When caring for a child with Wilm's tumor, which of the following ...

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When caring for a child with Wilm's tumor, which of the following nursing interventions would be most important?
 
  1. Place child on neutropenic precautions.
   2. Monitor bowel sounds in order to detect ileus.
   3. Position in the high fowler's position in order to increase lung capacity.
   4. Avoid palpation of the abdomen.

Question 2

It is May, and a mother brings in her 3-year-old son, who has had a harsh whooping cough, runny nose, and watery eyes for the past five days. What would be the most appropriate question to ask the mother?
 
  1. Are the child's immunizations up-to-date, including his Tdap vaccine?
   2. Did the child receive his Hib vaccine?
   3. Have you taken the child outside in the rain? If so, what happened?
   4. When was the last time your child was ill?

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Answer to Question 1

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1. The child will need neutropenic precautions if radiation or chemotherapy are provided.
2. A Wilm's tumor should not cause an ileus.
3. The lungs are not affected in a child with a Wilm's tumor, so it is not the most important intervention at this time.
4. The tumor is located in the abdomen and may be harmful to the child with palpation of the abdomen.

Answer to Question 2

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1. Up-to-date immunizations will include the Tdap vaccine. If the child has had the vaccine the occurrence/severity of the illness is less.
2. Hib does not include the Whooping Cough vaccine. The question would not be appropriate at this time.
3. Weather does not influence the vaccines.
4. Past illnesses is not the focus of the current assessment and is not appropriate at this time.