Chapter 27/35- Disorders of the Bladder and Lower Urinary Tract
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is:
Bladder
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.
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.
Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?
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 250 mL. Which information would the nurse tell the client?
"This value indicates you are having difficulty emptying your bladder."
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
While studying about the process of urination, the nursing student learns that which muscle is known as the "muscle of micturition"?
Detrusor muscle
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
The client has had prolonged urethral outlet obstruction. The nurse knows that physiologically the client may likely develop small pockets of mucosal tissue, called cellulae, which can ultimately cause which complication? Select all that apply.
Infections due to stasis; Development of hydroureters; Backpressure on the ureters
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
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.
Which nursing intervention would be most appropriate for the nurse to include on the plan of care of a client experiencing functional urinary incontinence?
Toileting the client every 2 to 4 hours
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 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."
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."
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 mother asks, "Why can't my 1-year-old go to the bathroom by himself?" What is the nurse's best response?
"Your child is too young to begin toilet training."
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
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; Sedatives; Hypnotics
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
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
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
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
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
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 client who is experiencing bladder overfilling will more than likely have which disease process? Select all that apply.
Multiple sclerosis; Diabetic neuropathies
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
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
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 urethra; Impairment of neurologic control of bladder function; Structural changes in the bladder
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
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 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 client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention?
Urinary catheterization
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.
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 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
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
Which cause can result in either urinary obstruction or urinary incontinence for clients?
Alterations in bladder function
