Patho II PrepU Chp. 35

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. Stop the medication if you develop spasms. b. Dry mouth and constipation are common. c. Increased tearing and drowsiness may occur. d. You may experience feelings of euphoria.

b 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.

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? a. spastic bladder dysfunction b. flaccid bladder dysfunction c. detrusor-sphincter dyssynergia d. uninhibited neurogenic bladder

b 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.

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. Biofeedback c. Calcium channel blockers d. Antibiotics

a 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.

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? a. DIAPPERS b. SBAR c. CBC d. FACES

a DIAPPERS is the preferred acronym. D stands for dementia, I for infection, A for atrophic vaginitis, P for pharmaceutical agents, P for psychological causes, E for endocrine conditions, and R for restricted mobility. FACES is the acronym for the pain scale used with children. SBAR refers to method used in the hand-off report. CBC stands for a complete blood count.

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? a. The stretch receptors in the bladder wall become hypersensitive. b. Ability to suppress urination is increased. c. The bladder begins to shrink. d. Bladder contraction weakens.

a During the early stage of obstruction, the bladder begins to hypertrophy and becomes hypersensitive to afferent stimuli arising from stretch receptors in the bladder wall. The ability to suppress urination is diminished, and bladder contraction can become so strong that it virtually produces bladder spasm. There is urgency, sometimes to the point of incontinence, and frequency during the day and at night.

The caregiver of an older adult client with dementia informs the nurse that her mother is voiding on her clothes and on the furniture and will tell the family when she has to void. The client has a negative urinalysis with no signs of urinary tract infection. Which type of incontinence will the nurse teach the caregiver about? a. Functional incontinence b. Stress incontinence c. Overactive bladder/urge incontinence d. Overflow

a Functional incontinence is related to a lack of cognitive function to go to the bathroom, resulting in spontaneous urination. Stress incontinence is an involuntary loss of urine associated with activities, such as coughing, that increases intra-abdominal pressure. Overactive bladder or urge incontinence is urgency and frequency associated with hyperactivity of the detrusor muscle. Overflow is involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure in the absence of detrusor activity.

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? a. Enlargement of prostate gland b. Bladder tumor c. Gonorrhea d. Kidney infection

a 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? a. Gross hematuria b. Frequent urination c. Pus in urine d. Amber-colored urine

a 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 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."

a 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.

An instructor is assisting a nursing student with inserting an indwelling catheter for a client with urinary retention and acute overdistention of the bladder. The student inserts the catheter and gets an immediate return of clear yellow urine. When should the student clamp the catheter? a. When the client returns 1000 mL of urine from the bladder at once b. When the client informs the student of feeling better c. When the client no longer has suprapubic distention d. When the student observes blood in the urine

a With acute overdistention of the bladder, usually no more than 1000 mL of urine is removed from the bladder at one time. The theory behind this limitation is that removing more than this amount at one time releases pressure on the pelvic blood vessels and predisposes to alterations in circulatory function.

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

b 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.

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. Functional incontinence b. Stress incontinence c. Overflow d. Urge incontinence

b 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.

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

b 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.

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. Stress incontinence b. Urge incontinence c. Overflow incontinence d. Transient incontinence

b 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 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 include urinary obstruction with retention or stasis of urine." b. "Alterations in bladder function occurs frequently in the elderly." c. "Alterations in bladder function can only occur when there is incontinence." d. "Alterations in bladder function can include urinary incontinence with involuntary loss of urine."

c 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.

Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer? a. "I can see that preventing bladder cancer is one more benefit of a healthy diet." b. "I suppose I should listen to my health care provider and drink more cranberry juice." c. "More than ever, I guess it would be worthwhile for me to quit smoking." d. "I think I should be okay because there's no history of bladder cancer in my family that I'm aware of."

c 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 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? a. Bladder cancer is the number one type of cancer in overweight smokers. b. There is insufficient evidence to make a conclusion. c. It is caused by carcinogens that are excreted in the urine and stored in the bladder. d. Obesity is a known cause of bladder cancer.

c Evidence suggests that bladder cancer is related to local influences such as carcinogens that are excreted in the urine and stored in the bladder. These include the breakdown products of aromatic amines used in the dye industry, and products used in the manufacture of rubber, textiles, paint, chemicals, and petroleum. About 30% to 50% of all bladder cancers are associated with cigarette smoking. Obesity is not related to bladder cancer.

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. Increased potassium levels b. Decreased urine output c. Urge incontinence d. No untoward effects

c 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.

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? a. Complete bladder emptying when the first sensation of fullness is felt b. Urinary retention followed by overflow and incomplete emptying c. Loss of small amounts of urine when laughing or sneezing d. Large amount of urine leakage during a hyperglycemic episode

c 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 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? a. Involuntary bladder continence during filling b. A decrease in bladder distensibility c. When intravesical pressure exceeds maximal urethral closure pressure d. A pressure difference between the urethra and bladder

c 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. Stress incontinence, which is a common problem in women of all ages, occurs as the result of weakness or disruption of pelvic floor muscles, leading to poor support of the vesicourethral sphincters. Except during the act of micturition, intraurethral pressure is normally greater than intravesical pressure. Urge incontinence and overactive bladder are associated with urgency caused by bladder infection or CNS or myogenic mechanisms. 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.

The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply. a. Structural changes in the pancreas b. Structural changes of the gallbladder c. Structural changes in the bladder d. Impairment of neurologic control of bladder function e. Structural changes in the urethra

c, d, e 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 nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is: a. Uterine b. Testicular c. Kidney d. Bladder

d 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.

A warehouse worker is experiencing trouble with incontinence, especially when lifting heavy objects. What intervention is most appropriate for this client's needs? a. Intermittent catheterization b. Bladder ultrasonography two to three times daily c. Administration of diuretics as ordered to promote frequent bladder emptying d. Administration of alpha-adrenergic agonist drugs as ordered

d 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.

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: a. bladder retraining. b. long-term intermittent catheterization. c. lithotripsy. d. cystoscopy.

d 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.