A nurse is assessing a 1-year-old toddler who notices a large abdominal mass and pink-tinged urine on the diaper. Which of the following disorders should the nurse suspect?

Choice A reason: Tracheoesophageal fistula is a congenital anomaly that results from an abnormal connection between the trachea and the esophagus. It causes respiratory distress, choking, coughing, and cyanosis during feeding, and increased risk of aspiration pneumonia.

Choice B reason: Inguinal hernia is a protrusion of abdominal organs through the inguinal canal into the scrotum or labia. It causes a bulge in the groin area that may increase in size with crying or straining. It may also cause pain, vomiting, and impaired blood flow to the herniated tissue.

Choice C reason: Intussusception is a telescoping of one segment of the bowel into another, causing obstruction and impaired blood supply. It causes a palpable mass in the upper right quadrant, stools mixed with blood and mucus (resembling currant jelly), abdominal pain, vomiting, and shock.

Choice D reason: Hypertrophic pyloric stenosis is a narrowing of the pyloric sphincter due to hypertrophy of the surrounding muscle. It causes projectile vomiting, dehydration, weight loss, and a palpable olive-shaped mass in the upper right quadrant.

Choice A reason: Bleeding precaution is indicated for a child who has leukemia and a critically low platelet count, as it reduces the risk of hemorrhage and injury. The nurse should monitor the child for signs of bleeding, such as petechiae, ecchymosis, epistaxis, hematuria, and melena. The nurse should also avoid invasive procedures, use soft-bristled toothbrushes, apply pressure to venipuncture sites, and administer platelet transfusions as prescribed.

Choice B reason: Droplet precaution is not indicated for a child who has leukemia and a critically low platelet count, unless the child has a respiratory infection that is transmitted by droplets. Droplet precaution involves wearing a mask when within 3 feet of the child, and placing the child in a private room or with a roommate who has the same infection.

Choice C reason: Neutropenic precaution is indicated for a child who has leukemia and a critically low neutrophil count, as it reduces the risk of infection and sepsis. Neutropenic precaution involves placing the child in a private room with positive pressure airflow, wearing gloves, gown, and mask when entering the room, and restricting visitors who are ill or immunocompromised.

Choice D reason: Contact precaution is not indicated for a child who has leukemia and a critically low platelet count, unless the child has a skin or wound infection that is transmitted by direct or indirect contact. Contact precaution involves wearing gloves and gown when entering the room, and placing the child in a private room or with a roommate who has the same infection.