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Pharmacology · chapter 33 · Introduction to the Renal and Urinary Systems

Introduction to the Urinary System

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Bladder capacity

    The bladder collapses when empty and can expand to accommodate 500–600 mL of urine.

  2. What prevents backflow into the ureters

    The ureters tunnel into the bladder surface, and pressure on this area prevents the backflow of urine into the ureter.

  3. Conditions that alter micturition

    Degenerative conditions such as Parkinson disease, multiple sclerosis, and stroke are commonly associated with altered micturition. Spinal cord injuries can disrupt signals to the bladder, causing alterations in the micturition process.

  4. Urge to void and loss of control

    The urge to void is sensed when the bladder contains 150 mL of urine. If this urge is not accommodated, the loss of voluntary control, resulting in urinary incontinence, can occur when the bladder contains 300–400 mL of urine.

  5. Normal residual volume

    Once micturition is complete, there is a normal residual volume of up to 50 mL of urine remaining in the bladder (Nandy Ranganathan, 2022).

  6. Urge incontinence

    There are multiple forms of UI, including: Urge incontinence: The client experiences a sudden strong urge to void and frequently does not have sufficient time to respond to the urge before urine leaks from the bladder. It is often the result of an overactive detrusor muscle.

  7. Stress incontinence

    Stress incontinence: This is caused by a sudden increase in intra-abdominal pressure as with sneezing, coughing, and bending, causing the urine to leak from the bladder.

  8. Stress incontinence risk factors

    This form of UI may be due to loss of pelvic muscle support of the bladder and urethra. Risk factors include estrogen depletion, obesity, childbirth trauma, and cancer therapies.

  9. Overflow incontinence

    Overflow incontinence: This type of UI results from obstruction of the urethra, which limits the amount of urine that is emptied with each void. This increases the residual volume of urine, which can lead to stasis of the urine and infection.

  10. Functional incontinence

    It often presents with other deficits such as immobility. The client has an intact urinary system but cannot respond quickly enough to avoid incontinence.

  11. How incontinence is treated

    Treatment is aimed at eliminating the underlying cause, strengthening the pelvic floor structures, the use of drugs to modify detrusor activity, and surgery.

  12. The voiding diary

    The voiding diary is one of the most important assessment tools for the diagnosis and treatment of all types of incontinence. The nurse provides the client with basic instructions and a template for recording liquid intake, urinary output, and any occurrences of incontinence.

  13. UTI risk factors

    Risk factors for urinary tract infections include increasing age, female sex, diabetes, obesity, congenital defects, neurogenic bladder, vesicoureteral reflux, and catheterization of the urinary tract.

  14. Urinary catheters in hospital

    The use of urinary catheters is a significant concern for hospitalized clients. The current recommendation is for short-term use only when necessary.

Terms to know

Micturition
Micturition, commonly called urination, is the process by which urine is discharged from the bladder.
Urinary incontinence
Urinary incontinence (UI) is defined as the involuntary loss of urine (Tran Puckett, 2022).
Cystitis
Cystitis is bladder inflammation usually caused by bacteria.
Vesicoureteral reflux
In addition, internally, sections of bladder mucosal tissue covering the entry of the ureters also inhibit the backflow of urine; this backflow is called vesicoureteral reflux.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A client reports leaking urine whenever she coughs, sneezes or bends over. Which type of incontinence does this describe?

    1. Functional incontinence
    2. Urge incontinence
    3. Stress incontinence
    4. Overflow incontinence

    Answer: Stress incontinence

    Stress incontinence is leakage with a sudden rise in intra-abdominal pressure, as with sneezing, coughing and bending. Urge incontinence is a sudden strong urge, overflow comes from urethral obstruction, and functional incontinence occurs with an intact urinary system.

  2. An older male client with benign prostatic hypertrophy dribbles urine and empties only a small amount with each void. The nurse recognises that this type of incontinence places the client at risk for what?

    1. Urinary stasis and infection
    2. An overactive detrusor muscle
    3. Loss of pelvic muscle support
    4. Dilute urine

    Answer: Urinary stasis and infection

    Overflow incontinence comes from urethral obstruction, which increases residual urine and can lead to stasis and infection. Loss of pelvic support relates to stress incontinence and an overactive detrusor to urge incontinence.

  3. A client is being evaluated for incontinence. Which action by the nurse best supports the diagnosis?

    1. Restrict all fluids for 24 hours before the visit.
    2. Insert an indwelling catheter to measure output.
    3. Ask the client to void only once every 8 hours.
    4. Give the client instructions and a template for a voiding diary.

    Answer: Give the client instructions and a template for a voiding diary.

    The voiding diary is one of the most important assessment tools for all types of incontinence; the nurse gives instructions and a template to record intake, output and episodes. Catheters are recommended only short term when necessary, and the other actions are not supported.

  4. Which clients have risk factors for a urinary tract infection? Select all that apply.

    1. An older adult client with diabetes
    2. A client with neurogenic bladder
    3. A young male client with no health problems
    4. A client with an indwelling urinary catheter
    5. A female client with obesity

    Answer: An older adult client with diabetes, A client with neurogenic bladder, A client with an indwelling urinary catheter, A female client with obesity

    Risk factors include increasing age, female sex, diabetes, obesity, neurogenic bladder, vesicoureteral reflux and catheterization. A young healthy male client has none of the listed risk factors.

  5. A client who had a stroke has urge incontinence. Which statements about this type of incontinence are accurate? Select all that apply.

    1. The client has an intact urinary system but cannot move quickly enough.
    2. It is often the result of an overactive detrusor muscle.
    3. It is common in clients with a history of stroke due to CNS damage.
    4. The client often does not have time to respond before urine leaks.
    5. It is caused only by coughing and sneezing.

    Answer: It is often the result of an overactive detrusor muscle., It is common in clients with a history of stroke due to CNS damage., The client often does not have time to respond before urine leaks.

    Urge incontinence is a sudden strong urge with too little time to respond, often from an overactive detrusor, and is common after stroke due to CNS damage. Leakage with coughing describes stress incontinence, and an intact system with limited mobility describes functional incontinence.

  6. A nurse measures a post-void residual of 40 mL in a client who has just urinated. How should the nurse interpret this?

    1. It indicates overflow incontinence.
    2. It means the urge to void has not been sensed.
    3. It is within the normal residual volume.
    4. It requires immediate catheterization.

    Answer: It is within the normal residual volume.

    After micturition, a normal residual volume of up to 50 mL remains in the bladder, so 40 mL is normal. It does not by itself indicate overflow incontinence or a need for catheterization.

Where every quote comes from

Section 33.3 Introduction to the Urinary System of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.