PATHO CH27
A 61 year-old woman who has had an upper respiratory infection for several weeks has presented to her family physician with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking non-prescription cold medications over and above the suggested dose for the past two weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention?
The anticholinergic effects of the medication are impairing normal bladder function.
Which of the following patients should have a feeling of bladder fullness?
The patient with 200 mL of urine in their bladder
The nurse understands that medications although very beneficial to clients can also have harmful effects. When working with elderly clients the nurse should recognize which of the following is a common result of potent, fast-acting diuretics?
Urge incontinence
A patient is admitted with lower urinary tract obstruction and stasis. Which of the following is the primary intervention?
Urinary catheterization
A client experienced asymptomatic UTIs while pregnant. The client asks the nurse if this places her at any risk for complications. Which would be the best response by the nurse?
"You are at risk for developing acute pyelonephritis."
A mother asks, "why can't my 1 year old go to the bathroom by himself?" Which of the following is the nurse's best response?
"Your child is too young to begin toilet training."
A client informs the nurse that he feels as if his bladder is getting full. The nurse understands that a client first experiences the sensation of bladder fullness when the bladder contains which of the following?
100-200 ml of urine
The nurse who is preparing to catheterize a client who has a neurogenic bladder and is suffering from over-distention understands the importance of not removing more than what quantity of urine at one time?
1000 ml
Select the client who is at the greatest risk of developing bladder cancer.
A 65-year-old white male with a history of bladder stones
The nurse is providing care for a 16-year-old male client, newly diagnosed with a spinal cord injury. He asks why he can no longer control his bladder. What would the nurse explain to him? (Select all that apply.)
• Your spinal cord injury has disrupted the control your brain has over your bladder. • You will have to learn how to in-and-out catheterize yourself. • You have a condition known as detrusor-sphincter dyssynergia.
The nursing instructor who is teaching about incontinence in the elderly recognizes a need for further instruction when one of the students makes which of the following statements?
"Frequency is not a major problem for the elderly."
A diabetes education nurse is teaching a group of recently diagnosed diabetics about the potential genitourinary complications of diabetes and the consequent importance of vigilant blood glucose control. Which of the following teaching points best conveys an aspect of bladder dysfunction and diabetes mellitus?
"It's important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying."
Which of the following types of pharmacological therapy does the nurse anticipate administering to a patient for treatment of a spastic bladder in order to decrease bladder hyperactivity?
Anticholinergic medications
What is the most common gram-negative bladder infection found in hospitalized clients?
Catheter-induced infection
Which physiologic change in the elderly population contributes to urinary incontinence?
Decline in detrusor muscle function
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 the elderly. One method of treatment is habit training, or bladder training. When using this treatment with an elderly person, how frequently should he or she be voiding?
Every 2 to 4 hours
Which of the following assessments indicates to the nurse that a patient may have a spastic bladder dysfunction?
Incontinence
A 51 year-old woman diagnosed with a cerebrovascular accident (CVA) five months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the facts that would underlie the nurse's response to the client?
She may be unable to sense her bladder filling as a result of her MS.
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 is providing emotional support to a patient who has just been diagnosed with low-grade urothelial bladder cancer. When the patient inquires about prognosis rates for this type of cancer, the nurse responds that:
it is usually non-invasive and has an excellent prognosis.
The nurse is scheduled to teach a client experiencing urinary incontinence about Kegel exercises. Which of the following descriptors should the nurse include in this education?
"Contract and relax the pelvic floor muscles at least 10 times every hour while awake."
A neighbor is complaining to a friend (who happens to be a nurse) about several changes in their body. Which of the following complaints raises a "red flag" because it could be a sign of epithelial cell bladder cancer?
"I noticed my urine is pinkish red, but I'm not having any pain when I pee."
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
A nurse is caring for a client who has just experienced a spinal cord injury. Which of the following bladder dysfunctions will the client experience?
The bladder becomes atonic.
A nurse is informing a client diagnosed with a neurogenic bladder about treatment options. Which options should be included in client teaching? Select all that apply.
• Catheterization • Bladder training • Surgery • Pharmacologic intervention
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
A client has just been diagnosed with a neurogenic disorder of the bladder. The nurse caring for him understands that this means that this client could demonstrate which of the following? Select all that apply.
• Failure to store urine • Failure to empty urine
The nurse working on a GU floor caring for clients who have bladder cancer identifies which of the following to be acceptable treatments for this cancer? Select all that apply.
• Surgical removal • Radiation therapy • Chemotherapy
A client who is admitted to the hospital receives a diagnosis of lower urinary tract obstruction. What does the nurse pick to be the immediate treatment for this problem?
Relief of bladder distention
In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." The student with the most accurate response would be:
"The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder."
A patient has a postvoid residual (PVR) volume of 40 mL. Which of the following information would the nurse teach the patient?
"This is a normal value."
A 24 year-old man is currently in a rehabilitation facility following a spinal cord injury at level T2. He is discussing his long term options for continence management. Which of the following statements by the client demonstrates he 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 young mother asks,"Why can my 3-year-old daughter have a bowel movement on the toilet but she wets her pants?" Which of the following is the nurse's best response?
"Bowel control occurs earlier than bladder control."
A bladder cancer client asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to do 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 40-year-old female with the diagnosis of multiple sclerosis has been experiencing severe bladder spasms along with less bladder volume. This is likely due to: Select all that apply.
• Uninhibited bladder • Neurogenic detrusor overactivity
A 63 year-old woman has visited a physician because she has been intermittently passing blood-tinged urine over the last several weeks, and cytology has confirmed a diagnosis of invasive bladder cancer. Which of the following statements by the physician is most accurate?
"It's likely that you'll need surgery; possibly a procedure called a cystectomy."
A client who has had recurrent UTIs asks the nurse about the old wise tale of drinking cranberry juice daily. The nurse can respond:
"Research suggests cranberry juice will reduce bacterial adherence to the lining of the urinary tract."
The client has just been diagnosed with bladder cancer and asks the nurse what causes it. Which of the following would be the nurse's best response to the client?
"The cause is unknown."
A patient with diabetes mellitus type 1 has bladder atony with dysfunction. Which of the following assessments indicates a primary concern for this patient?
Ascending urinary tract infection
The nurse is caring for a patient with a spinal cord injury at C-4 and assesses a blood pressure of 180/120 mm Hg, a heart rate of 42, and profuse diaphoresis. Which of the following priority actions should the nurse take?
Assess the patient for a kinked indwelling catheter.
The nursing instructor informs the students during a lecture on the lower urinary tract that which of the following controls the elimination of urine from the body?
Bladder
The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is which of the following?
Bladder
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. The nurse knows that all of his complaints is likely caused by which of the following medical diagnosis?
Bladder atony with dysfunction
A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and best way to remember the transient and treatable causes of urinary incontinence is to use which of the following acronyms?
DIAPPERS
While studying about the process of urination, the nursing student learns that which of the following is known as the "muscle of micturition"?
Detrusor muscle
An older male comes to the clinic with the chief complaint of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. Which of the following should the nurse suspect to be the most frequent cause of this client's problem?
Enlargement of prostate gland
Which of the following is the most common cause of lower uncomplicated urinary tract infections?
Escherichia coli
Which urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure?
External sphincter
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 patient who has been admitted with a problem with his bladder has a postvoid residual (PVR) of 250 ml. The nurse understands that this indicates which of the following?
Inadequate bladder emptying
A client reports that she frequently suffers from UTIs after engaging in sexual intercourse. Which would be the best information for the nurse to provide?
Increase fluid intake before intercourse
A female client asks the nurse if there is any noninvasive treatment to help with the involuntary loss of urine that occurs when she coughs or sneezes. Which is the best response by the nurse?
Kegel exercises
A patient with stress incontinence states, "every time I laugh or cough, I urinate on myself. Which of the following behavioral measures would be beneficial for the nurse to teach the patient?
Kegel exercises
A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. Their BP is 186/101; heart rate 45; profusely sweating and complaining of "not feeling right." The nurse should:
Palpate their bladder for overdistention.
A newly diagnosed paraplegic client who suffered an automobile accident appears to have control of bladder emptying. The health care provider explains this process to the client/family stating, "This function is allowing the motor component of the neural reflex to assist with bladder emptying and is primarily controlled by the:
Parasympathetic division of the ANS."
A nurse is caring for a patient in spinal shock. Which of the following interventions is appropriate in relation to the patient's urinary status?
Perform intermittent catheterization
An 87 year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority?
Performing a physical examination and history to determine the exact cause and character of the incontinence.
A client who has a problem with incontinence loses a small amount of urine every time she coughs or sneezes. This type of incontinence is known as which of the following?
Stress
Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help:
Stress incontinence
Which clients have an increased risk for developing UTIs? A client who is or is diagnosed with: Select all that apply.
• Urinary obstruction • Neurogenic disorders • Elderly • Prostate disease
The nurse is conducting a health education program on bladder cancer. The nurse teaches that which of the following is the most common type of bladder cancer?
Transitional carcinoma
The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder?
Ureters
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.
An instructor is assisting a nursing student with inserting an indwelling catheter for a patient 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?
When the patient returns 1000 mL of urine from the bladder at once
A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about:
Wiping from front to back to preventEscherichia coli contamination of the urethra
The client who has just been diagnosed with bladder cancer asks the nurse what treatment he will have to undergo. Which of the following 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 client who is suspected of having acute renal failure would first be assessed by which of the following blood tests? Select all that apply.
• Blood urea nitrogen • Creatinine
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: Select all that apply.
• Infections due to stasis • Backpressure on the ureters • Development of hydroureters
The nursing students are studying about common causes of congenital obstructions in the lower urinary tract. Which of the following do they correctly identify as sites of congenital obstruction? Select all that apply.
• Meatal stenosis in boys • Just inside the external urinary meatus in girls • Damage to sacral nerves
The nurse should anticipate that a patient diagnosed with spastic bladder dysfunction may be prescribed which of the following medications that will help decrease detrusor muscle tone and increase bladder capacity? Select all that apply.
• Oxybutynin (Ditropan), an antimuscarinic drug. • Detrol LA (Tolterodine Tartrate), an antimuscarinic drug.
The nursing instructor, while teaching about bladder cancer, informs the students that early screening of hematuria for bladder cancer should be done when there is a high risk such as in which of the following cases? Select all that apply.
• People who have a history of smoking • People who have a family history of bladder cancer • People who are exposed to chemicals • Males
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
