessed by the passage of meconium, not insertion of a finger into the rectum.
• • Inspection for rectal prolapseThe patency of the infant anus should not be assessed by inspection for rectal prolapse.
• Correct
  • Passage of meconiumThe patency of the infant anus can be assessed by the passage of meconium within the first 24 hours after birth.
• • Rectal inspectionThe patency of the infant anus should be assessed by the passage of meconium, not rectal inspection.

Question 9 of 18

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Which components are included in assessment of the anus and rectum in infants?

• • Insertion of a finger 0.20 in. (0.5 cm) into the rectum to assess patencyAssessment does not include insertion of finger into the rectum. Patency is assessed by passage of the first meconium.
• Correct
  • Inspection of the buttocks for redness or bruisingAssessment includes inspection of the buttocks for disease or trauma.
• Correct
  • Inspection of the pilonidal area for tufts of hairAssessment includes inspection of the pilonidal area for tufts of hair, which may indicate spinal tract deformities.
• Correct
  • Lightly touching the anus to assess contractionAssessment includes lightly touching the anus to elicit contraction of the anus (an “anal wink”).
• • Palpation of the testesPalpation of the testes is part of the male genitalia examination but is not part of assessment of the anus and rectum.

Question 10 of 18

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Which elements of the penis should be assessed on palpation?

• • ColorThe color of the penis should be inspected, not palpated.
• Correct
  • Foreskin retractionThe ability to retract the foreskin in an uncircumcised patient should be assessed when palpating the penis.
• Correct
  • Spermatic cordThe spermatic cord should be rolled beneath the fingers to feel the structure going through the ring when assessing the penis.
• Correct
  • TendernessThe penis should be assessed for tenderness on palpation, which is an unexpected finding and may indicate a problem.
• Correct
  • TextureThe texture of the penis should be evaluated on palpation. The texture of a flaccid penis should be soft.

Question 11 of 18

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On examination of the urethral meatus, which elements should be assessed?

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  • ColorThe color of the urethral meatus should be assessed on examination. A red color may indicate inflammation.
• Correct
  • DischargeThe urethral meatus should be assessed for discharge on examination, which can indicate inflammation. Discharge color and odor should be noted.
• Correct
  • LocationThe location of the urethral meatus should be assessed on examination. The urethra should be ventral to the tip of the glans.
• Correct
  • Orifice sizeThe orifice size of the urethral meatus should be assessed on examination. A pinpoint opening may indicate meatal stenosis.
• • TextureThe texture of the urethral meatus should not be assessed, because this is not relevant to the male genitalia assessment.

Question 12 of 18

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Which elements of the scrotum should the examiner assess on inspection?

• Correct
  • ColorThe color of the scrotum should be assessed on inspection. The scrotum may be deeply pigmented compared with the surrounding skin.
• Correct
  • Presence of cystsThe scrotum should be inspected for the presence of cysts, which are an abnormal finding.
• Correct
  • Presence of edemaThe scrotum should be inspected for the presence of edema, which may cause thickening and pitting of the scrotum.
• Correct
  • SymmetryThe symmetry of the scrotum should be assessed on inspection.
• • TextureThe texture of the scrotum should be assessed on palpation, not inspection.

Question 13 of 18

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How can the examiner determine whether a bulge in the groin is a hernia?

• Correct
  • Ask the patient to bear downBearing down may make the hernia more pronounced, facilitating identification.
• • Ask the patient to take a deep breathDeep breathing will not help identify a hernia.
• • Auscultate the femoral areaThe femoral area should not be auscultated when evaluating a patient for a hernia.
• • Inspect the abdomenInspection may identify a bulge but cannot identify the bulge as a hernia.
• Correct
  • Push contents back into the inguinal canalA hernia bulge should be able to be pushed back into the canal.

Question 14 of 18

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In which area do femoral hernias occur?

• Correct
  • Fossa ovalisFemoral hernias occur at the fossa ovalis, where the femoral artery exits in the abdomen.
• • Inguinal canalAn inguinal hernia, not a femoral hernia, can be identified in the inguinal area.
• • Penis shaftHernias in general do not occur in the penis shaft.
• • ScrotumA scrotal hernia, not a femoral hernia, may occur in the scrotum.

Question 15 of 18

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A hernia is described as indirect if swelling is identified in which area?

• • Hesselbach triangleA hernia is described as direct, not indirect, if a bulge lies in the Hesselbach triangle.
• Correct
  • Inguinal canalA hernia is described as indirect if swelling is identified in the inguinal canal.
• • ScrotumA large hernia, not an indirect hernia, is present in the scrotum.
• • ShaftAn indirect hernia would not be identified on the penile shaft.

Question 16 of 18

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Which structure should the examiner palpate to detect the testicles in an infant?

• • Fossa ovalisThe testes cannot be palpated in the fossa ovalis.
• • Glans penisThe testes cannot be palpated in the glans penis.
• • Inguinal canalA hernia, not the testes, can be palpated in the inguinal canal.
• Correct
  • ScrotumEach side of the scrotum should be palpated to detect the presence of the testes in an infant.

Question 17 of 18

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How can the examiner determine whether a scrotal mass, found on palpation, is filled with fluid or solid?

• • Palpate harderPalpating harder will not help the examiner determine whether a scrotal mass is filled with fluid or solid.
• • Pierce with a syringeThe mass should not be pierced, because this may cause infection.
• • Squeeze the massA scrotal mass found on palpation should not be squeezed.
• Correct
  • Transilluminate the massIf a mass is found in the scrotum on palpation, transillumination should be performed to determine whether the mass is filled with fluid or solid.

Question 18 of 18

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Which elements are included in assessment of the urethral meatus of an infant?

• Correct
  • Inspecting the placement of urethraThe nurse should inspect the placement of the urethral opening.
• Correct
  • Inspecting the shape of urethral openingThe nurse should inspect the shape of the urethral opening.
• • Palpating the penile shaftThe nurse should not palpate the penile shaft to assess the urethral opening in an infant.
• • Pressing the glans between the thumb and the forefingerThe nurse should not press the glans between the thumb and the forefinger to assess the urethral opening in an infant.
• Correct
  • Retracting the foreskin to see the urethraThe nurse should carefully retract the foreskin to visualize the urethra.