Ch. 35 Disorders of the Bladder and Lower Urinary Tract
A 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence?
Stress
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 client who has just been diagnosed with bladder cancer asks the nurse what treatment he will have to undergo. What would be the nurse's best response to this question?
"The methods used depend on the grade of the tumor and the lesion's invasiveness."
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."
A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client?
"This value indicates you are having difficulty emptying your bladder."
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
Which client is at greatest risk of developing bladder cancer?
A 65-year-old white male with a history of bladder stones
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
Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder?
Detrusor
Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder training. When using this treatment with an older adult, how frequently should he or she be voiding?
Every 2 to 4 hours
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
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.
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 nurse is scheduled to teach a client experiencing urinary incontinence about Kegel exercises. Which descriptor should the nurse include in this education?
"Contract and relax the pelvic floor muscles at least 10 times every hour while awake."
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 storing urine."
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."
A client has a postvoid residual (PVR) volume of 40 mL. Which information would the nurse teach the client?
"This is a normal value."
Which statements identify bladder function? Select all that apply.
- Control of function involves the autonomic and somatic nervous systems. - The sympathetic nervous system promotes bladder filling. - The parasympathetic nervous system promotes emptying.
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
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 cause can result in either urinary obstruction or urinary incontinence for clients?
Alterations in bladder function
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 adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education?
Dry mouth and constipation are common.
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 nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?
Perform intermittent catheterization
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
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 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.
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
The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder?
Ureters
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
A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention?
Urinary catheterization
A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle?
When intravesical pressure exceeds maximal urethral closure pressure
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.
Select the option that best describes the sensory process involved in the inhibition of micturition.
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.
A client is concerned about the possibility of having bladder cancer after his brother was diagnosed with it 2 years ago. Which assessment data obtained by the nurse would indicate that the client should be screened for this disease?
Client reports that he occasionally has blood in his urine but has no pain with it.
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.
An instructor is assisting a nursing student with inserting an indwelling catheter for a client with urinary retention and acute overdistention of the bladder. The student inserts the catheter and gets an immediate return of clear yellow urine. When should the student clamp the catheter?
When the client returns 1000 mL of urine from the bladder at once
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
A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis?
Incontinence related to neuropathy causing overactive bladder
A mother asks, "Why can't my 1-year-old go to the bathroom by himself?" What is the nurse's best response?
"Your child is too young to begin toilet training."