Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth
Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth
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Chapter 27- Disorders of the Bladder and Lower Urinary Tract
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | In anatomy class, the instructor asks, “Explain how urine is expelled from the bladder during voiding.” The student with the most accurate response would be: | |
| A) | “The urothelium acts as a barrier to prevent urine from seeping into capillaries.” | |
| B) | “The beginning of micturition occurs when neurons send messages down to the pudendal nerve.” | |
| C) | “The detrusor muscle contract down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder.” | |
| D) | “It’s really the external sphincter muscle that controls urination. The somatic nervous system innervates the muscles of the external sphincter and the pelvic floor muscles that together control the outflow of urine.” | |
| Ans: | C | |
| Feedback: | ||
| During the act of micturition, the detrusor muscle of the bladder fundus and bladder neck contracts down on the urine and the ureteral orifices are forced shut. The bladder neck is widened and shortened, and the external sphincter relaxes as urine moves out of the bladder. Descent of the diaphragm and contraction of the abdominal muscles raise intra-abdominal pressure and aid in the expulsion of urine from the bladder. | ||
| 2. | A newly diagnosed paraplegic client who suffered an automobile accident appears to have control of bladder emptying. The health care provider explains this process to the client/family stating, “This function is allowing the motor component of the neural reflex to assist with bladder emptying and is primarily controlled by the: | |
| A) | Parasympathetic division of the ANS.” | |
| B) | Sympathetic division of the ANS.” | |
| C) | Somatic nervous system.” | |
| D) | Hypogastric nervous system.” | |
| Ans: | A | |
| Feedback: | ||
| The motor component of the neural reflex to assist with bladder emptying is primarily controlled by the parasympathetic division of the ANS, and the relaxation and storage functions of the bladder are controlled by the sympathetic division. The somatic nervous system innervates the skeletal muscles of the external sphincter and the pelvic floor muscles that together control the outflow of urine. The afferent input from the bladder and urethra is carried to the CNS by fibers that travel with PS, somatic, and sympathetic (hypogastric) nerves. | ||
| 3. | After reviewing the 24-hour intake and output of a hospital client, the nurse suspects that the client may be experiencing flaccid bladder dysfunction. Which of the following diagnostic methods is most likely to confirm or rule out whether the client is retaining urine? | |
| A) | Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate | |
| B) | Urine test for culture and sensitivity | |
| C) | Routine urinalysis | |
| D) | Measurement of postvoid residual (PVR) by ultrasound | |
| Ans: | D | |
| Feedback: | ||
| Measurement of PVR can be achieved quickly, accurately, and painlessly by the use of ultrasonography. A PVR value of less than 50 mL is considered adequate bladder emptying, and more than 200 mL indicates inadequate bladder emptying. Urine tests and blood tests will not directly indicate whether a client is experiencing bladder fill with insufficiency in emptying. | ||
| 4. | Although urinary obstruction and urinary incontinence have almost opposite effects on urination, they can both result from: | |
| A) | Bladder structure changes | |
| B) | Bladder wall atrophy | |
| C) | Micturition reflex spasms | |
| D) | Bladder distensibility loss | |
| Ans: | A | |
| Feedback: | ||
| Disorders of lower urinary tract structure and function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Both types of disorders can have their origin in the structures of the lower urinary tract or in the neural mechanisms that control their function. Urinary incontinence can result from loss of bladder distensibility. Chronic outlet obstruction can cause bladder wall hypertrophy. Incontinence can result from reflex spasms, leading to segmental reflex bladder control instead of micturition center control. | ||
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