NUR 318 Pathophysiology Chapter 35: Disorders of the Bladder and Lower Urinary Tract

When determining the treatment and management for incontinence, the health care provider considers which aspects of the client's medical history? Select all that apply.

Person's age Accompanying health problems Type of incontinence

Which intervention would be most effective when caring for an older adult with advanced Alzheimer disease who is experiencing incontinence?

Prompted, timed voiding

A 71-year-old client reports to the nurse that he often notices a pink tinge to his urine. Upon further questioning, he states that he experiences no pain when voiding and has not noticed any change in the frequency of his voiding. Which response by the nurse is best?

Promptly report this finding to the client's health care provider.

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

Radiation therapy Surgical removal Chemotherapy

An older adult client who recently started taking furosemide tells the nurse about now experiencing problems with urine incontinence. Which type of incontinence is this client likely experiencing?

Transient

The older adult client tells the health care provider about experiencing incontinence ever since starting diuretic therapy 2 weeks ago. What term should the provider document in the medical record related to the type of incontinence?

Transient

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?

Perform intermittent catheterization

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 statement?

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

A young adult client is currently in a rehabilitation facility following a spinal cord injury at level T2. The nurse and client are discussing long-term options for continence management. Which statement demonstrates the client 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."

The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement?

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

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

Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer?

"More than ever, I guess it would be worthwhile for me to quit smoking."

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

"The cause is unknown."

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." Which student has given the most accurate response?

"The detrusor muscle contracts down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder."

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 put the chemotherapy directly into the bladder to kill any cancer cells."

In which client would the nurse recognize the symptoms of a lesion in the micturition center of the sacral cord?

A trauma client whose bladder ultrasound reveals 1140 mL of urine

One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study?

Activity of the voluntary muscles of the perineal area

A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs?

Administration of alpha-adrenergic agonist drugs as ordered

Which statement accurately describes the etiology of stress incontinence?

An increase in intra-abdominal pressure that results in involuntary urination

Which type of pharmacologic therapy does the nurse anticipate administering to a client for treatment of a spastic bladder in order to decrease bladder hyperactivity?

Anticholinergic medications

A client with type 1 diabetes mellitus has bladder atony with dysfunction. Which assessment indicates a primary concern for this client?

Ascending urinary tract infection

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

Bladder

A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and effective way to remember the transient and treatable causes of urinary incontinence is to use which acronym?

DIAPPERS

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder?

Detrusor

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

Detrusor muscle

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

Enlargement of prostate gland

A client is admitted with a diagnosis of flaccid bladder. The nurse caring for this client understands this client will exhibit which disorder of the bladder?

Failure to empty urine

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

The body compensates for obstructed urine outflow up to a certain point. Which signs/symptoms lead the nurse to suspect decompensatory changes are occurring? Select all that apply.

High residual volume up to 1000 mL Urinary frequency noted Must strain to initiate the stream of urine

A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 30.8 lb (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 nurse correctly identifies which approved treatments for a client who is admitted with a diagnosis of neurogenic bladder? Select all that apply.

Meds to manipulate bladder function Bladder training Surgery Catheterization

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. Which is the most likely diagnosis and possible underlying pathophysiologic problem?

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

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 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence?

Stress

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:

Stress

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

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

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.

Which events would suggest that an individual's physiologic response to an obstruction has progressed beyond the compensatory stage and is now in the decompensatory stage?

The detrusor muscle contraction becomes too short to expel urine completely.

The nursing student learns in her anatomy and physiology class that the bladder has how many main components?

Two

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

Urge incontinence

A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention?

Urinary catheterization

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

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

The nurse is providing care for a client newly diagnosed with a spinal cord injury. When the client asks why she can no longer control her bladder, which response by the nurse is the best explanation? Select all that apply.

Your spinal cord injury has disrupted the control your brain has over your bladder. You have a condition known as detrusor-sphincter dyssynergia. You will have to learn how to in-and-out catheterize yourself.

A 65-year-old female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include:

cystoscopy.

Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?

Incontinence

A nurse suspects a client may be experiencing flaccid bladder dysfunction based on 24-hour intake and output. Which diagnostic method is most likely to confirm or rule out whether the client is retaining urine?

Measurement of postvoid residual (PVR) by ultrasound

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

"This is a normal value."

The nurse is teaching a client about the different treatments used with bladder cancer. Which type of therapy will the nurse describe as being instilled directly into the bladder?

Immunotherapeutic agents

What is the most common sign of bladder cancer?

Painless hematuria