Disorders of the bladder and lower urinary tract Ch. 35
A client who has just been diagnosed with a spastic bladder asks the nurse what that means. What would be the nurse's best response? "It is a problem with the amount of urine." "It is a problem with producing urine." "It is a problem with getting rid of urine." "It is a problem with storing urine."
"It is a problem with storing urine." Rationale:Failure to store urine is known as a spastic bladder. It can result from conditions that cause reflex bladder spasm and a decrease in bladder volume.
A client with bladder cancer asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to go for treatments over months and months?" The best response would be: "This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder." "This is when they put the chemotherapy directly into the bladder to kill any cancer cells." "They will take you to radiology and inject some chemotherapy through your abdomen into your bladder." "The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining."
"This is when they put the chemotherapy directly into the bladder to kill any cancer cells." Rationale:Surgical treatment of superficial bladder cancer is often followed by intravesicular chemotherapy or immunotherapy, a procedure in which the therapeutic agent is directly instilled into the bladder. None of the other responses describe this procedure. The chemotherapy drug is not injected through the abdomen into the bladder. Bacillus Calmette-Guérin (BCG) vaccine is instilled into the bladder to elicit an inflammatory response that can kill the tumor. A CyberKnife is used with the brain, not the bladder.
For a normal adult, the client will sense fullness of the bladder when the bladder contains what amount of urine? 300 to 350 mL 100 to 150 mL 400 to 500 mL 200 to 250 mL
400 to 500 mL Rationale:The desire to void occurs when the bladder is full (normal capacity is ~400-500 mL). At this point, a definite sensation of fullness occurs, the pressure rises sharply to 40 to 100 cm H2O, and voiding occurs around the catheter.
Which client is at greatest risk of developing bladder cancer? A 50-year-old white woman with a history of two bladder infections A 40-year-old black male with a history of prostate enlargement A 65-year-old white male with a history of bladder stones A 30-year-old black female with a 2-year history of diabetes
A 65-year-old white male with a history of bladder stones Rationale:Cancer of the bladder is the sixth most common malignancy in the United States, accounting for 7% of cancers in men and 3% of cancers in women. Black Americans have only half the risk of white European Americans. Most cancers appear in older persons and are rare under the age of 50 years. Cigarette smoking is an important risk factor. Other risk factors include the presence of arsenic in the drinking water and industrial exposure to the breakdown products of aromatic amines used in the dye industry, and to chemicals used in the manufacture of rubber, textiles, paint, and petroleum products. Diabetes does not increase the risk factor for the development of bladder cancer.
The nurse is evaluating client risk for the development of overactive bladder/urge incontinence and determines that which client is at highest risk for this condition? A client with diabetes mellitus A client embarrassed to use a bedpan A client with a recent stroke A client whose arthritis makes walking difficult
A client with diabetes mellitus Rationale:Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.
Which statement accurately describes the etiology of stress incontinence? The involuntary release of urine related to a strong sense of urgency An increase in intra-abdominal pressure that results in involuntary urination Overactivity of the voiding reflexes related to the nervous system damage The decrease in smooth muscle of the bladder causing increased urination
An increase in intra-abdominal pressure that results in involuntary urination Rationale:Stress incontinence results in involuntary passage of urine related to increased intra-abdominal pressure with coughing, sneezing, or laughing. The other options refer to the etiology of overactive/urge incontinence.
A client who suffers from spastic bladder has been catheterized to promote bladder emptying. Which medication should the nurse plan on the physician ordering to also treat this problem? Skeletal muscle relaxant Cholinergic Calcium channel blocker Anticholinergic medication
Anticholinergic medication Rationale:Among the methods used to treat spastic bladder are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. A skeletal muscle relaxant is used to decrease the tone of the external sphincter. Calcium channel blockers are used to interfere with influx of calcium to support contraction of detrusor smooth muscle. Cholinergic medication stimulates parasympathetic receptors that cause detrusor contraction.
A client is scheduled for urodynamic studies and asks the nurse, "What exactly is this study going to show related to my voiding problems?" Which nursing response(s) is accurate related to bladder function assessment via urodynamic studies? Select all that apply. Characteristics of urine flow during voiding Intraluminal pressure changes along the entire urethra with the bladder at rest Muscle activity of the external urinary sphincter How fast (milliters/minute) the bladder can empty Pressure changes in the intra-abdominal area
Characteristics of urine flow during voiding, Muscle activity of the external urinary sphincter, Pressure changes in the intra-abdominal area Rationale:Urodynamic studies measure three aspects of bladder function: bladder, urethral, and intra-abdominal pressure changes; characteristics of urine flow; and the activity of the striated muscles of the external spincter and pelvic floor. The urethral pressure profile is used to evaluate the intraluminal pressure changes along the entire urethra with the bladder at rest. A uroflowmetry measures the flow rate (milliters/minute) during urination.
The nurse is conducting preoperative teaching for a client with bladder cancer who is scheduled to undergo surgical creation of an alternative bladder reservoir. The nurse determines that the client is understanding the preoperative teaching when the client identifies the surgical treatment as: Segmental surgical resection Diathermy Cystectomy Endoscopic resection
Cystectomy Rationale:A cystectomy requires the creation of a urinary diversion (reservoir) that collects the urine, and it is usually created from the ileum
Which physiologic change in the elderly population contributes to urinary incontinence? Side effects of medication Decline in detrusor muscle function Increased bladder capacity Increased bladder contractility
Decline in detrusor muscle function Rationale:In the older adult population, overall bladder capacity is reduced as is urethral closing pressure. Changes associated with aging include decline in detrusor muscle function, decrease in bladder contraction, and impairment in bladder emptying. Medications may contribute to incontinence; however, it is not a physiologic change but rather a chemical influence.
A client diagnosed with urinary obstruction exhibits a weak, small urinary stream and hesitancy. The client most likely is experiencing: Spasmodic response Decompensation Early obstruction Compensation
Decompensation Rationale:The signs of urinary decompensation include hesitancy, frequency, need to strain to urinate, a weak, small stream, and termination of the stream before the bladder is completely empty. The compensatory phase is in the early stage of obstruction, and the bladder begins to hypertrophy and becomes hypersensitive to afferent stimuli arising from stretch receptors in the bladder wall. Bladder spasms occur in the early phase of obstruction as a result of the diminished ability to suppress urination.
Which reserve urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure? Urinary vesicle Internal urethra External sphincter Detrusor muscle
External sphincter Rationale:The external sphincter operates as a reserve mechanism to stop micturition when it is occurring and to maintain continence in the face of unusually high bladder pressure. The urinary vesicle is the bladder that holds urine. The detrusor muscle is the muscle of the passage of urine. The internal urethra is a continuation of the detrusor muscle.
A client with a neurogenic bladder has a lesion at the level of sacral reflexes/peripheral nerves that innervate the bladder. The nurse anticipates the client will experience which type of bladder dysfunction? Incorrect optionBladder paralysis dysfunction Correct optionFlaccid bladder dysfunction Unanswered optionDetrusor-sphincter dyssynergia Unanswered optionSpastic bladder dysfunction
Flaccid bladder dysfunction Rationale:Flaccid bladder dysfunction results from lesions at the level of the sacral reflexes or the peripheral nerves that innervate the bladder. Spastic bladder dysfunction usually results from neurologic lesions located above the level of the sacral micturition reflexes. Detrusor sphincter dyssynergia is the presence of lesions that affect the micturition center in the pons or impair communication between the micturition center and spinal cord centers, interrupting the coordinated activity of the detrusor muscle and the external sphincter.
A middle-aged man reports new-onset urinary changes. Which reported change(s) would lead the health care provider to suspect an early stage of obstruction is occurring? Select all that apply. Increase in number of times client urinates throughout the day and night Bright red blood in the urine, especially in the early morning Reports of bladder spasm Constant pain in the back on the right side Diminished ability to suppress urination
Increase in number of times client urinates throughout the day and night, Reports of bladder spasm, Diminished ability to suppress urination Rationale:During the early stages of obstruction, the bladder begins to hypertrophy and becomes hypersensitive to afferent stimuli arising from stretch receptors in the bladder wall. The ability to suppress urination is diminished, and bladder contraction can become so strong that it produces bladder spasm. There is urgency, sometimes to the point of incontinence, and frequency during the day and at night. Constant pain is not associated with early obstuction, but colicky pain due to spasm may be present. Blood in the urine usually is not caused by obstruction but can be a sign of cancer or infection.
The nurse is conducting a community health education program on urinary retention and urinary incontinence. The nurse determines that the participants are understanding the education when they state that the most common cause of urinary retention is: Prostate enlargement Psychosocial disorders Pelvic inflammatory disease Chronic stress response
Prostate enlargement Rationale:In men, the enlarged prostate (due to hypertrophy or hyperplasia) frequently causes nonrelaxing external sphincter with urine retention. The stress response can cause retention of urine as part of the "fight-or-flight" response, unrelated to sphincter dysfunction. Developmental delays are associated with female or male children (not men). Psychosocial disorders sometimes have a transient effect on bladder function, and are rarely a cause of sphincter dysfunction in female or male clients.
A female client asks the nurse if there is any noninvasive treatment to help with the involuntary loss of urine that occurs when she coughs or sneezes. Which is the best response by the nurse? Periurethral injection of a bulking agent Self-catheterization Kegel exercises Implanted artificial sphincter
Rationale:Kegel exercise involves repetitive contraction and relaxation of the pelvic floor muscles and is a noninvasive way of strengthening the pelvic floor muscles. This is a client-dependent behavioral intervention. The remaining options are invasive procedures.
When conducting an admission interview with a client with a history of urinary incontinence, the nurse will specifically ask whether the client is prescribed which classification of medications in order to determine a possible cause? Select all that apply. Sedatives Diuretics Tricyclic antidepressants Hypnotics Acetylcholines
Sedatives, Diuretics, Hypnotics Rationale:Medication prescribed for other health problems may prevent a healthy bladder from functioning normally. Drugs such as hypnotics, tranquilizers, and sedatives can interfere with the conscious inhibition of voiding, leading to urge incontinence. Diuretics, particularly in older adults, increase the flow of urine and may contribute to incontinence, particularly in people with diminished bladder capacity and in those who have difficulty reaching the toilet. Acetylcholines and tricyclic antidepressants are sometimes used to treat specific types of incontinence.
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 over-the-counter glucosamine supplements for the treatment of arthritis. The client states that the majority of his fluid intake during the day is tea or coffee. The client's father was diagnosed with bladder cancer when he was in his 60s. The client takes his prescribed beta-blocker and diuretic each evening at bedtime.
The client takes his prescribed beta-blocker and diuretic each evening at bedtime. Rationale:Taking diuretics in the evening can cause nocturia. The fact that the client mostly drinks tea and coffee is unlikely to cause nocturia. Frequency is not suggestive of bladder cancer. Glucosamine supplements are not linked to changes in voiding behavior.
Which nursing intervention would be most appropriate for the nurse to include on the plan of care of a client experiencing functional urinary incontinence? Placing the urinal within reach Restricting client's use of diuretics Using adult diapers Toileting the client every 2 to 4 hours
Toileting the client every 2 to 4 hours Rationale:Functional incontinence is often a result of the lack of cognitive function to go to the bathroom, commode, or urinal/bedpan that results in spontaneous urination. Instituting a toileting training program that encourages the emptying of the bladder at regular intervals will help manage the problem. Placing the urinal within reach assumes that the client can manage the issue, which is not necessarily true. The use of adult diapers can increase moisture-associated dermatitis and formation of pressure ulcers. It is inappropriate for the nurse to restrict the client's prescribed diuretic therapy.
