,26/27 NSG500/NSG 500 EXAM 3 | ADVANCED
HEALTH ASSESSMENT | WILKES | Q +A &
DETAILED RATIONALES
1. During a routine digital rectal examination of an adult male, which position generally
provides good access while allowing the patient to remain relatively comfortable?
A) Left side-lying with hips and knees flexed
B) Supine with legs extended
C) Prone with arms overhead
D) High-Fowler position
Correct Answer: Left side-lying with hips and knees flexed
Rationale: The left lateral position with the hips and knees flexed relaxes the gluteal and
pelvic musculature and provides appropriate access to the anus, rectum, and posterior
surface of the prostate. Standing while leaning forward is another possible examination
position, but the side-lying position is often more comfortable and stable.
2. During digital rectal examination, the examiner palpates the prostate through which
rectal wall?
A) Posterior wall
B) Lateral wall
C) Anterior wall
D) Superior wall
Correct Answer: Anterior wall
Rationale: The prostate lies anterior to the rectum. Inserting the gloved finger and
directing the fingertip anteriorly allows palpation of the gland’s posterior surface through
the anterior rectal wall.
3. Which description is most consistent with a normal prostate on digital rectal
examination?
, A) Hard, irregular, and fixed
B) Boggy, hot, and exquisitely tender
C) Markedly enlarged with absent median sulcus
D) Smooth, firm-rubbery, symmetric, and nontender
Correct Answer: Smooth, firm-rubbery, symmetric, and nontender
Rationale: A normal prostate is generally smooth, rubbery to firm, symmetric, and
nontender, with a palpable median sulcus. Hard nodules raise concern for malignancy,
whereas a boggy tender gland is more suggestive of prostatitis.
4. A digital rectal examination reveals a uniformly enlarged, smooth, rubbery prostate
with reduced prominence of the median sulcus. Which condition is most likely?
A) Acute prostatitis
B) Benign prostatic hyperplasia
C) Prostate abscess
D) Prostate cancer
Correct Answer: Benign prostatic hyperplasia
Rationale: BPH commonly produces smooth, symmetric, non-tender enlargement of the
prostate. As the gland enlarges, the median sulcus may become less distinct. Irregular hard
nodules are more concerning for carcinoma.
5. Which prostate finding most strongly raises concern for malignancy?
A) Mild symmetric enlargement
B) Smooth rubbery consistency
C) Hard irregular nodule
D) Slight urge to void during palpation
Correct Answer: Hard irregular nodule
, Rationale: Prostate cancer may produce a hard, irregular, nodular, asymmetric, or fixed
gland. No single physical finding confirms malignancy, but these findings warrant further
evaluation.
6. A prostate that is hot, boggy, and markedly tender is most consistent with:
A) Benign prostatic hyperplasia
B) Acute prostatitis
C) Normal aging
D) Prostate carcinoma
Correct Answer: Acute prostatitis
Rationale: Acute bacterial prostatitis can cause a swollen, boggy, warm, exquisitely tender
prostate. Vigorous palpation should be avoided because manipulation may increase pain
and can theoretically contribute to bacteremia.
7. Which lower urinary tract symptom is commonly associated with benign prostatic
hyperplasia?
A) Weak urinary stream and hesitancy
B) Hemoptysis
C) Fecal incontinence
D) Pleuritic pain
Correct Answer: Weak urinary stream and hesitancy
Rationale: BPH can obstruct urinary outflow, producing hesitancy, decreased stream
caliber, intermittency, incomplete emptying, nocturia, frequency, and urgency.
8. Which finding most strongly supports rectal prolapse?
A) Small tender perianal skin tag
B) Purple perianal nodule
C) Midline anal fissure
D) Circumferential protrusion of rectal mucosa during straining
HEALTH ASSESSMENT | WILKES | Q +A &
DETAILED RATIONALES
1. During a routine digital rectal examination of an adult male, which position generally
provides good access while allowing the patient to remain relatively comfortable?
A) Left side-lying with hips and knees flexed
B) Supine with legs extended
C) Prone with arms overhead
D) High-Fowler position
Correct Answer: Left side-lying with hips and knees flexed
Rationale: The left lateral position with the hips and knees flexed relaxes the gluteal and
pelvic musculature and provides appropriate access to the anus, rectum, and posterior
surface of the prostate. Standing while leaning forward is another possible examination
position, but the side-lying position is often more comfortable and stable.
2. During digital rectal examination, the examiner palpates the prostate through which
rectal wall?
A) Posterior wall
B) Lateral wall
C) Anterior wall
D) Superior wall
Correct Answer: Anterior wall
Rationale: The prostate lies anterior to the rectum. Inserting the gloved finger and
directing the fingertip anteriorly allows palpation of the gland’s posterior surface through
the anterior rectal wall.
3. Which description is most consistent with a normal prostate on digital rectal
examination?
, A) Hard, irregular, and fixed
B) Boggy, hot, and exquisitely tender
C) Markedly enlarged with absent median sulcus
D) Smooth, firm-rubbery, symmetric, and nontender
Correct Answer: Smooth, firm-rubbery, symmetric, and nontender
Rationale: A normal prostate is generally smooth, rubbery to firm, symmetric, and
nontender, with a palpable median sulcus. Hard nodules raise concern for malignancy,
whereas a boggy tender gland is more suggestive of prostatitis.
4. A digital rectal examination reveals a uniformly enlarged, smooth, rubbery prostate
with reduced prominence of the median sulcus. Which condition is most likely?
A) Acute prostatitis
B) Benign prostatic hyperplasia
C) Prostate abscess
D) Prostate cancer
Correct Answer: Benign prostatic hyperplasia
Rationale: BPH commonly produces smooth, symmetric, non-tender enlargement of the
prostate. As the gland enlarges, the median sulcus may become less distinct. Irregular hard
nodules are more concerning for carcinoma.
5. Which prostate finding most strongly raises concern for malignancy?
A) Mild symmetric enlargement
B) Smooth rubbery consistency
C) Hard irregular nodule
D) Slight urge to void during palpation
Correct Answer: Hard irregular nodule
, Rationale: Prostate cancer may produce a hard, irregular, nodular, asymmetric, or fixed
gland. No single physical finding confirms malignancy, but these findings warrant further
evaluation.
6. A prostate that is hot, boggy, and markedly tender is most consistent with:
A) Benign prostatic hyperplasia
B) Acute prostatitis
C) Normal aging
D) Prostate carcinoma
Correct Answer: Acute prostatitis
Rationale: Acute bacterial prostatitis can cause a swollen, boggy, warm, exquisitely tender
prostate. Vigorous palpation should be avoided because manipulation may increase pain
and can theoretically contribute to bacteremia.
7. Which lower urinary tract symptom is commonly associated with benign prostatic
hyperplasia?
A) Weak urinary stream and hesitancy
B) Hemoptysis
C) Fecal incontinence
D) Pleuritic pain
Correct Answer: Weak urinary stream and hesitancy
Rationale: BPH can obstruct urinary outflow, producing hesitancy, decreased stream
caliber, intermittency, incomplete emptying, nocturia, frequency, and urgency.
8. Which finding most strongly supports rectal prolapse?
A) Small tender perianal skin tag
B) Purple perianal nodule
C) Midline anal fissure
D) Circumferential protrusion of rectal mucosa during straining
