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Gaining Control: Making Sense of OABThis activity is supported by an unrestricted educational grant from Pfizer Inc.

Journal of Wound, Ostomy and Continence Nursing: May-June 2005 - Volume 32 - Issue 3S - p S24-S26
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  • Read the articles beginning on page S1.
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Registration Deadline: June 30, 2007

Provider Accreditation:

This Continuing Nursing Education (CNE) activity for 7 contact hours (Pharmacology credit: 1.5) and is provided by Lippincott Williams & Wilkins, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation and by the American Association of Critical-Care Nurses (AACN 00012278, CERP Category A). This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 7 contact hours (Pharmacology credit: 1.5). LWW is also an approved provider of CNE in Alabama, Florida, and Iowa and holds the following provider numbers: AL #ABNP0114, FL #FBN2454, IA #75. All of its home study activities are classified for Texas nursing continuing education requirements as Type I.

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CE Test Questions

GENERAL PURPOSE: To provide registered professional nurses with a comprehensive overview of overactive bladder syndrome.

LEARNING OBJECTIVES: After reading this article and taking this test, you will be able to:

  1. Define overactive bladder (OAB) dysfunction and discuss its impact, epidemiology, and pathophysiology.
  2. Describe assessment strategies for identifying patients with OAB and distinguishing high-tone and low-tone pelvic floor dysfunction.
  3. Outline behavioral interventions and pharmacologic agents used in the management of OAB.

1. The characteristic symptom of overactive bladder (OAB) is

a. bothersome urgency.

b. daytime voiding frequency.

c. nocturia.

d. hematuria.

2. The current emphasis on a symptoms-based approach to diagnosis of OAB has

a. removed the stigma previously associated with this syndrome.

b. eliminated the need for complex urodynamic testing within specialty practices.

c. facilitated management of the syndrome within primary care settings.

d. led to a greater reliance on urodynamic testing in all care settings.

3. Urine loss caused by physical exertion, coughing, or sneezing

a. is known as urge urinary incontinence (UI).

b. is known as stress UI.

c. is associated with voiding frequency.

d. may be categorized as either urge UI or stress UI.

4. Findings from two major prevalence studies reveal

a. a significantly higher incidence of OAB in women than in men.

b. a similar presentation of OAB in both men and women.

c. that the majority of patients with OAB also experience urge UI.

d. that men and women are equally affected by OAB with women more likely to experience urge incontinence.

5. The greatest negative impact of OAB may be related to

a. quality of life.

b. multiple aspects of physical health.

c. an increased incidence of urinary tract infections.

d. an increased potential for falls and fractures.

6. An individual with OAB is most likely to

a. seek out medical care related to the condition.

b. manage troublesome symptoms with minimal impact on social situations.

c. experience some fatigue associated with the condition.

d. conceal the conditions from healthcare providers.

7. OAB dysfunction is strongly associated with

a. poor innervation of the detrusor muscle.

b. pelvic trauma.

c. detrusor overactivity alone.

d. both detrusor overactivity and increased bladder sensations.

8. Urodynamic findings

a. elucidate the underlying cause of detrusor overactivity.

b. clarify the pathophysiologic mechanisms underpinning OAB dysfunction.

c. suggest a single mechanism underpinning OAB dysfunction.

d. have led to novel interventions in the management of OAB dysfunction.

9. Based on studies of multiple animal models, detrusor activity is affected by modulatory centers in the

a. brainstem.

b. spinal cord.

c. cerebral cortex.

d. brain, brainstem, and cerebral cortex.

10. An increased risk of OAB is associated with the consumption of

a. coffee.

b. vegetables, bread, and poultry.

c. carbonated beverages.

d. alcoholic beverages.

11. Improved management of OAB may be facilitated by

a. patients who take the lead in discussing their symptoms with healthcare providers.

b. nurses who initiate dialogues with patients about bladder control problems.

c. prompt referral to specialists at the first indication of troublesome urinary symptoms.

d. an increased awareness of this syndrome in the pharmaceutical industry.

12. A questionnaire designed to detect symptoms of OAB

a. is most useful with patients who have an established history of urinary problems.

b. should be completed prior to a scheduled medical visit as a component of an overall health assessment.

c. must be completed with the assistance of an advanced practice nurse or physician.

d. is useful primarily with patients who are ill at ease in discussing bladder control problems.

13. In evaluating patients with OAB, it is particularly important to

a. determine the most bothersome symptoms.

b. investigate all possible triggers to sudden urgency.

c. determine the most common trigger to sudden urgency.

d. explore “self care” practices used to accommodate troublesome symptoms.

14. During an abdominal examination, prolonged gurgling bowel sounds

a. most often indicate decreased motility.

b. may result from increased motility accompanying diarrhea.

c. may indicate fecal impaction.

d. is generally not a cause for concern.

15. In women, signs of urogenital atrophy include

a. malodorous vaginal discharge.

b. copious, non-odorous vaginal discharge.

c. vaginal mucosa that appears dry, pale, or inflamed.

d. excoriations and maceration of the vulva.

16. The Baden-Walker Halfway system is used to

a. grade pelvic organ prolapse.

b. measure the strength of the pelvic floor muscle (PFM).

c. assess rectal sphincter tone and sensation.

d. rate the severity of OAB symptoms.

17. The strength of the pelvic floor muscle (PFM)

a. is primarily of concern to women and is assessed during a pelvic examination.

b. can be determined only during the rectal examination.

c. can be assessed as a component of a pelvic examination in women and a rectal examination in both men and women.

d. is determined by having the patient “bear down” while the practitioner examines the anal sphincter.

18. Criteria for referral to a specialist include

a. any degree of pelvic organ prolapse.

b. hematuria with infection.

c. prostate nodule/enlargement.

d. excoriations and macerations of the vulva secondary to infection.

19. Urinary retention and fecal impaction have been associated with the use of

a. neuroleptics.

b. tricyclic antidepressants.

c. sedative-hypnotics.

d. a number of medications including opioids and calcium channel blockers.

20. Pelvic floor dysfunction

a. involves impairment of tone within the pelvic floor muscles.

b. describes the diminished contractile force of the pelvic floor muscles.

c. describes impairment of tone and/or contractile force within the pelvic floor muscles.

d. is associated primarily with neurogenic factors directly affecting smooth muscles in the bladder wall.

21. In evaluating patients with high tone pelvic floor dysfunction, the practitioner will most likely find

a. a thin, atrophied muscle and a wider vaginal vault or lax anal sphincter.

b. a persistent and elevated resting tone along with pain or discomfort on palpation.

c. incontinence, urgency, and frequency.

d. pudental denervation and connective tissue laxity in parturious women.

22. Behavioral interventions offer the advantage of

a. eliminating the need for drug regimens.

b. relative simplicity, low cost, and freedom from unpleasant side effects.

c. cure for a high percentage of patients.

d. effective symptom reduction within a short span of time.

23. Lifestyle factors such as caffeine intake, smoking, and obesity

a. appear to have a similar effect on OAB symptoms in both men and women.

b. are emphasized in the treatment plans of all OAB patients.

c. have been associated with urge incontinence, OAB, and detrusor overactivity in various clinical studies on women.

d. are currently minimized in treatment plans as the evidence base for their role in OAB has not been established.

24. The standard nonpharmacologic treatment for OAB is

a. bladder training.

b. pelvic floor muscle training.

c. based on the modification of various lifestyle factors.

d. includes a combination of behavioral interventions such as lifestyle measures and scheduled voiding regimens.

25. Both timed voiding and habit retraining

a. involve a toileting schedule that is matched to the patient's voiding pattern.

b. have as their goal the prevention of incontinent episodes.

c. involve extensive patient education.

d. use a fixed voiding schedule that remains unchanged over the course of treatment.

26. The specific aim of pelvic floor muscle training is to

a. eliminate incontinent episodes.

b. increase bladder capacity.

c. correct habitual patterns of frequent urination.

d. inhibit involuntary detrusor contractions and suppress involuntary voidings.

27. Behavioral interventions represent safe and effective treatments for

a. urge incontinence.

b. urgency.

c. frequency.

d. nocturia.

28. Antimuscarinic agents used in the management of OAB

a. exert their effects by a poorly understood mechanism.

b. block acetyl choline activity within muscarinic receptors in the bladder wall.

c. promote the uptake of acetyl choline at specific receptor sites in the bladder wall.

d. degrade the acetyl choline molecule.

29. The most common side effect associated with OAB medications is

a. constipation.

b. dry mouth.

c. blurred vision.

d. gastroesophageal reflux.

30. In randomized clinical trials, the primary outcomes used to judge the effectiveness of antimuscarinic agents are

a. frequency of voiding and urge urinary incontinence (UI) episodes.

b. changes in voided volume.

c. psychosocial impact and quality of life issues.

d. frequency of urgency episodes and nighttime voiding.

31. Transdermal oxybutynin is most often discontinued because of

a. skin irritations associated with the patch.

b. cognitive impairment.

c. blurred vision.

d. drug-drug interactions

32. For patients who require PRN dosing of an OAB medication but experience significant side effects, the ideal agent may be

a. immediate-release tolterodine.

b. extended-release tolterodine.

c. immediate-release oxybutynin.

d. extended-release oxybutynin.

33. All antimuscarinic agents are contraindicated in patients with

a. any degree of hepatic or renal impairment.

b. uncontrolled narrow angle glaucoma.

c. myasthenia gravis.

d. gastroesophageal reflux.

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Copyright © 2005 by the Wound, Ostomy and Continence Nurses Society