A nurse is planning care for a preschooler who has leukemia. After reviewing the child's information, which of the following potential issues should the nurse identify that the child is at risk for developing? (Select all that apply.)

Choice A reason: Wheat is not a suitable food choice for a child who has celiac disease, as it contains gluten, a protein that triggers an immune response and damages the small intestine in people with celiac disease. Wheat is found in many breads, cereals, pastas, and baked goods, and it should be avoided by the child.

Choice B reason: Rice is a suitable food choice for a child who has celiac disease, as it is a gluten-free grain that does not cause any adverse reactions in people with celiac disease. Rice can be eaten plain or cooked with other gluten-free ingredients, such as vegetables, meat, or dairy.

Choice C reason: Barley is not a suitable food choice for a child who has celiac disease, as it contains gluten, a protein that triggers an immune response and damages the small intestine in people with celiac disease. Barley is found in some soups, stews, beers, and malt products, and it should be avoided by the child.

Choice D reason: Rye is not a suitable food choice for a child who has celiac disease, as it contains gluten, a protein that triggers an immune response and damages the small intestine in people with celiac disease. Rye is found in some breads, crackers, cereals, and whiskey, and it should be avoided by the child.

The correct answer is: B

Choice A reason: Determining if the child is having pain is important, but it is not the immediate priority. Pain assessment will help in managing the child’s comfort and can provide additional information about the condition. However, in the case of Wilms tumor, which is a common kidney cancer in children, the priority is to prevent any action that could potentially cause tumor spillage or spread.

Choice B reason: Instructing the parent to avoid pressing on the abdominal area is the priority action. Wilms tumor can rupture with pressure, which can lead to the spread of cancer cells. It is crucial to minimize handling of the tumor to prevent tumor spillage into the abdominal cavity.

Choice C reason: Scheduling the child for an abdominal ultrasound is a necessary diagnostic step, but it is not the immediate priority. The ultrasound will help in assessing the size and extent of the tumor, but the first action should be to ensure that the tumor is not disturbed.

Choice D reason: Obtaining a urine specimen for analysis is important for diagnosing the cause of the hematuria (blood in the urine), which is a common symptom of Wilms tumor. However, this is not the immediate priority compared to preventing potential harm to the child by avoiding pressure on the abdominal area.