Review Exam 5 (Ch.35)

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 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.

A client who has just been diagnosed with a spastic bladder asks the nurse what that means. What would be the nurse's best response?

"It is a problem with storing urine."

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

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 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."

An client is diagnosed with urinary obstruction and retention. Which clinical manifestations would the nurse expect this client to demonstrate? Select all that apply.

- Bladder distention - Hesitancy - Frequency - Overflow incontinence

A client is scheduled for urodynamic studies and asks the nurse, "What exactly is this study going to show related to my voiding problems?" Which nursing response(s) is accurate related to bladder function assessment via urodynamic studies? Select all that apply.

- Pressure changes in the intra-abdominal area - Characteristics of urine flow during voiding - Muscle activity of the external urinary sphincter

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

alteration in bladder function - causes

- Structural changes in the bladder, urethra, or surrounding organs - Impairment of neurologic control of bladder function

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

incontinence - treatment

- behavioral and pharmacological measures - excerises to strengthen the pelvic muscle - surgical correction - indwelling catheters

bladder cancer - s/s

- increased frequency - urgency - dysuria (painful urination) - hematuria (painless, bloody urination)

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

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 - 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.

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

A client is admitted with a diagnosis of flaccid bladder. The nurse caring for this client understands this client will exhibit which disorder of the bladder?

Failure to empty urine

While studying the GU system the nursing students learn that which sex achieves continence first?

Girls

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

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.

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 is conducting a health education program on bladder cancer. What is the most common type of bladder cancer?

Transitional carcinoma

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

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.

urine flow obstructions - s/s

bladder distention, hestiancy, straining when initating urination, small and weak stream, frequency, feeling of incomplete bladder emptying, overflow incontinence

neurogenic bladder - treatment

catheterization, bladder retraining, pharmacologic manipulation

bladder cancer - causes

unknown - r/t smoking

urine flow obstructions - causes

1. BPH, renal canculi, pregancy, turmors; lower UT - gonrrhea, STI's, bladder turmors, congential defects, chronic constipation, bowel obstruction

incontinence

inability to control bladder and/or bowels

overactive bladder/urge incontince

urgency and frequency associated with hyperactivity of the detrusor muscle; may or may not involve involuntary loss of urine

Urine Tests

urine tests, x-rays, uroflowmetry, cystometry, urethral pressure profile, sphincter electromyography (bladder control study), ultrasound bladder scan (to see bladder retention)

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

The client who has just been diagnosed with bladder cancer asks the nurse what treatment he will have to undergo. What would be the nurse's best response to this question?

The methods used depend on the grade of the tumor and the lesion's invasiveness."

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 - the most common diagnostic tests related to bladder cancer.

bladder cancer - diagnostic

early screening, urinalysis, hematuria, genetic component - cytologic studies, excretory urography, cystocopy, biopsy, ultrasonography, ct scans, mri

neurogenic bladder

impairment of bladder control due to brain or nerve conduction

stress incontinence

involuntary loss of urine associated with activities, such as coughing, sneezing, laughing, and lifting; that increase intra-abdominal pressure

overflow incontinence

involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure in the absence of detrusor activity - common: in men

The nurse is providing emotional support to a client who has just been diagnosed with low-grade urothelial bladder cancer. When the client inquires about prognosis rates for this type of cancer, the nurse responds that:

it is usually noninvasive and has an excellent prognosis.

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.

functional incontince

lack of cognitive function to go the bathroom, commode, or urinal/bedpan resulting in spontaneous urination - causes: meds (nighttime sedatives)

neurogenic bladder - causes

stroke, advanced age, parkinson dz, spinal cord injury, radical pelvic surgery, diabetic neuropathies, multiple sclerosis