Oncology/ blood
The nurse instructs the parents of a child with leukemia regarding measures related to monitoring for infection. Which statement, if made by the parent, indicates a need for further instructions? 1. "I will take a rectal temperature daily." 2. "I will inspect the skin daily for redness." 3. "I will inspect the mouth daily for lesions." 4. "I will perform proper hand washing techniques."
1. "I will take a rectal temperature daily." Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The risk of injury to fragile mucous membranes is so high in the child with leukemia that tympanic or axillary temperatures should be taken. Rectal abscesses can occur easily to damaged rectal tissue. No rectal temperatures should be taken. In addition, oral temperature taking should be avoided, especially if the child has oral ulcers. All other options are appropriate measures to prevent infection.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.
1. Initiate bleeding precautions. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has a platelet count less than 20,000 cells/mm3, bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding.
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache
1. Vomiting The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in intracranial pressure (ICP), which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which intervention? 1. Restrict oral fluids. 2. Use good hand washing technique. 3. Give immunizations appropriate for age. 4. Institute strict isolation with no visitors allowed.
2. Use good hand washing technique. A child with myelosuppression is at risk for infection. Good hand washing technique is necessary to prevent the spread of infection. Restricting oral fluids would not be an intervention to reduce the risk of infection and could actually be harmful to the child. Live virus vaccines are not given when the child is myelosuppressed, so assessment of the child's immune status should be done before administration of immunizations appropriate for age. Strict isolation without visitors is not warranted, although visitors should wear a mask and gloves while in the child's room.
A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. What is the nurse's best response? 1. "It's very costly, and chemotherapy works just as well." 2. "I'm not sure. I'll discuss it with the health care provider." 3. "Sometimes age has to do with the decision for radiation therapy." 4. "The health care provider would prefer that you discuss treatment options with the oncologist."
3. "Sometimes age has to do with the decision for radiation therapy." Radiation therapy is usually delayed until a child is 8 years old, whenever possible, to prevent retardation of bone growth and soft tissue development. Options 1, 2, and 4 are inappropriate responses to the mother and place the mother's question on hold.
The nurse is monitoring for bleeding in a child following surgery for removal of a brain tumor. The nurse checks the head dressing and notes the presence of dried blood on the back of the dressing. The child is alert and oriented, and the vital signs and neurological signs are stable. Which nursing action is most appropriate initially? 1. Prepare to change the dressing. 2. Recheck the dressing in 1 hour. 3. Check the operative record to determine whether a drain is in place. 4. Document the findings and notify the health care provider immediately.
3. Check the operative record to determine whether a drain is in place. The initial nursing action is to determine whether a drain is in place because this could attribute to the drainage seen on the dressing. The nurse would not change the dressing without a health care provider's prescription. Rechecking the dressing is an appropriate action, but it is not the initial action. The findings would be documented however there is no reason to notify the health care provider immediately. The initial action would be to assess the cause of the drainage further.
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes
4. The presence of Reed-Sternberg cells in the lymph nodes Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-Barr virus is associated with infectious mononucleosis.
The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. The nurse understands that which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area
1. Abdominal pain 5. Painless, firm, and movable adenopathy in the cervical area Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.
The nurse is providing home care instructions to the mother of a child receiving radiation therapy. Which statement by the mother indicates a need for further teaching? 1. "I should dress my child in loose-fitting clothing." 2. "I won't need to limit the amount of sun that my child gets." 3. "My child may experience fatigue and need more rest periods." 4. "I need to try to provide food and fluids to prevent dehydration."
2. "I won't need to limit the amount of sun that my child gets." Sun protection is essential during radiation treatments. The child should not be exposed to sun during these treatments because of the risk of an alteration of skin integrity. Options 1, 3, and 4 are appropriate measures for the child during radiation therapy.
The nurse is caring for a 3-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL). The child is crying and complaining that his knees hurt. Which nursing intervention is most appropriate? 1. Involve the child in a diversional activity. 2. Ask the child if he would like a "baby aspirin." 3. Administer acetaminophen (Tylenol) to the child. 4. Apply heat to the child's knees and elevate the knees on a pillow.
3. Administer acetaminophen (Tylenol) to the child. Acetaminophen is acceptable and does not have anticoagulant properties. Diversional activities would not relieve the pain. Aspirin is not administered to the child with ALL because of its anticoagulant properties and administering aspirin could lead to bleeding in the joints. Heat also would increase the pain by increasing circulation to the area.
The pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a lack of understanding of the pathophysiology of this disease? 1. The platelet count is decreased. 2. Red blood cell production is affected. 3. Reed-Sternberg cells are found on biopsy. 4. Normal bone marrow is replaced by blast cells.
3. Reed-Sternberg cells are found on biopsy. In leukemia, normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually red blood cell and platelet production is affected, and the child becomes anemic and thrombocytopenic. The Reed-Sternberg cell is found in Hodgkin's disease.
A nurse is reviewing the record of a 10-year-old child suspected of having Hodgkin's disease. Which characteristic manifestation should the nurse anticipate to be documented in the assessment notes? 1. Fever 2. Malaise 3. Painful lymph nodes in the supraclavicular area 4. Painless and movable lymph nodes in the cervical area
4. Painless and movable lymph nodes in the cervical area Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular area. Hepatosplenomegaly is also noted. Although anorexia, weight loss, fever, and malaise are associated with Hodgkin's disease, these manifestations are vague and can be seen in many disorders.
The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question should the nurse ask to elicit data related to the classic symptoms of a brain tumor? 1. "Do you have trouble seeing?" 2. "Do you feel tired all the time?" 3. "Do you throw up in the morning?" 4. "Do you have headaches late in the day?"
3. "Do you throw up in the morning?" The classic symptoms of children with brain tumors are headache and morning vomiting related to the child getting out of bed. Headaches worsen on arising but improve during the day. Fatigue may occur but is a vague symptom. Visual changes may occur, including nystagmus, diplopia, and strabismus, but these signs are not the hallmark symptoms with a brain tumor.
The nurse is reviewing the laboratory and diagnostic test results of a child scheduled to be seen in the clinic. The nurse notes that the health care provider documented that diagnostic studies revealed the presence of Reed-Sternberg cells. The nurse prepares to assist the health care provider to discuss treatment options for which disease with the parents? 1. Leukemia 2. Neuroblastoma 3. Hodgkin's disease 4. Infectious mononucleosis
3. Hodgkin's disease Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the hallmark of this disease. The presence of blast cells in the bone marrow is indicative of leukemia. Infectious mononucleosis and Epstein-Barr virus have been associated with Hodgkin's disease, but the exact relationship is unknown. Elevated vanillylmandelic acid (VMA) urinary levels are found in children with neuroblastoma.
A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which finding is most specifically related to this type of tumor? 1. Positive Babinski's sign 2. Presence of blast cells in the bone marrow 3. Projectile vomiting, usually in the morning 4. Elevated vanillylmandelic acid (VMA) urinary levels
4. Elevated vanillylmandelic acid (VMA) urinary levels Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.
A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. Which is the appropriate and supportive response to the mother? 1. "The child is too young to have radiation therapy." 2. "It's very costly, and chemotherapy works just as well." 3. "I'm not sure. I'll discuss it with the health care provider." 4. "The health care provider (HCP) would prefer that you discuss treatment options with the oncologist."
1. "The child is too young to have radiation therapy." Radiation therapy is usually delayed until a child is 8 years of age, if possible to prevent retardation of bone growth and soft tissue development. The remaining options are inappropriate responses to the mother.
A 14-year-old girl is admitted to the hospital with a diagnosis of acute lymphocytic leukemia. She is receiving a combination chemotherapeutic regimen that includes cyclophosphamide. The nurse plans care understanding that which are associated with this medication? Select all that apply. 1. It is platelet sparing. 2. It causes constipation. 3. It causes hemorrhagic cystitis. 4. It causes bone marrow depression. 5. Increased fluid intake is necessary.
1. It is platelet sparing. 3. It causes hemorrhagic cystitis. 4. It causes bone marrow depression. 5. Increased fluid intake is necessary. Cyclophosphamide is an alkylating agent used as a chemotherapeutic agent in children with leukemia and other cancers. It also causes hemorrhagic cystitis; therefore increased fluid intake is necessary. It does not cause constipation. Its side effects include bone marrow depression (BMD), but it is platelet sparing.
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 1. Notify the health care provider (HCP). 2. Place the child in a supine position. 3. Place the child in Trendelenburg's position. 4. Increase the flow rate of the intravenous fluids.
1. Notify the health care provider (HCP). In the event of shock, the HCP is notified immediately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg's position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension
1. Palpating the abdomen for a mass Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.
A 13-year-old child is diagnosed with Ewing's sarcoma of the femur. After a course of radiation and chemotherapy, it was decided that leg amputation is necessary. After the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which nursing statement is most appropriate to assist in alleviating the child's fear? 1. "The pain medication that I give you will take these feelings away." 2. "This aching and cramping is normal and temporary and will subside." 3. "This pain is not real pain, and relaxation exercises will help it go away." 4. "This normally occurs after the surgery, and we will teach you ways to deal with it."
2. "This aching and cramping is normal and temporary and will subside." After amputation, phantom limb pain is a temporary condition that some children experience. This sensation of burning, aching, or cramping in the missing limb is distressing to the child. The child needs to be reassured that the condition is normal and only temporary. All other options are not appropriate responses to the child, as they are incorrect or inappropriate statements.
A nurse is caring for a 9-year-old child with leukemia who is hospitalized for the administration of chemotherapy. The nurse would monitor the child specifically for central nervous system (CNS) involvement by checking which item? 1. Pupillary reaction 2. Level of consciousness (LOC) 3. The presence of petechiae in the sclera 4. Color, motion, and sensation of the extremities
2. Level of consciousness (LOC) The CNS status is monitored in the child with leukemia because of the risk of infiltration of blast cells into the CNS. The nurse should check the child's LOC and should also monitor for signs of irritability, vomiting, and lethargy. Changes in pupillary reaction are specific to conditions related to increased intracranial pressure. The presence of petechiae in the sclera is an objective sign that may be noted in leukemia but is not specifically related to the CNS. Color, motion, and sensation of the extremities relate to a neurovascular assessment and are not specifically related to CNS status.
A child is scheduled for allogeneic bone marrow transplantation (BMT). The parent of the child asks the nurse about the procedure. The nurse should provide which description about the BMT transplantation? 1. Aspiration of bone marrow from the child 2. Obtaining bone marrow from the child's twin 3. Obtaining bovine (cow) bone marrow and administering it to the child 4. Obtaining bone marrow from a donor who matches the child's tissue type
4. Obtaining bone marrow from a donor who matches the child's tissue type In allogeneic BMT, a donor who matches the child's tissue type is found. That bone marrow is then given to the child. In autologous BMT, the child undergoes general anesthesia for aspiration of his or her bone marrow, which is then processed in the laboratory and frozen until that marrow needs to be infused back into the child. Syngeneic BMT is done when the child has an identical twin. Option 3 is not used in a BMT.
The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."
2. "The child does not experience pain at the primary tumor site." Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma.
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.
2. Notify the health care provider (HCP). Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention because they do not address the need for immediate intervention to prevent complications.
Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle stick area for at least 10 minutes
2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand-washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle stick area for at least 10 minutes is a measure to prevent bleeding.
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."
3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.
The pediatric nurse assists the health care provider in performing a lumbar puncture (LP) on a 3-year-old child with leukemia and suspected central nervous system metastasis. The nurse should place the child in which position for this procedure? 1. Lithotomy position 2. Modified Sims position 3. Prone, with the knees flexed to the abdomen and the head bent, the chin resting on the chest 4. Lateral recumbent, with the knees flexed to the abdomen and the head bent, the chin resting on the chest
4. Lateral recumbent, with the knees flexed to the abdomen and the head bent, the chin resting on the chest A lateral recumbent position, with the knees flexed to the abdomen and the head bent with the chin resting on the chest, is assumed for a lumbar puncture. This position separates the spinal processes and facilitates needle insertion into the subarachnoid space. The remaining options are incorrect positions.
The nurse has reviewed the health care provider's prescriptions for a child suspected of a diagnosis of neuroblastoma and is preparing to implement diagnostic procedures that will confirm the diagnosis. What should the nurse expect to do next to assist in confirming the diagnosis? 1. Collect a 24-hour urine sample. 2. Perform a neurological assessment. 3. Assist with a bone marrow aspiration. 4. Send to the radiology department for a chest x-ray.
1. Collect a 24-hour urine sample. Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor infringes on adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated vanillylmandelic acid (VMA) levels. A bone marrow aspiration will assist in determining marrow involvement. A neurological examination and a chest x-ray may be performed but will not confirm the diagnosis.
A 9-year-old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. Which is an appropriate response by the clinic nurse to the mother? 1. "There is no need to be concerned." 2. "Bring the child into the clinic for a vaccine." 3. "Keep the child out of school for a 2-week period." 4. "Monitor the child for an elevated temperature, and call the clinic if this happens."
2. "Bring the child into the clinic for a vaccine." Immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the immunocompromised child. If an immunocompromised child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella-zoster immune globulin within 96 hours of exposure. All other options are incorrect because they do nothing to minimize the chances of developing the disease.
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis? 1. Platelet count 2. Lumbar puncture 3. Bone marrow biopsy 4. White blood cell count
3. Bone marrow biopsy Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease. The white blood cell count may be normal, high, or low in leukemia. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis.
The nurse is asked to prepare for the admission of a child to the pediatric unit with a diagnosis of Wilms' tumor. The nurse is developing a plan of care for the child and should include which intervention in the plan? 1. Monitor the temperature for hypothermia. 2. Monitor the blood pressure for hypotension. 3. Palpate the abdomen for an increase in the size of the tumor. 4. Inspect the urine for the presence of hematuria at each voiding.
4. Inspect the urine for the presence of hematuria at each voiding. If Wilms' tumor is suspected, the tumor mass should not be palpated. Excessive manipulation can cause seeding of the tumor and cause spread of the cancerous cells. Fever (not hypothermia), hematuria, and hypertension (not hypotension) are clinical manifestations associated with Wilms' tumor.
