Bladder Cancer

1. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach?

"Good evening, Mr. Pablo. Wasn’t it a pleasant day, today?"

"Mr, Pablo, you must be so worried, I’ll leave you alone with your thoughts.

“Mr. Pablo, you’ll wear out the hospital floors and yourself at this rate."

"Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow’s surgery?"

The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns.

Explanation

The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns.

2. The health of the patient is a factor in deciding to use or not to use Chemo

True

False

3. Occupational exposure to aromatic amines cannot cause cancer

True

False

4. Recurring UTI, N/V and leukopenia are all adverse reactions to Chemotherapy and what else is one?

Fistula's

BPH

Penile Prosthetic

Nephrotoxicity

5. How many grades of cancer are there?

5

4

3

6

8

6. Aniline dyes have been linked to cancer

True

False

7. The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing:

Rupture of the bladder

The development of a vesicovaginal fistula

Extreme stress caused by the diagnosis of cancer

Altered perineal sensation as a side effect of radiation therapy

A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina.

Explanation

A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina.

8. Occupational exposure to pizza making has been linked to bladder cancer

True

False

9. Lowest degree of malignancy

Grade 1

Grade 2

Grade 3

Grade 4

10. Does not respond at all to radiation

Grade 2

Grade 3

Grade 1

Grade 4

11. Toxicity levels are unacceptable if the patient is worse off then before treatment

True

False

12. A client has been diagnosed as having bladder cancer, and a cystectomy and an ileal conduit are scheduled. Preoperatively, the nurse plans to:

Limit fluid intake for 24 hours

Teach the procedure for irrigation of the stoma

Teach muscle-tightening exercises

Provide cleansing enemas and laxatives as ordered

13. High degree of malignancy, usually anaplastic CA

Grade 2

Grade 1

Grade 4

Grade 3

14. A male client is being transferred to the nursing unit for admission after receiving a radium implant for bladder cancer. The nurse in-charge would take which priority action in the care of this client?

Place client on reverse isolation.

Admit the client into a private room.

Encourage the client to take frequent rest periods.

Encourage family and friends to visit.

The client who has a radiation implant is placed in a private room and has a limited number of visitors. This reduces the exposure of others to the radiation.

Explanation

The client who has a radiation implant is placed in a private room and has a limited number of visitors. This reduces the exposure of others to the radiation.

15. Most frequent presenting symptom is?

Painless hematuria

Flank pain due to ureteral obstruction or pelvic mass

Frequency

Constipation

16. Artificial sweeteners, pelvic irradiation and chronic cystitis can't cause cancer

True

False

17. What is a random bladder biopsy done for?

Stage and grade verification

Invasive

Noninvasive

Smaller tumors

Stages T1-T4

18. Higher levels of toxicity are acceptable if the cure can be achieved?

True

False

19. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed:

Intraventricular administration

Intravesical administration

Intravascular administration

Intrathecal administration

Medications administered intravesically are instilled into the bladder. Intraventricular administration involves the ventricles of the brain. Intravascular administration involves blood vessels. Intrathecal administration involves the fluid surrounding the brain and spinal cord.

Explanation

Medications administered intravesically are instilled into the bladder. Intraventricular administration involves the ventricles of the brain. Intravascular administration involves blood vessels. Intrathecal administration involves the fluid surrounding the brain and spinal cord.

20. What is the most common type of Bladder Cancer?

Squamous Cell Carcinoma

Transistional cell carcinoma

Epithelial hyperplasia

21. Cholinergics

Drugs that increase bladder outlet resistance

Drugs that inhibit contractility and promote urine storage

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that decrease bladder outlet resistance

22. Can coffee cause bladder tumors?

Yes

No

23. A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude?

The skin wasn’t lubricated before the pouch was applied.

The pouch faceplate doesn’t fit the stoma.

A skin barrier was applied properly.

Stoma dilation wasn’t performed.

If the pouch faceplate doesn’t fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn’t be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn’t performed with an ileal conduit, although it may be done with a colostomy if ordered.

Explanation

If the pouch faceplate doesn’t fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldn’t be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isn’t performed with an ileal conduit, although it may be done with a colostomy if ordered.

24. How does bladder cancer rate on the most commonly occurring GU cancer in adults list?

1st

2nd

4th

8th

25. A male client is receiving the cell cycle–nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?

It interferes with deoxyribonucleic acid (DNA) replication only.

It interferes with ribonucleic acid (RNA) transcription only.

It interferes with DNA replication and RNA transcription.

It destroys the cell membrane, causing lysis.

Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane.

Explanation

Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane.

26. Drugs that decrease bladder outlet resistance

Alpha-adrenergics blockers

Estrogens

Beta-adrenergics

Alpa-adrenergics

27. Well differentiated but fully malignant

Grade 1

Grade 2

Grade 3

Grade 4

28. Transitional cell carcinoma (TCC) is

A poorly differentiated carcinoma often without any papillary growth

A benign proliferation of urothelium in response to inflammation or irritation

A type of malignancy that arises from the urothelial lining of the urinary tract

A cancerous growth on the urothelium causing disintegration of the bladder wall and urothelium.

29. A client with bladder cancer is being treated with iridium seed implants. The nurse's discharge teaching should include telling the client to:

Strain his urine

Increase his fluid intake

Report urinary frequency

Avoid prolonged sitting

Iridium seeds can be expelled during urination, so the client should be taught to strain his urine and report to the doctor if any of the seeds are expelled. Increasing fluids, reporting urinary frequency, and avoiding prolonged sitting are not necessary

Explanation

Iridium seeds can be expelled during urination, so the client should be taught to strain his urine and report to the doctor if any of the seeds are expelled. Increasing fluids, reporting urinary frequency, and avoiding prolonged sitting are not necessary

30. Estrogens

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that increase bladder outlet resistance

Drugs that decrease bladder outlet resistance

Drugs that inhibit contractility and promote urine storage

31. Drugs that inhibit contractility and promote urine storage

Antispasmodics

Alpa-adrenergics

Cholinergics

External sphincter/striated muscle relaxent

32. Cigarette smoking can cause bladder cancer, but at what ratio to non-smokers?

3 times greater

4 times greater

5 times greater

2 times greater

33. Anticholinergics

Drugs that decrease bladder outlet resistance

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that inhibit contractility and promote urine storage

Drugs that increase bladder outlet resistance

34. Alpha-adrenergics

Drugs that inhibit contractility and promote urine storage

Drugs that decrease bladder outlet resistance

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that increase bladder outlet resistance

35. Beta-adrenergics

Drugs that increase bladder outlet resistance

Drugs that inhibit contractility and promote urine storage

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that decrease bladder outlet resistance

36. Tricyclic antidepressants

Drugs that inhibit contractility and promote urine storage

Drugs that increase bladder outlet resistance

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that decrease bladder outlet resistance

37. What percentage of bladder cancers does squamous cell carcinoma account for?

3%

5%

50%

95%

75%

38. Resistant

Grade 1

Grade 2

Grade 3

Grade 4

39. Does respond to radiation

Grade 3

Grade 4

Grade 2

Grade 1

40. Very low degree of malignancy

Grade 2

Grade 3

Grade 1

Grade 4

41. Beta-adrenergic blockers

Drugs that increase bladder outlet resistance

Drugs that decrease bladder outlet resistance

Drugs that simulate detrusor contractility and promote bladder emptying

Drugs that inhibit contractility and promote urine storage

42. Response is poor to radiation

Grade 3

Grade 1

Grade 2

Grade 4

43. From below what are symptoms of bladder cancer?

Painful hematuria

Frequency and urgency

Dysuria

Flank pain

Abdominal pain

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44. What would be a indication to use Chemotherapy?

Complete resolution of abnormal serum tumor markers

Location of tumor

Chronic reflux

N/V

Recurring CIS

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