When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most important to avoid which of the following?

A. Adhere to strict dietary reduction of oily foods:

Dietary changes, particularly reducing oily and greasy foods, are often recommended as a measure to manage acne. However, the evidence supporting this recommendation is mixed, and strict dietary restrictions may not be necessary for all individuals with acne. Therefore, while the nurse might mention the potential impact of diet on acne, strict dietary reduction of oily foods is not typically the primary focus of acne treatment.

B. Express the larger comedones periodically:

Expressing or squeezing comedones (blackheads or whiteheads) can lead to further inflammation, scarring, and infection. It is not recommended to express comedones at home without proper training and technique. Attempting to express comedones can exacerbate acne and may cause more harm than good.

C. Minimize sun exposure:

Sun exposure can worsen acne and lead to increased inflammation and hyperpigmentation. Therefore, it is important for individuals with acne to minimize sun exposure and use sunscreen with a broad-spectrum SPF of 30 or higher.

D. Use friction when washing the face:

Excessive friction or aggressive scrubbing when washing the face can irritate the skin and worsen acne. Instead, the nurse should advise gentle cleansing of the face using a mild, non-comedogenic cleanser and lukewarm water. Harsh scrubbing or using abrasive cleansers can disrupt the skin barrier and exacerbate acne symptoms.

A. Gross hematuria: Gross hematuria refers to visible blood in the urine, which can present as pink, red, or cola-colored urine. While hematuria can be associated with various kidney conditions, including Wilms' tumor, it is not a consistent or defining symptom of this specific tumor. Additionally, because the tumor is typically confined within the kidney and does not usually invade the urinary tract, gross hematuria might not always be present.

B. Dysuria: Dysuria is the medical term for painful or difficult urination. It is not a typical symptom of Wilms' tumor, as this tumor primarily affects the kidney and may not directly affect the urinary tract in a way that causes painful urination.

C. An abdominal mass: This is the correct answer. Wilms' tumor often presents as a palpable abdominal mass, which may be felt during physical examination. The mass is usually firm, non-tender, and confined to one side of the abdomen. Detection of an abdominal mass should prompt further diagnostic evaluation to confirm the diagnosis and plan appropriate treatment.

D. Nausea and vomiting: While some children with Wilms' tumor may experience nausea and vomiting, these symptoms are nonspecific and can be caused by various conditions. They are not considered characteristic or defining features of Wilms' tumor. The presence of nausea and vomiting would prompt further assessment to determine the underlying cause