Which physical assessment technique will the nurse omit when caring for a 2-year-old child diagnosed with Wilms' tumor?

Percussing ankle and knee reflexes

Assessing for bowel sounds

Performing range-of-motion exercises on low extremities

Palpating the abdomen

Answer and Explanation

The Correct Answer is D

A. Percussing ankle and knee reflexes. Safe and non-invasive, and does not risk disturbing the tumor.
B. Assessing for bowel sounds. Routine part of assessment and does not involve manipulating the tumor.
C. Performing range-of-motion exercises on lower extremities. Safe and non-invasive, unrelated to the abdominal tumor.
D. Palpating the abdomen. Palpating the abdomen in a child with Wilms' tumor is avoided to prevent the risk of tumor rupture and subsequent metastasis.

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Correct Answer is D

Explanation

A. "I will report changes in breathing or signs of confusion." Correct action as changes in breathing or confusion can indicate diabetic ketoacidosis or other serious complications.
B. "I will encourage him to drink a half a cup of water or sugar-free fluid every 30 minutes."Ensuring adequate fluid intake helps prevent dehydration and helps manage blood sugar levels during illness.
C. "I will notify the doctor if his temperature is not controlled with acetaminophen." Correct action as fever may indicate an infection that needs further medical evaluation and treatment.
D. "I will continue to check his blood sugar two times every day." When a child with diabetes is ill, blood sugar should be monitored more frequently, typically every 3-4 hours, to manage the risk of hyperglycemia or hypoglycemia due to illness.

A. Apply cold compresses to the affected areas. B. Implement pain management on a PRN basis. C. Active range-of-motion (ROM) exercises daily. D. Promote hydration with IV and oral fluids.

Correct Answer is D

Explanation

A. Apply cold compresses to the affected areas. Cold can cause vasoconstriction, which may worsen the sickling and pain. Heat packs are generally recommended to promote circulation and relieve pain.
B. Implement pain management on a PRN basis. Pain management should be consistent and proactive rather than PRN (as needed). Regular pain control is essential in managing sickle cell crises.
C. Active range-of-motion (ROM) exercises daily. During a crisis, the child should rest and avoid physical activity to prevent further pain and complications. ROM exercises are more appropriate during non-crisis times for maintaining joint function.
D. Promote hydration with IV and oral fluids. Hydration is crucial during a sickle cell crisis as it helps to decrease blood viscosity, reducing the risk of further sickling and vaso-occlusive events.

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Which physical assessment technique will the nurse omit when caring for a 2-year-old child diagnosed with Wilms' tumor?

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