Question 1

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.

Accepted Answer

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.

Question 2

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.

Accepted Answer

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.

Question 3

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.

Accepted Answer

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.

Question 4

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

Accepted Answer

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.

Question 5

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.

Accepted Answer

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 H}2^{O; and voiding occurs around the catheter.}

Question 6

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 chronic constipation 
F) A 20-year-old man who has spina bifida and consequent impaired mobility.

Accepted Answer

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.

Question 7

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

Accepted Answer

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.

Question 8

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.

Accepted Answer

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.

Question 9

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.

Accepted Answer

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.

Question 10

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 areflex ia
B) Detrusor-sphincter dyssynergia
C) Uninhibited neurogenic bladder
D) Bladder atony with dysfunction

Accepted Answer

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.

Question 11

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."

Accepted Answer

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 yieldhigh-glucose urine, and the bladder deficits associated with diabetes are neurological in nature rather than a result of particular urine chemistry.

Question 12

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."

Accepted Answer

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.

Question 13

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 $\alpha$-adrenergic antagonist
D) Flomax (tamsulosin), an $\alpha$-blocker
E) Bactrim (sulfamethoxazole and trimethoprim), antibiotics

Accepted Answer

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.

Question 14

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 uretha

Accepted Answer

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.

Question 15

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.

Accepted Answer

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 increasesintra-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.

Question 16

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?
A) Performing a physical examination and history to determine the exact cause and character of the incontinence
B) Providing client education focusing on the fact that occasional incontinence is a normal, age-related change
C) Teaching the resident about protective pads, collection devices, and medications that may be effective
D) Showing the resident the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone

Accepted Answer

The priority in the treatment of incontinence in the elderly is an acknowledgement that it is not an inevitability and that the exact causes should and most often can be identified. This identification by way of history-taking and examination would supersede teaching about protective devices or exercises.

Question 17

A patient asks the nurse what it means when the doctor said that he had adenocarcinoma of the bladder. Reviewing the pathophysiologic principles behind this type of cancer, the nurse knows
A) it is a low-grade tumor that is readily cured with bladder surgery.
B) after resection of the cancer, the prognosis is excellent with this type of cancer cell.
C) that these types of cancer cells are very invasive to the tissue; therefore, the entire bladder must be removed.
D) this is a rare but highly metastatic tumor that has a very poor prognosis.

Accepted Answer

Adenocarcinoma is rare and highly metastatic. Answer choices A and B relate to urothelial carcinoma; answer choice C relates to squamous cell carcinoma.

Question 18

When teaching a community education class about the seven warning signs of cancer, the nurse will note that the most common sign of bladder cancer is
A) inability to empty the bladder fully.
B) colic spasms of the ureters.
C) painless bloody urine.
D) passage of large clots after voiding.

Accepted Answer

The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of people with the disease, and microscopic hematuria is present in most others. Answer choice A refers to flaccid bladder; answer choice B refers to kidney stones; answer choice D refers to clots that are usually seen after surgery such as TURP where bladder irrigation is called for to prevent the clots from blocking urine output.

Question 19

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?
A) "There are new and highly effective chemotherapy regimens that we will investigate."
B) "Fortunately, bladder cancer has a very low mortality rate, and successful treatment is nearly always possible."
C) "It's likely that you'll need surgery, possibly a procedure called a cystectomy."
D) "Unfortunately, there are nearly no treatment options for this type of cancer, but we will focus on addressing your symptoms."

Accepted Answer

Surgical interventions are common in the treatment of bladder cancer. Effective chemotherapeutic regimens are not yet available, though there are certainly treatment options. The mortality rate of bladder cancer is high, at around 25%.

Question 20

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.
A) Intravesical chemotherapy with doxorubicin (Adriamycin)
B) Intravenous chemotherapy with at least three agents
C) Bacillus Calmette-Guérin (BCG) vaccine
D) Endocan, a tumor angiogenesis inhibitor

Accepted Answer

No chemotherapeutic regimens for bladder cancer have been established. Instillation of chemotherapeutic drugs into the bladder is currently done using thiotepa, mitomycin C, and doxorubicin. BCG vaccine causes a significant reduction in the rate of relapse and prolongs relapse-free intervals in people with cancer in situ. Inhibitors of tumor angiogenesis and inhibitors of EGF drugs are proving effective with bladder cancer.

Quiz 41: Disorders of Endocrine Control

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

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

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?

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

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 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 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 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 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?

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 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?

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

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?

A patient asks the nurse what it means when the doctor said that he had adenocarcinoma of the bladder. Reviewing the pathophysiologic principles behind this type of cancer, the nurse knows

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

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?

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.