Which type of urinary incontinence occurs as a result of spinal cord damage between C1 and S2

A 70-year-old woman complains of involuntary passage of urine. The leakage of urine occurs in small amounts and is more frequent when she coughs. What should the nurse teach the patient about her disorder? Select all that apply.

A. It occurs due to local irritation.

B. It occurs due to nervous system disorders.

C. It occurs due to weakness of muscles around the urethra.

D. It is called stress incontinence.

E. It occurs when the intraabdominal pressure exceeds urethral resistance.

Rationale: Involuntary voiding of urine on coughing occurs due to weakness of muscles around the urethra and is called stress incontinence. Stress incontinence occurs in older women when intraabdominal pressure exceeds urethral resistance. Involuntary voiding occurs only when abdominal pressure rises above the urethral pressure. Local irritating factors and nervous system disorders usually lead to urge incontinence.

Study Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the old material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don't wait until the middle or end of the semester to try to cram information.

Pg. 1104

The nurse works in a renal care unit. Which patient would require a long-term indwelling catheter?

A. A patient who underwent surgical repair of the bladder

B. A patient with prostate enlargement

C. A patient who needs assessment of residual urine volume

D. A patient with terminal illness requiring frequent changes of the bed linen

Rationale: Long-term indwelling catheterization is used in patients who have a permanent condition and cannot be managed with intermittent or short-term catheterization. The patient who has a terminal illness and requires frequent changes of bed linens should be catheterized long term. Frequent changes of linen may be uncomfortable and painful for the patient. The patient who underwent a surgical repair of the bladder would need a short-term catheter until recovery. A patient with prostate enlargement would also require a short-term catheterization until the enlargement is treated. A patient who requires an assessment of residual urine volume would require an intermittent catheterization.

Pg. 1119

Which type of urinary incontinence occurs due to spinal cord damage between C1 and S2?

A. Functional incontinence

B. Stress urinary incontinence

C. Reflex urinary incontinence

D. Urge urinary incontinence

Rationale: Reflex urinary incontinence is the involuntary loss of urine at somewhat predictable intervals when the patient reaches a specific bladder volume; it is related to spinal cord damage between C1 and S2. Functional incontinence is the loss of continence with a cause outside the urinary tract. Stress urinary incontinence is caused by increased intraabdominal pressure related to either urethral hypermobility or an incompetent urinary sphincter. Urge urinary incontinence is caused by neurological problems, bladder inflammation, or bladder outlet obstruction.

Pg. 1105

The nurse is reviewing the urinalysis report for a patient. Which finding indicates possible glomerular injury?

A. White blood cells

B. Casts

C. Large proteins

D. Glucose

Rationale: The presence of large proteins in the urine is suggestive of glomerular injury, because they are not normally able to filter through the glomerulus. White blood cells and casts can indicate a urinary tract infection. Glucose in the urine may be indicative of diabetes mellitus.

Study Tip: Proteins are large molecules, so the kidney does not normally filter them into the urine. The filtering apparatus does not normally let them pass; you could think of it as trying to force a goldfish through a window screen. The presence of large proteins in the urine means there is damage (think of it as holes in the screen) to the filtering apparatus, the glomerulus.

Pg. 1113

A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. What is the probable cause of these symptoms and findings?

A. Cystitis

B. Hematuria

C. Pyelonephritis

D. Dysuria

Rationale: Urine is cloudy in cystitis because of bacteria and white cells. Hematuria is blood in the urine. Pyelonephritis is a serious upper urinary tract infection. Dysuria is painful urination.

Pg. 1103, 1112

Which statement is true about the structure of the urethra?

A. The lower part of the urethra is called the detrusor.

B. The external urethral sphincter is made up of smooth muscles.

C. Striated muscles are responsible for voluntary control over the flow of urine.

D. The greater length of the male urethra increases the risk of urinary tract infection.

Rationale: The external urethral sphincter, which is made up of striated muscles, contributes to voluntary control over the flow of urine. The distensible body of the urinary bladder is called the detrusor. The shorter length of the female urethra increases the risk of urinary tract infection because it provides close access to the bacteria-contaminated perineal area.

Pg. 1103

A patient reports a strong urge to urinate when hearing running water and leaks small amounts of urine on the way to the bathroom. Which type of urinary incontinence does the nurse suspect in this patient?

A. Stress urinary incontinence

B. Reflex urinary incontinence

C. Urge urinary incontinence

D. Overflow urinary incontinence

Rationale: Urge urinary incontinence is caused by involuntary contractions of the bladder associated with an urge to void that causes leakage of urine. One of the symptoms of this type of incontinence is having strong urges or leaks when one hears water running, washes hands, or drinks fluids. Stress urinary incontinence is characterized by small-volume losses of urine when coughing, laughing, exercising, or walking. Reflex urinary incontinence is characterized by leakage of urine without awareness. Overflow urinary incontinence is characterized by urinary frequency and involuntary leakage of small volumes of urine. Stress urinary incontinence, reflex urinary incontinence, and overflow urinary incontinence do not create an urge to urinate when hearing running water.

Pg. 1105

A patient experiencing bladder cancer is operated on, and an orthotopic neobladder is placed in the patient. What should the nurse explain to this patient?

A. The neobladder has to be catheterized frequently.

B. The patient can void normally.

C. The urine drains continuously.

D. The patient has to use a collection pouch at all times.

Rationale: An orthotopic neobladder is placed at the same position as the normal bladder, and the patient is able to void normally. The bladder pouch must be catheterized frequently in case a continent urinary reservoir is created from a distal portion of the ileum and proximal portion of the colon. In an incontinent urinary diversion, the urine drains continuously and needs application of a collection pouch at all times.

Pg. 1106

Which type of urinary incontinence is managed with timed voiding and double voiding?

A. Transient incontinence

B. Urge incontinence

C. Stress urinary incontinence

D. Overflow urinary incontinence

Rationale: Urinary incontinence associated with chronic retention of urine, also known as overflow urinary incontinence in its mild form, is managed by timed voiding and double voiding. Transient incontinence is managed by identifying reversible causes. Urge incontinence can be managed by avoiding stimulants including caffeine, artificial sweeteners, and alcohol. Stress urinary incontinence is managed by instructing the patient to do pelvic muscle exercises as directed by the health care provider.

Pg. 1104

A patient is scheduled for a cystoscopy. What instructions should the nurse give to this patient about cystoscopy?

A. The patient should limit the intake of fluids before the test.

B. Urine output will increase after the test.

C. The patient may have difficulty in voiding after the test.

D. Urine will be straw colored after the test.

Rationale: Cystoscopy involves the visualization of urinary structures through a scope inserted into the urinary tract. It may cause tissue edema, and as a result, the patient may have difficulty voiding after the test. Fluid intake is limited for intravenous pyelogram (IVP) but not for cystoscopy. Because of edema, the urine output may decrease, not increase. The urine may be red or pink in color after the test because of local injury.

Pg. 1114

A patient with a bladder disorder is advised to get a urinary diversion. The patient wishes to have the type of urinary diversion that allows normal voiding. Which type of urinary diversion suits the patient's requirement?

A. Insertion of bilateral nephrostomy tubes

B. Incontinent urinary diversion

C. Orthotopic neobladder using an ileal pouch

D. Radical cystectomy with an ileal conduit

Rationale: Orthotopic neobladder of the ileal pouch is the diversion procedure that allows the patient to have normal voiding. Nephrostomy tubes need urinary drainage directly from the renal pelvis. Incontinent urinary diversion is associated with continuous urinary drainage without the patient's voluntary control. A radical cystectomy with an ileal conduit forms a stoma on the abdominal wall and necessitates lifelong wearing of a stoma appliance and a drainage bag.

Pg. 1106

An elderly male patient has been admitted to the hospital for a urinary tract infection. About which physiological changes in the urinary system should the nurse teach the patient? Select all that apply.

A. Nocturia is less common in elders.

B. Urinary retention increases the risk of urinary infection.

C. Prostate enlargement decreases urinary frequency.

D. Prostate enlargement may lead to urinary retention.

E. Ineffective bladder contraction leads to urinary retention.

Rationale: Urinary retention increases the risk for bacterial growth and development of urinary infection. Prostate enlargement may lead to urinary retention by obstructing the flow of urine. Because the bladder cannot contract effectively, an older adult often retains urine after voiding. The older adult often experiences nocturia. Prostate enlargement increases urinary frequency due to incomplete voiding.

Study Tip: The old standbys of enough sleep and adequate nutritional intake can help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage, so be sure to eat healthy foods before the exam.

Pg. 1102

A student nurse is learning about the structure and function of the urinary system. Which statement if made by the student nurse indicates effective knowledge about the ureters?

A. "A kidney stone can result in hydroureter."

B. "The distensible body of the ureters is called the detrusor."

C. "Urine enters the urinary bladder through the ureter in a steady flow."

D. "Compression of the upper part of the ureters prevents backflow of urine during micturition."

Rationale: A kidney stone can obstruct the flow of urine through the ureters, causing a backflow of urine into the ureters and kidney. This can cause distension, such as hydroureter or hydronephrosis. The distensible body of the urinary bladder is called the detrusor. Peristaltic waves cause urine to enter the bladder in spurts rather than steadily. Contractions of the bladder during micturition compress the lower part of the ureters to prevent urine from flowing back into the ureters.

Pg. 1103

To minimize nocturia, what should the nurse teach the patient to do?

A. Perform perineal hygiene after urinating.

B. Set up a toileting schedule.

C. Double void.

D. Limit fluids before bedtime.

Rationale: With nocturia the patient has to get up during the night to urinate. Limiting fluids 2 hours before bedtime minimizes nocturia. Performing perineal hygiene after urinating, a toileting schedule, and double voiding will not minimize nocturia.

Pg. 1118

A patient reports a burning sensation and pain while passing urine. What should the nurse include in the assessment?

A. Ask if other family members are sick.

B. Determine height and weight.

C. Look for presence of blood in the urine.

D. See if the patient has a history of hypertension.

Rationale: Pain and a burning sensation during urination are symptoms of a lower urinary tract infection. Irritation to the bladder mucosa by bacteria frequently causes hematuria (blood in the urine), so presence of blood in the urine is another sign of a urinary tract infection. Urinary tract infections are not contagious, so asking if any other family members are sick will not help. Assessing the patient's height and weight is important but not relevant to a urinary tract infection. Whether or not the patient has a history of hypertension is irrelevant to urinary tract infections.

Test-Taking Tip: Notice that the correct answer for this question corresponds directly to the question set-up. The burning sensation while urinating correlates directly with checking urine. It is not a hidden or tricky answer—just a direct correlation.

Pg. 1103

A patient complains that he is not able to pass urine completely. Even after voiding, the patient does not feel that the bladder is empty. Which tests can be done to assess the postvoid residual (PVR) in the patient?

A. Portable noninvasive bladder ultrasound device

B. Cystoscopy

C. X-ray of the abdomen

D. Intravenous pyelogram (IVP)

Rationale: Postvoid residual can be assessed using a portable noninvasive bladder ultrasound device, which helps to determine the amount of urine left in the bladder after voiding. A cystoscopy helps to visualize the structures of the urinary tract. An x-ray exam of the abdomen may show the condition of abdominal organs but is not helpful in determining the residual urine left in the bladder. An intravenous pyelogram may help to determine the function of the kidneys but does not help in determining postvoid residual.

Pg. 1123

Which measures should the nurse emphasize to prevent urinary infection in females? Select all that apply.

A. Proper hand washing

B. Use of indwelling catheters

C. Frequent sexual intercourse

D. Wiping from front to back after voiding and defecation

E. Adequate fluid intake

Rationale: Proper hand washing may prevent the spread of microorganisms. Wiping from front to back after voiding and defecation prevents the entry of microorganisms to the urinary system. Adequate fluid intake promotes urine formation and prevents bacterial growth. Indwelling urinary catheters serve as a port of entry for microorganisms and increase the risk of infection. Frequent sexual intercourse increases the risk of infection by introducing microorganisms into the genital area.

Pg. 1108

Which term describes leakage of urine despite voluntary control of urination?

A. Urgency

B. Dribbling

C. Hesitancy

D. Incontinence

Rationale: Dribbling is the leakage of urine despite voluntary control of urination. Urgency is the feeling of the need to void immediately. Hesitancy is difficulty initiating urination. Incontinence is the involuntary loss of urine.

Pg. 1110

The nurse is reviewing the laboratory reports of a patient. The urine report shows the presence of large proteins in the urine. What is the most probable cause of proteinuria?

A. Glomerular injury

B. Infection of the urinary tract

C. Excessive aspirin ingestion

D. Starvation

Rationale: The glomerular capillaries filter water, glucose, amino acids, urea, creatinine, and major electrolytes from the blood. Large proteins do not normally get filtered because of the size of protein molecules. However, if the glomeruli are injured, the large proteins may pass into the urine. The presence of white blood cells in the urine indicates infection of the urinary tract. The presence of ketones in urine may be due to excess ingestion of aspirin and starvation.

Test-Taking Tip: The longest answer is not always the correct one! You must read and evaluate each choice without regard to length or pattern of previous answers.

Pg. 1113

The nurse is caring for a patient who exhibits slow movements associated with Parkinson's disease. For which type of urinary incontinence should the nurse assess in this patient?

A. Transient incontinence

B. Functional incontinence

C. Reflex urinary incontinence

D. Overflow urinary incontinence

Rationale: Functional incontinence is a loss of continence with a cause outside the urinary tract, usually related to functional deficits such as altered mobility and manual dexterity. Parkinson's disease alters a patient's mobility, which can result in functional incontinence. Transient incontinence is caused by medical conditions that in many cases are treatable and reversible. Parkinson's disease and its associated problems of mobility are not reversible. Reflex urinary incontinence is related to spinal cord damage between C1 and S2; it is not associated with mobility problems caused by Parkinson's disease. Overflow urinary incontinence is related to bladder outlet obstruction or poor bladder emptying because of weak or absent bladder contractions, not Parkinson's disease.

Pg. 1104

Which measurement lies in the normal range for the length of an adult female urethra?

A. 2 cm

B. 4 cm

C. 15 cm

D. 19 cm

Rationale: The average adult female urethra is approximately 3 to 4 cm; therefore, a length of 2 cm is shorter than average and a length of 15 cm is too long. The male urethra is about 18 to 20 cm long.

Pg. 1103

Which is a cause of transient urinary incontinence?

A. Idiopathic

B. Fecal impaction

C. Cognitive impairment

D. Overactive bladder caused by neurological problems

Rationale: Transient incontinence is caused by medical conditions that in many cases are treatable and reversible. Fecal impaction is a reversible condition that can cause transient urinary incontinence. Urge urinary incontinence can be caused by idiopathic bladder overactivity, meaning the cause of this type of incontinence is unknown. Cognitive impairment can cause functional incontinence. Urge urinary incontinence can also be often associated with a strong sense of urgency related to an overactive bladder caused by a neurological problem.

Pg. 1104

Which bone-related changes should the nurse expect to see in a patient with chronic renal failure?

A. Calcification

B. Demineralization

C. Increased bone density

D. Bone marrow hyperplasia

Rationale: A patient with chronic renal failure cannot make sufficient amounts of active vitamin D. As a result, these patients are at risk of demineralization of the bone due to impaired calcium absorption in the intestine. The patient with chronic renal failure will be hypocalcemic due to impaired calcium and phosphorus metabolism; therefore, there will not be calcification in the bones. Bone density will decrease due to demineralization. Chronic renal failure does not cause bone marrow hyperplasia.

Test-Taking Tip: Once you have read each choice, if you are unsure, notice similarities and differences between the choices; these often provide a clue. Notice how all three incorrect choices imply "more bony material," whereas the correct response means "less bony material."

Pg. 1103

What are the characteristics associated with overflow urinary incontinence? Select all that apply.

A. Nocturia

B. Fecal impaction

C. Altered mobility

D. High post void residual volume

E. Distended bladder on palpation

Rationale: The characteristics associated with overflow urinary incontinence, or urinary incontinence associated with chronic retention of urine, are nocturia (waking up during the night to urinate), a high post void residual volume (the amount of urine left in the bladder after urination), and a distended bladder on palpation. Fecal impaction is usually associated with transient incontinence. Altered mobility is associated with functional incontinence.

Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Pg. 1104

A patient complains of passing only a small amount of urine despite a normal fluid intake. As what should the nurse record this?

A. Dysuria

B. Polyuria

C. Hematuria

D. Oliguria

Rationale: Oliguria is the decrease in urine output in spite of normal intake. It often occurs when fluid loss through other means such as sweating, diarrhea, or vomiting increases. Pain or burning during urination is called dysuria. Excessive output of urine is known as polyuria, and blood tinged urine is called hematuria.

Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the question, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled

Pg. 1110

What level of spinal cord injury causes urinary incontinence?

What are the 2 types of neurogenic bladder?

How does a spinal cord injury affect the urinary system?

Which condition is a cause of transient urinary incontinence?