Which physical assessment technique should be omitted when caring for a 2-year-old child diagnosed with Wilms' tumor?

Correct Answer: B

Rationale: In caring for a 2-year-old child diagnosed with Wilms' tumor, the physical assessment technique that should be omitted is palpating the abdomen (Option B). This is because Wilms' tumor is a type of kidney cancer that primarily affects the kidneys, and palpating the abdomen could potentially disrupt the tumor or cause discomfort to the child due to the proximity of the tumor to the abdominal area. Performing range-of-motion exercises on lower extremities (Option A) is important for maintaining muscle tone and preventing contractures in pediatric patients. Assessing for bowel sounds (Option C) is essential to monitor gastrointestinal function, which can be affected by various conditions including cancer. Percussing ankle and knee reflexes (Option D) is a neurological assessment technique that helps evaluate the integrity of the nervous system in pediatric patients. Educationally, understanding the rationale behind omitting abdominal palpation in a child with Wilms' tumor emphasizes the importance of tailoring physical assessments to specific conditions to prevent harm or discomfort to the patient. It highlights the significance of considering the underlying pathology when conducting assessments in pediatric patients to provide safe and effective care.

Correct Answer: C

Rationale: In this scenario, option C, "It is acceptable to take frequent bubble baths," indicates a need for further teaching. Bubble baths can irritate the urethra and increase the risk of urinary tract infections (UTIs) in children by introducing bacteria into the urinary tract. Therefore, this statement goes against the goal of preventing UTIs. Option A is correct because washing and wiping the perineal area from front to back helps prevent the introduction of bacteria into the urinary tract. Option B is also correct as cotton underwear helps keep the perineal area dry, reducing the risk of UTIs. Option D is correct as staying hydrated and voiding frequently help flush out bacteria from the urinary tract. In a pediatric nursing context, it is crucial to educate parents on proper hygiene practices and lifestyle modifications to prevent UTIs in children. Emphasizing the importance of these strategies can help parents play an active role in maintaining their child's urinary health and well-being.

Correct Answer: A

Rationale: The most appropriate nursing intervention for a 7-year-old child with acute glomerulonephritis experiencing gross hematuria and bed rest is to provide activities for the child on restricted activity. Although the child may feel well, it is essential to limit activity until hematuria resolves to prevent complications and promote recovery.

Correct Answer: A

Rationale: In this scenario, option A, "The posterior fontanel is open," would require further action by the nurse for a 4-month-old infant. The posterior fontanel typically closes by 2 months of age, so its persistence being open at 4 months could indicate a potential issue with normal growth and development or increased intracranial pressure, necessitating further assessment and intervention. Option B, "The infant has good head control when held upright," is a normal developmental milestone for a 4-month-old infant, indicating appropriate muscle strength and coordination. Option C, "The infant is able to roll only from abdomen to back," is also a normal developmental milestone at this age, as infants typically develop the ability to roll from abdomen to back before mastering back to abdomen rolling. Option D, "The anterior fontanel is open and soft," is a normal finding in infants, as the anterior fontanel can remain open and soft until around 18 months of age, allowing for brain growth and development. Educationally, understanding the significance of fontanel closure and developmental milestones is crucial for pediatric nursing practice. This knowledge helps nurses identify deviations from normal growth and development, enabling timely interventions and promoting optimal health outcomes for infants.

Correct Answer: D

Rationale: In a young child with suspected bacterial meningitis presenting with fever, irritability, and vomiting, the nurse should anticipate a decreased glucose level in the cerebrospinal fluid (CSF). This is because bacterial meningitis causes an inflammatory response in the central nervous system, leading to increased consumption of glucose by the infecting organisms and inflammatory cells. A decreased CSF glucose level is a hallmark finding in bacterial meningitis and indicates the presence of an infectious process. Option A: Decreased protein count is not the expected finding in bacterial meningitis. In fact, bacterial meningitis typically presents with an elevated protein count in the CSF due to the inflammatory response. Option B: Clear, straw-colored fluid is not indicative of bacterial meningitis. In meningitis, the CSF is typically cloudy due to the presence of increased white blood cells and protein. Option C: A positive for red blood cells (RBCs) is not a characteristic finding in bacterial meningitis. The presence of RBCs in the CSF may suggest a traumatic tap rather than an infectious process. Educationally, understanding the expected CSF findings in bacterial meningitis is crucial for nurses caring for pediatric patients. Recognizing these key diagnostic indicators can help in prompt identification and treatment of this potentially life-threatening condition. Nurses must be knowledgeable about interpreting CSF results and understand the implications for patient care and management.