Answer to Question 1
B
Excessive manipulation of the tumor area can cause seeding of the tumor and spread of the malignant cells. Fluids are not routinely limited in a child with a Wilms' tumor. However, intake and output are important because of the kidney involvement. Fluids are not forced on a child with a Wilms' tumor. Normal intake for age is usually maintained. The abdomen of a child with a Wilms' tumor should never be palpated because of the danger of seeding the tumor and spreading malignant cells.
Answer to Question 2
C
Suggesting that noticing subtle changes in their children's health is not uncommon minimizes the role the mother played in not seeking early medical attention. It also displays empathy, which helps to build trust, thereby enabling the mother to talk about her feelings. Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness. The goal is to relieve the mother's guilt and build trust so that she can talk about her feelings. Telling the mother that she should have called the pediatrician will only reinforce her guilt. Adages such as It is better to be safe than sorry are flippant and reinforce the belief that the mother was negligent, which will only increase her guilt. Telling the mother that you hope the delay does not affect the treatment plan shows a total lack of empathy and would increase the mother's feelings of guilt.
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Treating the younger school-age child
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Long-term relationships, especially those who are married, having a child