Patho Ch 35
a) "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" Pg. 911 Micturition and Maintenance of Continence During the act of micturition, the detrusor muscle of the bladder fundus and bladder neck contracts down on the urine and the ureteral orifices are forced shut. The bladder neck is widened and shortened, and the external sphincter relaxes as urine moves out of the bladder. Descent of the diaphragm and contraction of the abdominal muscles raise intra-abdominal pressure and aids in the expulsion of urine from the bladder.
30. In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." Which student has given the most accurate response? a) "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" b) "The beginning of micturition occurs when neurons send messages down to the pudendal nerve" c) "The urothelium acts as a barrier to prevent urine from seeping into capillaries" d) "It's really the external sphincter muscle that controls urination. The somatic nervous system innervates the muscles of the external sphincter and the pelvic floor muscles that together control the outflow of urine"
a) Anticholinergic medications Pg. 915 Treatment of Spastic Bladder Among the methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. Antibiotics are used to treat urinary tract infections. Biofeedback is a behavioral method of treatment. Calcium channel blockers would not be effective in treating this disorder.
12. 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? a) Anticholinergic medications b) Antibiotics c) Biofeedback d) Calcium channel blockers
d) Painless hematuria Pg. 920 Clinical Manifestations 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.
1. A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse? a) Continual dysuria b) Intermittent urgency c) Urinary frequency d) Painless hematuria
c) Dry mouth and constipation are common Pg. 911 Pharmacology of Micturition 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.
21. An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education? a) You may experience feelings of euphoria b) Stop the medication if you develop spasms c) Dry mouth and constipation are common d) Increased tearing and drowsiness may occur
d) "The cause is unknown" Pg. 920 Etiology and Pathophysiology 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.
6. 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? a) "It is due to something outside the body" b) "You should not worry about its cause" c) "It is usually inherited" d) "The cause is unknown"
c) Administration of alpha-adrenergic agonist drugs as ordered Pg. 917 Stress Incontinence 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.
10. A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs? a) Administration of diuretics as ordered to promote frequent bladder emptying b) Intermittent catheterization c) Administration of alpha-adrenergic agonist drugs as ordered d) Bladder ultrasonography two to three times daily
a) "More than ever, I guess it would be worthwhile for me to quit smoking" Pg. 920 Etiology and Pathophysiology 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.
11. Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer? a) "More than ever, I guess it would be worthwhile for me to quit smoking" b) "I suppose I should listen to my health care provider and drink more cranberry juice" c) "I can see that preventing bladder cancer is one more benefit of a healthy diet" d) "I think I should be okay because there's no history of bladder cancer in my family that I'm aware of"
d) Bladder Pg. 920 Cancer of the Bladder 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.
13. The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is: a) Testicular b) Uterine c) Kidney d) Bladder
c) Transient Pg. 918 Other Causes of Incontinence 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).
14. 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? a) Neurogenic b) Stress c) Transient d) Chronic
d) Perform intermittent catheterization Pg. 916 Bladder Dysfunction Caused by Peripheral Neuropathies 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.
15. A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status? a) Perform a urine culture b) Palpate the lower abdomen c) Assess bowel sounds d) Perform intermittent catheterization
a) Urge incontinence Pg. 917 Overactive Bladder/Urge Incontinence 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.
16. 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: a) Urge incontinence b) Stress incontinence c) Overflow incontinence d) Transient incontinence
a) Confusional states c) Recurrent urinary tract infections e) Stool impaction Pg. 919 Diagnosis and Treatment Among the transient causes of urinary incontinence are recurrent urinary tract infections; medications that alter bladder function or perception of bladder filling and the need to urinate; diuretics and conditions that increase bladder filling; stool impaction; restricted mobility; and confusional states. Spinal cord injury and diarrhea are not associated with transient urinary incontinence.
17. Incontinence can be transient. What are the possible causes of transient urinary incontinence? Select all that apply. a) Confusional states b) Diarrhea c) Recurrent urinary tract infections d) Spinal cord injury e) Stool impaction
d) Incontinence related to neuropathy causing overactive bladder Pg. 914 Spastic Bladder: Failure to Store Urine 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.
18. 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? a) Incontinence caused by stress on the bladder b) Incontinence related to having large volumes stored in the bladder c) Incontinence caused by a physical block in the urethra d) Incontinence related to neuropathy causing overactive bladder
b) Bladder atony and dysfunction arising from peripheral neuropathy Pg. 916 Bladder Dysfunction Caused by Peripheral Neuropathies Diabetes causes peripheral neuropathy, which can affect the sensory axons of the urinary bladder. Bladder atony and dysfunction, with infection resulting, are common among people with diabetes.
19. 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: a) Weak, ineffective bladder contractions caused by detrusor muscle areflexia b) Bladder atony and dysfunction arising from peripheral neuropathy c) Uninhibited neurogenic bladder caused by increased detrusor muscle tone and spasticity d) Constriction of the external sphincter during urination stemming from detrusor-sphincter dyssynergia
b) Stress Pg. 917 Stress Incontinence 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.
2. A 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence? a) Overflow b) Stress c) Overactive d) Urge
d) Measurement of postvoid residual (PVR) by ultrasound Pg. 912 Physical Examination 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.
20. 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? a) Urine test for culture and sensitivity b) Routine urinalysis c) Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate d) Measurement of postvoid residual (PVR) by ultrasound
a) Ureters Pg. 909 Bladder Structure Urine passes from the kidneys to the bladder through the ureters. The Bowman's capsule is a component of the kidney. The external sphincter serves as a reserve mechanism to stop micturition when it is occurring, while the trigone is the smooth triangular area that is bounded by the openings of the ureters and the urethra.
22. The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder? a) Ureters b) Bowman's capsule c) Trigone d) External sphincter
a) Transient Pg. 918 Other Causes of Incontinence Transient incontinence is caused by medications such as long-acting sedatives and hypnotics, psychotropic medications, and diuretics such as furosemide. It can also be caused by rectal distension, fecal impaction, and acute cystitis or polyuria. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure. Stress incontinence is the involuntary loss of urine during coughing, laughing, sneezing, or lifting that increases intra-abdominal pressure because of pelvic floor muscle dysfunction.
23. 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? a) Transient b) Stress c) Neurogenic d) Overflow
d) "An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications" Pg. 918 Treatment Indwelling catheters carry a risk of infections and kidney stones. Catheterization does not influence the activity of the neural pathways, and intermittent catheterization can be performed using clean technique. Indwelling urethral catheters carry a high risk of urinary tract infections.
24. 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? a) "It is critical that intermittent catheterization be performed using sterile technique" b) "An indwelling urethral catheter is the option that best minimizes my chance of a urinary tract infection" c) "Self-catheterization can limit the recovery of my neural pathways that control my voiding if I do it too often" d) "An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications"
b) Anticholinergic medication Pg. 915 Treatment of Spastic Bladder Among the methods used to treat spastic bladder are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. A skeletal muscle relaxant is used to decrease the tone of the external sphincter. Calcium channel blockers are used to interfere with influx of calcium to support contraction of detrusor smooth muscle. Cholinergic medication stimulates parasympathetic receptors that cause detrusor contraction.
25. 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? a) Calcium channel blocker b) Anticholinergic medication c) Cholinergic d) Skeletal muscle relaxant
c) A client with diabetes mellitus Pg. 917-918 Overactive Bladder/Urge Incontinence 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.
26. 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) A client embarrassed to use a bedpan b) A client whose arthritis makes walking difficult c) A client with diabetes mellitus d) A client who gave birth to two large-for-gestational age infants
a) "Alterations in bladder function can only occur when there is incontinence" Pg. 913 Alterations in Bladder Function 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.
27. 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? a) "Alterations in bladder function can only occur when there is incontinence" b) "Alterations in bladder function can include urinary incontinence with involuntary loss of urine" c) "Alterations in bladder function occurs frequently in the elderly" d) "Alterations in bladder function can include urinary obstruction with retention or stasis of urine"
c) The client takes his prescribed beta-blocker and diuretic each evening at bedtime Pg. 919 Special Needs of Older Adults 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.
28. 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? a) The client's father was diagnosed with bladder cancer when he was in his 60s b) The client takes over-the-counter glucosamine supplements for the treatment of arthritis c) The client takes his prescribed beta-blocker and diuretic each evening at bedtime d) The client states that the majority of his fluid intake during the day is tea or coffee
d) Gross hematuria Pg. 920 Clinical Manifestations 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.
29. 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? a) Pus in urine b) Amber-colored urine c) Frequent urination d) Gross hematuria
b) The anticholinergic effects of the medication are impairing normal bladder function Pg. 911 Micturition and Maintenance of Continence Many over-the-counter cold medications have an anticholinergic effect that interferes with normal bladder emptying. These effects on micturition are not a result of cholinergic actions or miscommunication between the pontine micturition center and the spinal cord. Stimulation of the parasympathetic nervous system would tend to increase rather than decrease bladder emptying.
3. 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? a) Antihistamine effects inhibit communication between the pons and the thoracolumbar cord b) The anticholinergic effects of the medication are impairing normal bladder function c) Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying d) Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction
a) You will have to learn how to in-and-out catheterize yourself c) Your spinal cord injury has disrupted the control your brain has over your bladder e) You have a condition known as detrusor-sphincter dyssynergia Pg. 910 Pontine Micturition Center Disruption of pontine control of micturition, as in spinal cord injury, results in uninhibited spinal reflex-controlled contraction of the bladder without relaxation of the external sphincter, a condition known as detrusor-sphincter dyssynergia.
31. The nurse is providing care for a client newly diagnosed with a spinal cord injury. When the client asks why she can no longer control her bladder, which response by the nurse is the best explanation? Select all that apply. a) You will have to learn how to in-and-out catheterize yourself b) You have a condition known as a relaxed bladder c) Your spinal cord injury has disrupted the control your brain has over your bladder d) You will always have to wear an internal catheter e) You have a condition known as detrusor-sphincter dyssynergia
a) Stress incontinence Pg. 917 Stress Incontinence Stress incontinence is the loss of urine associated with activities, such as coughing, that increase intra-abdominal pressure. Overactive bladder/urge incontinence is urgency and frequency associated with hyperactivity of the detrusor muscle that may or may not involve involuntary loss of urine. Overflow is the involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure in the absence of detrusor activity. Functional incontinence is a lack of cognitive function to go to the bathroom, commode, or urinal/bedpan, resulting in spontaneous urination.
4. 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? a) Stress incontinence b) Urge incontinence c) Overflow d) Functional incontinence
a) Urge incontinence Pg. 919 Special Needs of Older Adults 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.
5. 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? a) Urge incontinence b) No untoward effects c) Decreased urine output d) Increased potassium levels
b) Detrusor muscle Pg. 909 Bladder Structure 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.
7. While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"? a) External sphincter muscle b) Detrusor muscle c) Trigone muscle d) Internal sphincter muscle
a) "This value indicates you are having difficulty emptying your bladder" Pg. 912 Physical Examination 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.
8. A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client? a) "This value indicates you are having difficulty emptying your bladder" b) "This is a normal value" c) "This value indicates you are emptying your bladder too completely" d) "This test indicates you do not have adequate bladder control"
b) Stress incontinence Pg. 917 Stress Incontinence Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.
9. 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? a) Overflow incontinence b) Stress incontinence c) Mixed incontinence d) Urge incontinence