Ch.27 Prep U

The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which of the following statements?

"Alterations in bladder function can only occur when there is incontinence."

A 24 year-old man is currently in a rehabilitation facility following a spinal cord injury at level T2. He is discussing his long term options for continence management. Which of the following statements by the client demonstrates he has a clear understanding of the issue?

"An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications."

A young mother asks,"Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" Which of the following is the nurse's best response?

"Bowel control occurs earlier than bladder control."

A client has bladder distension. Which intervention should the nurse implement?

Assisting the client to urinate

The nursing instructor who is teaching about incontinence in the elderly recognizes a need for further instruction when one of the students makes which of the following statements?

"Frequency is not a major problem for the elderly."

A 63 year-old woman has visited a physician because she has been intermittently passing blood-tinged urine over the last several weeks, and cytology has confirmed a diagnosis of invasive bladder cancer. Which of the following statements by the physician is most accurate?

"It's likely that you'll need surgery; possibly a procedure called a cystectomy." Surgical interventions are common in the treatment of bladder cancer. Effective chemotherapeutic regimens are not yet available, though there are certainly treatment options. The mortality rate of bladder cancer is high, at around 25%.

The client has just been diagnosed with bladder cancer and asks the nurse what causes it. Which of the following would be the nurse's best response to the client?

"The cause is unknown."

A patient has a postvoid residual (PVR) volume of 40 mL. Which of the following information would the nurse teach the patient?

"This is a normal value." The nurse should teach the patient that PVR values under 50 mL indicate that the patient is adequately emptying the bladder and further evaluation is not necessary.

A patient has a postvoid residual (PVR) volume of 250 mL. Which of the following information would the nurse tell the patient?

"This value indicates you are having difficulty emptying your bladder."

A mother asks, "why can't my 1 year old go to the bathroom by himself?" Which of the following is the nurse's best response?

"Your child is too young to begin toilet training."

Which of the following types of pharmacological therapy does the nurse anticipate administering to a patient for treatment of a spastic bladder in order to decrease bladder hyperactivity?

Anticholinergic medications

The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is which of the following?

Bladder

Which physiologic change in the elderly population contributes to urinary incontinence?

Decline in detrusor muscle function

When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition? Their correct reply is the:

Detrusor

While studying about the process of urination, the nursing student learns that which of the following is known as the "muscle of micturition"?

Detrusor muscle

An older male comes to the clinic with the chief complaint of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. Which of the following should the nurse suspect to be the most frequent cause of this client's problem?

Enlargement of prostate gland

Urinary incontinence can be a problem with the elderly. One method of treatment is habit training, or bladder training. When using this treatment with an elderly person, how frequently should he or she be voiding?

Every 2 to 4 hours

A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer?

Gross hematuria

Which of the following assessments indicates to the nurse that a patient may have a spastic bladder dysfunction?

Incontinence A spastic bladder condition causes inability to store urine. Incontinence would be a symptom of inability to store urine.

A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 14 kg overweight. What conclusion can the nurse best draw about the etiology and pathophysiology of his bladder cancer?

It is caused by carcinogens that are excreted in the urine and stored in the bladder.

A 55 year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void, and often has a sudden need to void with little warning during the day. What is the man's most likely diagnosis and possible underlying pathophysiological problem?

Overactive bladder that may result from both neurogenic and myogenic sources.

When teaching a community education class about the 7 warning signs of cancer, the nurse will note that the most common sign of bladder cancer is:

Painless bloody urine.

A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse?

Painless hematuria

A patient is concerned about the possibility of having bladder cancer after his brother was diagnosed with it 2 years ago. Which of the following assessment data obtained by the nurse would indicate that the patient should be screened for this disease?

Patient reports that he occasionally has blood in his urine but has no pain with it.

A nurse is caring for a patient in spinal shock. Which of the following interventions is appropriate in relation to the patient's urinary status?

Perform intermittent catheterization

An 87 year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority?

Performing a physical examination and history to determine the exact cause and character of the incontinence.

A client receives a diagnosis of lower urinary tract obstruction. What intervention should the nurse choose to be the immediate treatment for this problem?

Relief of bladder distention The immediate treatment of lower urinary tract obstruction and stasis is directed toward relief of bladder distention, which is usually accomplished through catheterization. Correcting the problem that is the cause is a long-term treatment. Pain med does not help the problem, nor does bladder training.

What is a common cause of spastic bladder dysfunction?

Spinal cord injury

A client who has a problem with incontinence loses a small amount of urine every time she coughs or sneezes. This type of incontinence is known as which of the following?

Stress

A patient is describing difficulty with urinating and informs the nurse that every time she coughs or laughs, she urinates and has begun to wear a thin pad. Which of the following types of urinary incontinence is the patient describing?

Stress incontinence

Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help:

Stress incontinence

A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises, because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?

Stress incontinence Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.

The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply.

Structural changes in the bladder Structural changes in the urethra Impairment of neurologic control of bladder function

The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer? Select all that apply.

Surgical removal Radiation therapy Chemotherapy

A 61 year-old woman who has had an upper respiratory infection for several weeks has presented to her family physician with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking non-prescription cold medications over and above the suggested dose for the past two weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention?

The anticholinergic effects of the medication are impairing normal bladder function.

An older adult states that he awakens at least three times each night to void. When assessing the client, what potential causative factor should the nurse prioritize?

The client takes his prescribed beta blocker and diuretic each evening at bedtime.

A parent asks the nurse what signs and symptoms a child would display if the child had a urinary tract infection. Which is the best response by the nurse?

They do not present with typical symptoms. Unlike adults, children frequently do not present with the typical signs of a UTI. A urinary tract infection should be suspected when the child presents with a fever that has no other cause. The parents should be educated to report any abnormal colored or cloudy urine because this is also an early indication of a urinary tract infection.

Urinary obstruction in the lower urinary tract triggers changes to the urinary system to compensate for the obstruction. What is an early change the system makes in its effort to cope with an obstruction?

The stretch receptors in the bladder wall become hypersensitive.

The nurse is conducting a health education program on bladder cancer. The nurse teaches that which of the following is the most common type of bladder cancer?

Transitional carcinoma

A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:

Urge incontinence

The nurse understands that medications although very beneficial to clients can also have harmful effects. When working with elderly clients the nurse should recognize which of the following is a common result of potent, fast-acting diuretics?

Urge incontinence

A patient is admitted with lower urinary tract obstruction and stasis. Which of the following is the primary intervention?

Urinary catheterization

Which of the following clinical manifestations would tell a nurse that a patient is having progressive decompensation related to obstruction of urinary outflow?

When tested for residual urine volume, 1400 mL of urine is obtained when patient is catheterized.