NRS233 Exam 1-Chapter 35 PrepU
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 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 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."
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."
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."
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."
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 can estimate bladder volume." -"A cystoscopy enables direct visualization of the urethra, bladder, and ureteral orifices." -"A cystoscopy provides information about bladder emptying." -"A cystoscopy provides information about the flow rate during urination."
-"A cystoscopy enables direct visualization of the urethra, bladder, and ureteral orifices."
The nursing instructor informs the students during a lecture that the control of the emptying functions of the bladder involves which portion of the nervous system? Select all that apply. -Involuntary autonomic nervous system -Parasympathetic nervous system -Voluntary somatic nervous system -Reticular activating system -Limbic center
-Involuntary autonomic nervous system -Voluntary somatic nervous system
Which is a common cause(s) of congenital obstructions in the lower urinary tract? Select all that apply. -meatal stenosis -bladder tumors -spina bifida -meningomyelocele -enlarged prostate
-Meatal stenosis -Spina bifida -Meningomyelocele
The nurse is instructing a client with neurogenic bladder to perform intermittent self-catheterization. What teaching points should the nurse include? Select all that apply. -How to maintain sterile technique -Scheduling catheterization for every 4 hours -Signs and symptoms of autonomic dysreflexia -Using sterile water to inflate the catheter balloon -How to apply pressure to achieve full bladder emptying
-Scheduling catheterization for every 4 hours -Signs and symptoms of autonomic dysreflexia
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
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
Which statement accurately describes the etiology of stress incontinence?
An increase in intra-abdominal pressure that results in involuntary urination
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is:
Bladder
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 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 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 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
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
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 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 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 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
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
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 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 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 client is describing difficulty with urinating and informs the nurse that every time she coughs or laughs, she urinates and has begun to wear a thin pad. Which type of urinary incontinence is the client describing?
Stress incontinence
An older adult client with an upper respiratory infection for several weeks has presented with urinary retention. The client reports taking nonprescription cold medications over and above the suggested dose. Which medication most likely is contributing to this urinary retention?
The anticholinergic effects of the medication are impairing normal bladder function.
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.
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 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 nurse is conducting a health education program on bladder cancer. What is the most common type of bladder cancer?
Transitional carcinoma
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
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 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.
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? -"You will need to ask your physician." -"I really do not have anything to do with the treatments." -"The methods used depend on the grade of the tumor and the lesion's invasiveness." -"It's whatever you prefer. You can have either chemo or radiation therapy."
-"The methods used depend on the grade of the tumor and the lesion's invasiveness."
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. -Storage and filtration of urine. -Striated muscles provide involuntary control of urination.
-Control of function involves the autonomic and somatic nervous systems. -The sympathetic nervous system promotes bladder filling. -The parasympathetic nervous system promotes emptying.
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
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?
Anticholinergic medication
The nurse is preparing to assist a client for a procedure to measure bladder pressure during filling and voiding to determine total bladder capacity. For which procedure should the nurse assemble equipment?
Cystometry
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 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. -Reports of renal colic -Urinary frequency noted -High residual volume up to 1000 mL -Postvoid residual volume less than 50 mL -Must strain to initiate the stream of urine
-Urinary frequency noted -High residual volume up to 1000 mL -Must strain to initiate the stream of urine
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
The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer? Select all that apply. -Surgical removal -Radiation therapy -Hypnosis -Chemotherapy -Herbal therapy
-Surgical removal -Radiation therapy -Chemotherapy
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 asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse?
Painless hematuria
Which client should have a feeling of bladder fullness?
The client with 200 mL of urine in the bladder
