PrepU CH. 27

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.

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

Which of the following are risk factors for developing a UTI? (Select all that apply.)

Urinary obstruction Postmenopausal status Prostate disease Neurogenic bladder

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

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."

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

A 65-year-old Caucasian female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include.

cystoscopy.

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:

flaccid bladder dysfunciton

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 patient has a postvoid residual (PVR) volume of 250 mL. Which of the following information would the nurse tell the patient?

"This value indicates you are having difficulty emptying your bladder."

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 patient will sense fullness of the bladder when the bladder contains what amount of urine?

400mL

Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction? Select all that apply.

68 year-old man who has been diagnosed with benign prostatic hyperplasia (BPH). 30 year-old woman who has been diagnosed with gonorrhea. 74 year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation. 20 year-old man who has spina bifida and consequent impaired mobility.

The nurse is evaluating patient risk for the development of overactive bladder/urge incontinence and determines that the patient at highest risk is which of the following?

A patient with diabetes mellitus

In which client would the nurse recognize the symptoms of a lesion in the micturition centre of the sacral cord?

A trauma client whose bladder ultrasound reveals 1,140 mL of urine

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 a-adrenergic agonistic drugs as ordered

A client who suffers from spastic bladder has been catheterized to promote bladder emptying. Which of the following medications should the nurse plan on the physician ordering to also treat this problem?

Anticholinergic medication

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

Incontinence can be transient. What are the causes of transient urinary incontinence? (Select all that apply.)

Confusional states Stool impaction Recurrent urinary tract infections

Which statements identify bladder function? Select all that apply.

Control of function involves the autonomic and somatic nervous systems. The sympathetic nervous system promotes bladder filling. The parasympathetic nervous system promotes emptying.

The nurse is conducting pre-operative teaching for a patient with bladder cancer who is scheduled to undergo surgical creation of an alternative bladder reservoir. The nurse determines that the patient is understanding the pre-operative teaching when the patient identifies the surgical treatment as which of the following?

Cystectomy

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

Which physiologic change in the elderly population contributes to urinary incontinence?

Decline in detrusor muscle function

When explaining about the passage of urine to a group of nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition? Their correct reply is the:

Detrusor.

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

The nurse is caring for a patient with a sacral cord injury that resulted in loss of the perception of bladder fullness and loss of voluntary urination. When planning care for the patient, the nurse should include nursing interventions for which of the following?

Flaccid bladder dysfunction

A 68 year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention?

Hypertrophy of the bladder muscle and increased bladder wall thickness.

Which of the following assessments indicates to the nurse that a patient may have a spastic bladder dysfunction?

Incontinence

When educating the patient about possible treatments following surgery for bladder cancer, the nurse might include which of the following chemotherapy options? Select all that apply.

Intravesical chemotherapy with doxorubicin (Adriamycin). Bacillus Calmette-Guerin (BCG) vaccine. Endocan, a tumor angiogenesis inhibitor.

A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 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 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 is concerned about the possibility of having bladder cancer after his brother was diagnosed with it 2 years ago. Which of the following assessment data obtained by the nurse would indicate that the patient should be screened for this disease?

Patient reports that he occasionally has blood in his urine but has no pain with it.

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.

During male ejaculation, which of the following statements addresses why sperm is not normally seen inside the bladder?

The musculature of the trigone area, bladder neck, and prostatic urethra contract at the same time.

Which of the following patients should have a feeling of bladder fullness?

The patient with 200 mL of urine in their bladder

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 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.

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:

bladder atony and dysfunction arising from peripheral neuropathy.

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."

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."

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 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

Which methods are most commonly used to treat detrusor-sphincter dyssynergia?

Anticholinergic medications and urinary catheterization

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

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

A patient has a spastic bladder. Which of the following is of most concern to the nurse?

"The patient has an elevated temperature."

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."

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 of the following statements?

"Alterations in bladder function can only occur when there is incontinence."

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."

The nurse is teaching a patient with a spinal cord injury about self-catheterization. Which of the following measurements is important to include about the amount of urine that should be allowed to collect in the bladder between catheterizations?

300-400 mL

Which of the following accurately describes the etiology of stress incontinence?

An increase in intra-abdominal pressure which results in involuntary urination

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

A patient has bladder distension. Which of the following is the nurse's best action?

Assisting the patient to urinate

A client has just been diagnosed with urinary incontinence. His primary nurse knows that the treatment/management of incontinence can include which of the following? Select all that apply.

Behavioral measures Surgical correction Pharmacologic measures Non-catheter devices to obstruct urine flow 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 nurse is assessing a patient with suspected urine retention. Which of the following assessments help to confirm this diagnosis? Select all that apply.

Bladder distension Hesitancy Straining when initiating urination Frequency

An adult client presents to the emergency department with manifestations of acute cystitis. For which would the nurse assess the client? Select all that apply.

Burning on urination Back discomfort Cloudy urine

A nurse correctly identifies which of the following to be approved treatments for a client who is admitted with a diagnosis of neurogenic bladder? Select all that apply.

Catheterization Bladder training Meds to manipulate bladder function Surgery

A 45-year-old man is being treated for bladder cancer. Which therapy would have the least complications?

Intravesical chemotherapy

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

Which urinary structure helps to stop micturition when it is occurring and maintains continence under high bladder pressure?

External sphincter

What is a common cause of spastic bladder dysfunction?

External sphincter spasticity

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

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. What is the man's most likely diagnosis and possible underlying pathophysiological problem?

Overactive bladder that may result from both neurogenic and myogenic sources.

The nurse is teaching a client about the different treatments used with bladder cancer. Which type of therapy does she inform the client can be done by instilling directly into the bladder?

Immunotherapuetic agents

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 patient diagnosed with flaccid neurogenic bladder is taught to apply pressure with the hand above the symphysis pubis while in the sitting position. What is the expected outcome of this technique?

Increase in intravesical pressure

Which layer is produced by the bladder epithelia that binds water and forms a protective barrier between the bladder wall and the components of urine, thus protecting the bladder from carcinogens and infective organisms?

Mucin

An elderly woman comes to the hospital and is diagnosed with urinary obstruction and retention. Which of the following symptoms would the nurse expect this client to demonstrate? Select all that apply.

Nladder distention • Hesitancy • Frequency • Overflow incontinence

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

When teaching a community education class about the 7 warning signs of cancer, the nurse will note that the most common sign of bladder cancer is:

Painless bloody urine

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 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 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 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 primary care provider.

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

A patient 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 of the following types of urinary incontinence is the patient describing?

Stress incontinence

Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help:

Stress incontinence

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

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 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 learns in her anatomy and physiology class that the bladder has how many main components?

Two

When determining the treatment and management for incontinence, the physician considers which of the following? Select all that apply.

Type of incontinence Accompanying health problems Person's age

The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder?

Ureters

Which of the following clinical manifestations would tell a nurse that a patient is having progressive decompensation related to obstruction of urinary outflow?

When tested for residual urine volume, 1400 mL of urine is obtained when patient is catheterized.

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 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

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

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