Unit1:Ch 35- Disorders of the Bladder and Lower Urinary Tract (Porth 5th Ed) Flashcards
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
A) urinary vesicle.
B) trigone.
C) detrusor.
D) external sphincter.
Ans: C
Feedback:
The detrusor muscle is the muscle of micturition. When it contracts, urine is expelled
from the bladder. External sphincter is a circular muscle that surrounds the urethra distal
to the base of the bladder and can stop micturition when it is occurring. Trigone is a
smooth triangular area that is bounded by the ureters and the urethra. Urinary vesicle is
another name for the bladder.
During male ejaculation, which of the following statements addresses why sperm is not
normally seen inside the bladder?
A) The parasympathetic nervous system keeps the seminal fluid inside the urethra.
B) The musculature of the trigone area, bladder neck, and prostatic urethra contract at
the same time.
C) With ejaculation, the male expels some urine along with the seminal fluid to wash
any extra sperm out of the bladder.
D) The detrusor muscle relaxes allowing for the closing of the sphincter at the base of
the bladder.
Ans: B
Feedback:
During male ejaculation, which is mediated by the SNS, the musculature of the trigone
area and that of the bladder neck and prostatic urethra contracts and prevents the
backflow of seminal fluid into the bladder.
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 nonprescription cold medications
over and above the suggested dose for the past 2 weeks. Which of the following
phenomena will her physician most likely suspect is contributing to her urinary
retention?
A) Cholinergic actions of the cold medicine are triggering internal and external
sphincter contraction.
B) Antihistamine effects inhibit communication between the pons and the
thoracolumbar cord.
C) The anticholinergic effects of the medication are impairing normal bladder
function.
D) Over-the-counter medications such as cold medicine stimulate the
parasympathetic nervous system and inhibit bladder emptying.
Ans: C
Feedback:
Many over-the-counter cold medications have an anticholinergic effect that interferes
with normal bladder emptying. These effects on micturition are not a result of
cholinergic actions or miscommunication between the pontine micturition center and the
spinal cord. Stimulation of the parasympathetic nervous system would tend to increase
rather than decrease bladder emptying.
An 82-year-old resident of a long term care facility with a recent history of repeated
urinary tract infections and restlessness is suspected of having urinary retention. Which
of the following actions by the care team is most appropriate?
A) Uroflowmetry to determine the rate of the client’s urine flow
B) Ultrasound bladder scanning to determine the residual volume of urine after
voiding
C) Renal ultrasound aimed at identifying acute or chronic kidney disease
D) Urinalysis focusing on the presence of or absence of microorganisms, blood, or
white cells in the man’s urine
Ans: B
Feedback:
Ultrasound bladder scanning yields a fast and noninvasive indication of whether or not
an individual is adequately emptying his or her bladder with each void. Uroflowmetry
would be less indicative of whether the man is retaining, and renal ultrasound would
address deficits in urine production rather than bladder emptying. Urinalysis would be
useful in the diagnosis of infections and/or renal issues more than deficiencies in
bladder emptying.
When explaining a cystometry test to measure bladder pressure during filling and
voiding in a normal adult, the nurse informs the nursing students that the normal
capacity when adults have a desire to void is
A) 100 to 150 mL.
B) 200 to 250 mL.
C) 300 to 399 mL.
D) 400 to 500 mL.
Ans: D
Feedback:
The desire to void occurs when the bladder is full (normal capacity is approximately 400
to 500 mL). At this point, a definite sensation of fullness occurs; the pressure rises
sharply to 40 to 100 cm H2O; and voiding occurs around the catheter.
Which of the following individuals are likely to display identified risk factors for the
development of lower urinary tract obstruction? Select all that apply.
A) A 32-year-old woman who had a healthy delivery of her third child 4 months ago
B) A 68-year-old man who has been diagnosed with benign prostatic hyperplasia
(BPH)
C) A 55-year-old man with diabetes who is receiving diuretic medications for the
treatment of hypertension
D) A 30-year-old woman who has been diagnosed with gonorrhea
E) A 74-year-old woman who has developed a lower bowel obstruction following
several weeks of constipation
F) A 20-year-old man who has spina bifida and consequent impaired mobility.
Ans: B, D, E, F
Feedback:
BPH frequently obstructs the urethra, while sexually transmitted diseases, bowel
obstructions, and spina bifida are also associated with physical blockages of the lower
urinary tract. Postpartum women and individuals receiving diuretics would be more
likely to be at risk for incontinence rather than urinary retention.
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 currently occur as a result of her urinary retention?
A) Hypertrophy of the bladder muscle and increased bladder wall thickness
B) Decreased urine production and nitrogenous waste excretion by the kidneys
C) Decompensation, bladder stretching, and high residual urine volume
D) Overflow incontinence and loss of contraction power
Ans: A
Feedback:
Early accompaniments to urinary retention include hypertrophy of the bladder muscle
and increased thickness of the bladder wall. Renal effects are unlikely, and
decompensation and loss of contraction power are most often later rather than early
effects.
A 51-year-old woman diagnosed with a cerebrovascular accident (CVA) 5 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 fact that would underlie the nurse’s response to the client?
A) Neurological diseases like MS often result in flaccid bladder dysfunction.
B) She may be unable to sense her bladder filling as a result of her MS.
C) Lesions to the basal ganglia or extrapyramidal tract associated with MS inhibit
detrusor contraction.
D) Pathological reductions in bladder volume brought on my MS necessitate frequent
micturition.
Ans: B
Feedback:
MS may result in neurogenic bladder characterized by an inability to sense filling and
consequent incontinence. She is not demonstrating the signs of a flaccid bladder, and
lesions to the basal ganglia or extrapyramidal tract are associated with Parkinson
disease, not MS. Her disease is unlikely to directly reduce bladder volume.
A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in
condition. His BP is 186/101; heart rate is 45; and he is profusely sweating and
complaining of “not feeling right.” The nurse should
A) call a “Code Blue.”
B) page physician stat. and ask for an antihypertensive medication.
C) palpate his bladder for overdistention.
D) place his bed flat and elevate the foot of the bed.
Ans: C
Feedback:
The most common causes of spastic bladder dysfunction are spinal cord lesions such as
spinal cord injury, herniated intervertebral disk, vascular lesions, tumors, and myelitis.
Because the injury interrupts CNS control of sympathetic reflexes in the spinal cord,
severe hypertension, bradycardia, and sweating can be triggered by insertion of a
catheter or mild overdistention of the bladder. The patient does not qualify for a Code
Blue since he still has a pulse and is breathing. Antihypertensive medication is not
necessary if the bladder is emptied. Placing him flat with the foot of the bed elevated
will not help this situation.
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 are likely caused by which of the
following medical diagnoses?
A) Detrusor muscle areflexia
B) Detrusor–sphincter dyssynergia
C) Uninhibited neurogenic bladder
D) Bladder atony with dysfunction
Ans: D
Feedback:
Diabetes causes peripheral neuropathy, which can affect the sensory axons of the
urinary bladder. Bladder atony with dysfunction is a frequent complication of diabetes
mellitus.
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?
A) “People with diabetes are highly susceptible to urethral obstructions, and these
can heal more slowly and cause more damage than in people without diabetes.”
B) “High blood sugar results in a high glucose level in your urine, and this can make
your bladder muscle less able to fully empty the bladder.”
C) “Many people with diabetes find it necessary to live with an indwelling catheter to
ensure their bladders do not become too full.”
D) “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.”
Ans: D
Feedback:
Diabetics are vulnerable to peripheral neuropathies that can be somewhat mitigated by
regular voiding; they are also especially vulnerable to renal damage from high blood
sugars, a situation that is worsened when accompanied by incomplete bladder emptying.
Urethral obstructions are not a noted complication of diabetes, and indwelling catheter
placement is not normally necessary. High blood sugars do not necessarily yield
high-glucose urine, and the bladder deficits associated with diabetes are neurological in
nature rather than a result of particular urine chemistry.
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?
A) “Self-catheterization can limit the recovery of my neural pathways that control my
voiding if I do it too often.”
B) “It’s critical that intermittent catheterization be performed using sterile technique.”
C) “An indwelling catheter certainly would work well, but it comes with a number of
risks and possible complications.”
D) “An indwelling urethral catheter is the option that best minimizes my chance of a
urinary tract infection.”
Ans: C
Feedback:
Indwelling catheters carry a risk of infections and kidney stones. Catheterization does
not influence the activity of the neural pathways, and intermittent catheterization can be
performed using clean technique. Indwelling urethral catheters carry a high risk of
urinary tract infections.
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.
A) Ditropan (Oxybutynin), an antimuscarinic drug
B) Detrol LA (tolterodine tartrate), an antimuscarinic drug
C) Uroxatral (alfuzosin), an -adrenergic antagonist
D) Flomax (tamsulosin), an -blocker
E) Bactrim (sulfamethoxazole and trimethoprim), antibiotics
Ans: A, B
Feedback:
Antimuscarinic drugs, such as oxybutynin, tolterodine, and propantheline, decrease
detrusor muscle tone and increase bladder capacity in people with spastic bladder
dysfunction. Answer choices C and D are medications prescribed for males with BPH.
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?
A) Stress incontinence due to damage to CNS inhibitory pathways
B) Overactive bladder that may result from both neurogenic and myogenic sources
C) Overactive bladder due to intravesical pressure exceeding urethral pressure
D) Overflow incontinence that can result from displacement of the angle between the
bladder and the posterior proximal urethra
Ans: B
Feedback:
The man’s complaints are typical of overactive bladder, a condition that can result from
the interaction of both the nervous control of bladder emptying and the muscles of the
bladder itself. His symptoms are not characteristic of stress incontinence, and when
intravesical pressure exceeds, urethral pressure overflow incontinence results. The angle
between the bladder and the posterior proximal urethra is more commonly a factor in the
continence of females.
Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help A) overflow incontinence. B) urge incontinence. C) stress incontinence. D) mixed incontinence.
Ans: C
Feedback:
: Stress incontinence is commonly caused by weak pelvic floor muscles, which allow
the angle between the bladder and the posterior proximal urethra to change so that the
bladder and urethra are positioned for voiding when some activity increases
intra-abdominal pressure. Overflow incontinence results when the bladder becomes
distended and detrusor activity is absent. Urge incontinence is probably related to CNS
control of bladder sensation and emptying or to the smooth muscle of the bladder.
Mixed incontinence, a combination of stress and urge incontinence, probably has more
than one cause.
