Ans to Pass the Exam Advanced
Health Assessment - Wilkes
1. What is the best position for a patient during a routine digital
rectal examination (DRE) for the prostate?
A. Standing, leaning over the exam table.
B. Supine with knees bent.
C. Lithotomy position.
D. Side-lying with hips and knees flexed.
Answer: D. Side-lying with hips and knees flexed.
Rationale: The side-lying (left lateral decubitus) position with hips and
knees flexed (toward the chest) is often preferred as it is comfortable for
the patient, allows relaxation of the gluteal muscles, and provides good
access for the examiner to palpate the posterior surface of the prostate
gland.
,2. A healthy, non-pathological prostate gland on digital rectal
examination (DRE) should feel:
A. Hard, nodular, and fixed.
B. Rubbery, smooth, and round.
C. Soft, boggy, and tender.
D. Firm, irregular, and non-tender.
Answer: B. Rubbery, smooth, and round.
Rationale: A normal prostate gland is described as feeling rubbery,
smooth, and rounded, about 2.5 cm long, and non-tender. Hardness or
nodularity is concerning for malignancy, while a boggy feeling can be
associated with acute prostatitis.
3. Which of the following is an expected symptom of Internal
Hemorrhoids?
A. Profuse, dark, foul-smelling diarrhea.
B. Severe, sudden, and constant pain below the dentate line.
, C. Bright red spot on the toilet paper or in the toilet bowl, not mixed
with stool.
D. Painful, visible perianal mass that increases in size over time.
Answer: C. Bright red spot on the toilet paper or in the toilet bowl,
not mixed with stool.
Rationale: Internal hemorrhoids, especially during or after a bowel
movement, typically present with painless bleeding of bright red blood
(not mixed with stool), as they are located above the dentate line (which
is generally less sensitive to pain). The blood is bright red because the
source is close to the anal opening. Options B and D are more
characteristic of External Hemorrhoids.
4. A patient reports a perianal mass that prolapses during a bowel
movement but then spontaneously reduces (returns inside the anus)
when they relax. This presentation is consistent with which degree of
hemorrhoids?
A. 1st Degree