Chapter 35: Disorders of the Bladder and Lower Urinary Tract
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?
flaccid bladder dysfunction
The nurse is providing emotional support to a client who has just been diagnosed with low-grade urothelial bladder cancer. When the client inquires about prognosis rates for this type of cancer, the nurse responds that:
it is usually noninvasive and has an excellent prognosis.
A client who is having problems with his bladder and kidneys is scheduled for a cystoscopy. He asks the nurse why he has to have the test. What would be the best response by the nurse?
"A cystoscopy enables direct visualization of the urethra, bladder, and ureteral orifices."
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."
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."
A client has a spastic bladder. Which comment is of most concern to the nurse?
"I feel like I have a fever."
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 has a postvoid residual (PVR) volume of 40 mL. Which information would the nurse teach the client?
"This is a normal value."
An adult client is diagnosed with a low-grade bladder tumor and undergoes a cystectomy with resection of the pelvic lymph nodes and the prostate and seminal vesicles. Which response by the health care provider is the most plausible when asked about prognosis?
"Your prognosis is excellent, and you are likely to have a full recovery."
The nurse who is preparing to catheterize a client who has a neurogenic bladder and is suffering from overdistention understands the importance of not removing more than what quantity of urine at one time?
1000 mL
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
In women, stress incontinence is a common problem. The loss of the angle between the urethrovesical junction and the bladder contributes to stress incontinence. What is the normal angle between the bladder and the urethrovesical junction?
90 to 100 degrees
Which client is at greatest risk of developing bladder cancer?
A 65-year-old white male with a history of bladder stones
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 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
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
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.
Diuretics Hypnotics Sedatives
The nurse is caring for a client with a spinal cord injury at C4 and assesses a blood pressure of 180/120 mm Hg; heart rate of 42 beats/min; and profuse diaphoresis. Which priority intervention should the nurse implement?
Assess the client for a kinked indwelling catheter.
One of the treatments for bladder cancer in situ is the intervesicular administration of which drug?
Bacillus Calmette-Guerin vaccine
The nursing instructor informs the students that which anatomical structure controls the elimination of urine from the body?
Bladder
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is:
Bladder
Incontinence can be transient. What are the possible causes of transient urinary incontinence? Select all that apply.
Confusional states Stool impaction Recurrent urinary infections
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
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 reserve urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure?
External sphincter
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
An older adult client who is immobile and has difficulty seeing—but is otherwise healthy—would be at a high risk for which type of incontinence?
Functional
While studying the GU system the nursing students learn that which sex achieves continence first?
Girls
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
Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?
Incontinence
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 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
A nurse is caring for a client admitted for chemotherapy due to bladder cancer. Which route would the nurse anticipate that the chemotherapy will be administered when the goal is to minimize systemic side effects?
Intravesical
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 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
The adult child of an older adult has noticed that the parent has become incontinent of urine for the first time. The client is diagnosed with transient urinary incontinence. To what is this condition most attributable in this population?
Medications
Acute overdistention of the bladder can occur in anyone with a neurogenic bladder that does not empty. What is the maximum amount of urine a nurse should empty out of a neurogenic bladder at one time?
No more than 1000 cc of urine at one time
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.
What is the most common sign of bladder cancer?
Painless hematuria
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
The lower motor neurons in the sacral segment of the spinal column control what aspect of urination?
Reflex control of bladder function
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
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 Structural changes in the urethra Impairment of neurologic control of bladder function Structural changes of the gallbladder Structural changes in the pancreas
Structural changes in the bladder Structural changes in the urethra Impairment of neurologic control of bladder function
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.
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 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 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 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
Which assessment findings would the nurse expect in a client with chronic urinary obstruction?
Urinary frequency
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.
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 middle-aged man with diabetes reports that he must strain to urinate and that his urine stream is weak and dribbling. He also reports feeling that his bladder never really empties. His problem is most likely:
bladder atony and dysfunction arising from peripheral neuropathy.
A young mother asks, "Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" What is the nurse's best response?
"Bowel control occurs earlier than bladder control."
A nurse correctly identifies which approved treatments for a client who is admitted with a diagnosis of neurogenic bladder? Select all that apply. Catheterization Bladder training Meds to manipulate bladder function Hypnosis Surgery
Catheterization Bladder training Meds to manipulate bladder function Surgery
Which method/maneuver describes an appropriate nursing intervention for a client with a neurogenic bladder that involves applying hand pressure to the suprapubic area?
Credé maneuver
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:
Cystectomy
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.
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.
