Chapter 35 disorders of the bladder and lower urinary tract

A client who has a problem with incontinence loses a small amount of urine every time she coughs or sneezesThis 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 the client describing ?

Stress incontinence

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.

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."

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."

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

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, chemotherapy

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 is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention ?

urinary catheterization

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 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."

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."

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."

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 ?

90-100 degrees

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

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

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

A client diagnosed with urinary obstruction exhibits a weak, small urinary stream and hesitancy. The client most likely is experiencing:

Decompensation

Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder trainingWhen using this treatment with an older adult, how frequently should he or she be voiding ?

Every 2 to 4 hours

A client diagnosed with flaccid neurogenic bladder is taught to apply pressure with the hand above the symphysis pubis while in the sitting position. What is the expected outcome of this technique?

Fairly efficient emptying of the bladder

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

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 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?

The client with diabetes mellitus

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 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 a common result of potent , fast-acting diuretics ?

Urge incontinence

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.

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?

cause is unknown

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder?

detrusor

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

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 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 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

While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"?

detrusor muscle