Ch. 27

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." R:The nurse should tell the patient that the cause of bladder cancer is unknown; however, evidence suggests that its origin is due to local influences such as carcinogens that are excreted in the urine and stored in the bladder. It is not inherited and it would not be therapeutic to tell the patient not to be concerned about its cause.

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 R:Among the methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. Antibiotics are used to treat urinary tract infections. Biofeedback is a behavioral method of treatment. Calcium channel blockers would not be effective in treating this disorder.

Which methods are most commonly used to treat detrusor-sphincter dyssynergia?

Anticholinergic medications and urinary catheterization R:The methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying.

What is the most common gram-negative bladder infection found in hospitalized clients?

Catheter-induced infection R:Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of gram-negative septicemia in hospitalized clients. Studies have shown that bacteria adhere to the surface of the catheter and initiate the growth of a biofilm that then covers the surface of the catheter.

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

Decline in detrusor muscle function R: In the elderly 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; it is a chemical influence.

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 R:In males the most important acquired cause of urinary stasis and urinary obstruction is external compression of the urethra caused by the enlargement of the prostate gland. Bladder tumors, gonorrhea and kidney infections can cause the same symptoms but the most important and frequent cause is BPH.

Which of the following is the most common cause of lower uncomplicated urinary tract infections?

Escherichia coli R:Most uncomplicated lower UTIs are caused by Escherichia coli. Other common uropathic pathogens include Enterococcus faecalis, Staphylococcus saprophyticus, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas species. Helicobacter, H. pylori, and Proteus amoeba do not cause UTIs

A client reports that she frequently suffers from UTIs after engaging in sexual intercourse. Which would be the best information for the nurse to provide?

Increase fluid intake before intercourse R:A nonpharmacologic approach to the treatment of frequent UTIs associated with sexual intercourse is to increase fluid intake before intercourse and to void soon after intercourse. This procedure uses the washout phenomenon to remove bacteria from the bladder.

A patient with stress incontinence states, "every time I laugh or cough, I urinate on myself. Which of the following behavioral measures would be beneficial for the nurse to teach the patient?

Kegel exercises R: Behavioral methods for incontinence include fluid management, timed/prompted voiding, pelvic floor exercises (Kegel exercises), bladder retraining, and toileting assistance. Bladder retraining and biofeedback techniques seek to reestablish cortical control over bladder function by having the person ignore urgency and respond only to cortical signals during waking hours. Indwelling catheters are not used routinely to control incontinence and is a medical intervention. Administering medications is considered to be a pharmacological intervention

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?

Kegel exercises R:Kegel exercise involves repetitive contraction and relaxation of the pelvic floor muscles and is a noninvasive way of strengthening the pelvic floor muscles and is a client-dependent behavioral intervention. The remaining options are invasive procedures.

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 R:After a spinal cord injury, the early effects on bladder function are quite different from those that follow recovery from the initial injury. During the period immediately after spinal cord injury, a state of spinal shock develops, during which all the reflexes, including the micturition reflex, are depressed. The bladder is atonic and cannot contract. Intermittent catheterization is necessary to prevent injury to urinary structures associated with overdistension of the bladder

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 R:After a spinal cord injury, the early effects on bladder function are quite different from those that follow recovery from the initial injury. During the period immediately after spinal cord injury, a state of spinal shock develops, during which all the reflexes, including the micturition reflex, are depressed. The bladder is atonic and cannot contract. Intermittent catheterization is necessary to prevent injury to urinary structures associated with overdistension of the bladder.

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 R:Stress incontinence is the involuntary loss of urine associated with activities such as coughing and sneezing. Urge incontinence is the urgency and frequency associated with hyperactivity of the detrusor muscle. Overflow incontinence is the involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure. Functional incontinence is the lack of cognitive function to go to the bathroom.

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 R:Urinary obstruction and urinary incontinence can be caused by several factors, including structural changes in the bladder, structural changes in the urethra, and impairment of neurologic control of bladder function. Changes in the gallbladder or pancreas do not cause urinary obstruction or incontinence.

Which of the following patients should have a feeling of bladder fullness?

The patient with 200 mL of urine in their bladder R:In a normally functioning bladder, the sensation of bladder fullness is first perceived when the bladder contains 100-200 mL of urine. The patient who has neuropathy or is incontinent may not have a feeling of bladder fullness.

The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder?

Ureters R:Urine passes from the kidneys to the bladder through the ureters. The bowman's capsule is a component of the kidney. The external sphincter serves as a reserve mechanism to stop micturition when it is occurring, while the trigone is the smooth triangular area that is bounded by the openings of the ureters and the urethra.

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

Urinary catheterization R: The relief of lower urinary tract obstruction is directed toward relief of bladder distension through urinary catheterization. This is the primary intervention. The other interventions are not the priority

Select the option that best describes the sensory process involved in the inhibition of mictur

When the bladder is distended to 150 to 250 mL in the adult, the sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex, allowing for conscious inhibition of the micturition reflex. R:Micturition, or urination, involves the activity of both sensory and motor neurons. When the bladder is distended to 150 to 250 mL in the adult, the first sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex, and at 350 to 450 mL, there is a definite sense of bladder fullness.

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

cystoscopy. R:The most common sign of bladder cancer is painless hematuria. Frequency, urgency, and dysuria occasionally accompany the hematuria. Cystoscopy is among the most common diagnostic tests related to bladder cancer. Lithotripsy addresses renal calculi. Bladder retraining and catheterization are not directly related to the diagnosis and treatment of bladder cancer.

Which of the following patients would the nurse assess for possible urinary retention? Select all that apply.

• The patient receiving an antihistamine • The patient taking over-the-counter medication for a cold or flu • The patient with diabetes mellitus and neuropathy • The patient with an enlarged prostate R:he nurse should assess the patients taking an antihistamine and cold medication for urinary retention, as these medications impair urinary flow. The patient with diabetes mellitus and neuropathy is also at risk, as is the patient with prostatic hypertrophy. The patient who takes aspirin and the patient with diverticular disease would not be seen to be at increased risk.

The nurse is providing care for a 16-year-old male client, newly diagnosed with a spinal cord injury. He asks why he can no longer control his bladder. What would the nurse explain to him? (Select all that apply.)

• Your spinal cord injury has disrupted the control your brain has over your bladder. • You will have to learn how to in-and-out catheterize yourself. • You have a condition known as detrusor-sphincter dyssynergia. R:Disruption of pontine control of micturition, as in spinal cord injury, results in uninhibited spinal reflex-controlled contraction of the bladder without relaxation of the external sphincter, a condition known as detrusor-sphincter dyssynergia. The other answers are not true.