Deck 41: Disorders of Endocrine Control

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.

Answer 1

detrusor.

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.

Answer 2

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

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.

Answer 3

The anticholinergic effects of the medication are impairing normal bladder function.

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

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.

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.

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

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.

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.

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

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."

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."

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

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

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.

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

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.

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.

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."

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