CHAPTER 35: DISORDERS OF THE BLADDER & LOWER URINARY TRACT
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: Urge Stress Overflow Functional
Stress EXPLANATION: 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.
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 Stress incontinence Overflow incontinence Transient incontinence
Urge incontinence EXPLANATION: Urge incontinence is the involuntary loss of urine associated with a strong desire to void (urgency). Stress incontinence represents the involuntary loss of urine that occurs when, in the absence of detrusor muscle action, the intravesical pressure exceeds the maximum urethral closure pressure. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity. Incontinence may occur as a transient and correctable phenomenon, or it may not be totally correctable and may occur with various degrees of frequency.
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? Increased potassium levels Urge incontinence Decreased urine output No untoward effects
Urge incontinence EXPLANATION: Medications prescribed for other health problems may prevent a healthy bladder from functioning properly. Potent, fast-acting diuretics are known for their ability to cause urge incontinence. They can decrease potassium levels and increase urine output. They do have untoward effects.
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: long-term intermittent catheterization. cystoscopy. lithotripsy. bladder retraining.
cystoscopy EXPLANATION: 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.
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 include urinary obstruction with retention or stasis of urine." "Alterations in bladder function can include urinary incontinence with involuntary loss of urine." "Alterations in bladder function can only occur when there is incontinence." "Alterations in bladder function occurs frequently in the elderly."
"Alterations in bladder function can only occur when there is incontinence." EXPLANATION: Alterations in bladder function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Alterations in bladder function does occur more frequently with aging.
The nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement? "Many factors can contribute to incontinence." "A number of factors that contribute to incontinence can be altered." "Incontinence can increase social isolation in the elderly." "Frequency is not a major problem for the elderly."
"Frequency is not a major problem for the elderly." EXPLANATION: Incontinence can increase social isolation in the older adult population and frequency can lead to institutionalization of older adults. Many factors can contribute to incontinence but many of these can be altered.
Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer? "I suppose I should listen to my health care provider and drink more cranberry juice." "More than ever, I guess it would be worthwhile for me to quit smoking." "I can see that preventing bladder cancer is one more benefit of a healthy diet." "I think I should be okay because there's no history of bladder cancer in my family that I'm aware of."
"More than ever, I guess it would be worthwhile for me to quit smoking." EXPLANATION: Cigarette smoking is highly correlated with all bladder cancers. Cranberry juice may be of benefit in the prevention of urinary tract infections, not cancer, and neither poor diet nor family history is as significant as cigarette smoking in the etiology of bladder cancer.
A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client? "This is a normal value." "This value indicates you are having difficulty emptying your bladder." "This value indicates you are emptying your bladder too completely." "This test indicates you do not have adequate bladder control."
"This value indicates you are having difficulty emptying your bladder." EXPLANATION: The nurse should inform the client that values over 200 mL indicate an inability to adequately empty the bladder and that further evaluation is necessary. It is not a normal value, nor does it indicate that the client does or does not have adequate bladder control.
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 who gave birth to two large-for-gestational age infants A client with diabetes mellitus A client embarrassed to use a bedpan A client whose arthritis makes walking difficult
A client with diabetes mellitus EXPLANATION: Overactive bladder/urge incontinence can be caused by disorders of the detrusor muscle structure, which can occur as the result of the aging process or disease conditions such as diabetes mellitus. A stroke client develops this condition as a result of neurogenic causes rather than having a disorder of detrusor muscle problem.
One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study? Ability of the bladder to store urine Activity of the voluntary muscles of the perineal area Pressure of the bladder during filling and emptying Flow rate during urination
Activity of the voluntary muscles of the perineal area EXPLANATION: Sphincter electromyelogram allows the activity of the striated (voluntary) muscles of the perineal area to be studied. Cystometry measures the ability of the bladder to store urine as well as the pressure of the bladder during filling and emptying. Uroflowmetry measures the flow rate during urination.
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 diuretics as ordered to promote frequent bladder emptying Administration of alpha-adrenergic agonist drugs as ordered Bladder ultrasonography two to three times daily Intermittent catheterization
Administration of alpha-adrenergic agonist drugs as ordered EXPLANATION: The client likely has stress incontinence, for which alpha-adrenergic agonist drugs may be ordered. Diuretics are not used to treat incontinence. Bladder ultrasound neither assesses nor treats stress incontinence. Catheterization does not address the underlying problem.
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is: Kidney Bladder Uterine Testicular
Bladder EXPLANATION: Bladder cancer is the most frequent form of urinary cancer in the United States. Uterine cancer and testicular cancer are not considered to be cancers of the urinary tract.
While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"? External sphincter muscle Internal sphincter muscle Detrusor muscle Trigone muscle
Detrusor Muscle EXPLANATION: The detrusor muscle is the muscle of micturition. In the bladder neck is the continuation of the detrusor muscle known as the internal urethral sphincter, which acts as a sphincter when closed. The external sphincter muscle surrounds the urethra distal to the base of the bladder. There is not a trigone muscle; the trigone is the smooth triangular area that is bounded by the openings for the both ureters and the urethra.
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. Stop the medication if you develop spasms. You may experience feelings of euphoria. Increased tearing and drowsiness may occur.
Dry mouth and constipation are common. EXPLANATION: Anticholinergic effects of the muscarinic blocking agent oxybutynin include dry mouth and constipation. People taking anticholinergic drugs may also experience gastroesophageal reflux, blurred vision, urinary retention, and cognitive effects. Spasms are not 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? Kidney infection Enlargement of prostate gland Bladder tumor Gonorrhea
Enlargement of prostate gland EXPLANATION: In men, 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 benign prostatic hyperplasia (BPH).
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? Frequent urination Gross hematuria Pus in urine Amber-colored urine
Gross hematuria EXPLANATION: The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of cases. Frequency, urgency, and dysuria occasionally accompany the hematuria.
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 caused by stress on the bladder Incontinence related to having large volumes stored in the bladder Incontinence caused by a physical block in the urethra Incontinence related to neuropathy causing overactive bladder
Incontinence related to neuropathy causing overactive bladder EXPLANATION: Neural damage is brought about by chronic diabetes and can result in the loss of control of the detrusor muscle. Stress, urge, and functional incontinence are all caused by pressure or blockage.
An older adult presents to the primary health care provider's office with a report of bladder leakage. Which assessment correlates with a diagnosis of stress incontinence? Loss of small amounts of urine when laughing or sneezing Urinary retention followed by overflow and incomplete emptying Complete bladder emptying when the first sensation of fullness is felt Large amount of urine leakage during a hyperglycemic episode
Loss of small amounts of urine when laughing or sneezing EXPLANATION: Stress incontinence is leaking small amounts of urine when the bladder is placed under stress by increased abdominal pressure. This occurs when laughing, sneezing, coughing, exercising, or lifting increases intra-abdominal pressure. Urinary retention and overflow can occur as a result of neurogenic incontinence caused by spinal cord injury or diabetes mellitus. Outlet obstruction from benign prostatic hyperplasia and urethral stricture can produce similar symptoms. Functional incontinence is urine leakage due to environmental, cognitive, or physical circumstances that prevent toileting. Urge incontinence is the inability to hold urine after the first sensation of fullness occurs.
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? Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate Urine test for culture and sensitivity Routine urinalysis Measurement of postvoid residual (PVR) by ultrasound
Measurement of postvoid residual (PVR) by ultrasound EXPLANATION: Measurement of postvoid residual (PVR) can be achieved quickly, accurately, and painlessly by the use of ultrasonography. A PVR value of less than 50 mL is considered adequate bladder emptying, and more than 200 mL indicates inadequate bladder emptying. Urine tests and blood tests will not directly indicate whether a client is experiencing bladder fill with insufficiency in emptying.
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 Urinary frequency Intermittent urgency Continual dysuria
Painless hematuria EXPLANATION: The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in 75% of persons with the disease, and microscopic hematuria is present in most others. Frequency, urgency, and dysuria occasionally accompany the hematuria.
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 Assess bowel sounds Perform a urine culture Palpate the lower abdomen
Perform intermittent catheterization EXPLANATION: 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 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence? Urge Stress Overflow Overactive
Stress EXPLANATION: In women, pelvic floor weakness may cause involuntary loss of urine (stress incontinence) during any activity that increases intra-abdominal pressure, such as laughing or coughing. Urge incontinence and overactive bladder are associated with urgency caused by bladder infection, central nervous system, or myogenic mechanisms. Overflow incontinence is the result of bladder distention in the absence of detrusor muscle activity.
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 EXPLANATION: 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.
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? "It is usually inherited." "The cause is unknown." "It is due to something outside the body." "You should not worry about its cause."
The cause is unknown EXPLANATION: The nurse should tell the client 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 client not to be concerned about its cause.
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 Chronic Neurogenic Stress
Transient EXPLANATION: The causes of incontinence can be divided into two categories: transient and chronic. Of particular importance is the role of pharmaceuticals as a cause of transient urinary incontinence. Numerous medications, such as long-acting sedatives and hypnotics, psychotropics, and diuretics, can induce incontinence. Chronic urinary incontinence occurs as a failure of the bladder to store urine (stress incontinence) or a failure to empty urine (neurogenic incontinence).
A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention? Urinary catheterization Increased oral fluids Administration of intravenous fluids Laxative administration
Urinary catheterization EXPLANATION: 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.
Nurses should screen for hematuria to rule out bladder cancer in which clients at high risk for development of bladder cancer? Select all that apply. People who have a history of smoking People who have a family history of bladder cancer People under 40 years of age People who are exposed to chemicals Males
People who have a history of smoking People who have a family history of bladder cancer People who are exposed to chemicals Males EXPLANATION: Early screening of hematuria for bladder cancer is needed especially with people who have high-risk factors such as history of cigarette smoking, family history of bladder cancer, exposure to chemicals, male gender, and age greater than 55 years.
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. EXPLANATION: The kidneys control the formation of urine, the urinary bladder (which serves as reservoir for urine storage), and the urethra and urethral sphincter (which function as an outlet for urine elimination). The control and storage involve both the autonomic and somatic nervous systems. The SNS promotes bladder filling, and the PNS promotes emptying. Striated muscles provide voluntary control.
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 Urethral pressure profile Uroflowmetry Sphincter electromyography
Cystometry EXPLANATION: Cystometry is used to measure bladder pressure during filling and voiding. It provides valuable information about total bladder capacity. The urethral pressure profile is used to evaluate the intraluminal pressure changes along the length of the urethra with the bladder at rest. This provides information about smooth muscle activity along the length of the urethra. Uroflowmetry measures the flow rate during urination. Sphincter electromyography allows the activity of the striated muscles of the perineal area to be studied. Activity is recorded using an anal plug electrode, a catheter electrode adhesive skin electrodes, or needle electrodes.
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 client states that the majority of his fluid intake during the day is tea or coffee. The client's father was diagnosed with bladder cancer when he was in his 60s. The client takes over-the-counter glucosamine supplements for the treatment of arthritis.
The client takes his prescribed beta-blocker and diuretic each evening at bedtime. EXPLANATION: Taking diuretics in the evening can cause nocturia. The fact that the client mostly drinks tea and coffee is unlikely to cause nocturia. Frequency is not suggestive of bladder cancer. Glucosamine supplements are not linked to changes in voiding behavior.
Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow? Client complains of waking up several times in the night to void. When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized. Client states that he or she is incontinent. Client complains of urinary urgency.
When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized. EXPLANATION: When compensatory mechanisms are no longer effective, signs of decompensation begin to appear. The period of detrusor muscle contraction becomes too short to expel the urine completely, and residual urine remains in the bladder. At this point, symptoms of obstruction become pronounced. These symptoms include frequency of urination, hesitancy, need to strain to initiate urination, a weak and small stream, and termination of the stream before the bladder is completely emptied. With progressive decompensation, the bladder may become severely overstretched with a residual urine volume of 1000 to 3000 mL. Urinary urgency is a compensatory mechanism. Incontinence may be caused by many different factors and does not indicate decompensation.
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 spastic bladder dysfunction uninhibited neurogenic bladder detrusor-sphincter dyssynergia
flaccid bladder dysfunction EXPLANATION: Flaccid bladder dysfunction results in the ability to fill, but failure to empty urine. It is caused by lesions at the level of the sacral reflexes or the peripheral nerves that innervate the bladder. Spastic bladder dysfunction usually results from neurologic lesions located above the level of the sacral micturition reflexes. Detrusor sphincter dyssynergia is the presence of lesions that affect the micturition center in the pons or impair communication between the micturition center and spinal cord centers, interrupting the coordinated activity of the detrusor muscle and the external sphincter. In uninhibited neurogenic bladder the sacral reflex arc and sensation are retained and most functions are normal, but bladder capacity is diminished.
