What nursing action would be avoided when caring for a child diagnosed with Wilms’ tumor?

Choice A reason: Whole-wheat bread contains gluten, a protein harmful in celiac disease, causing villous atrophy and malabsorption in the small intestine. This triggers diarrhea, weight loss, and nutrient deficiencies. A gluten-free diet is essential, making a chicken sandwich on whole-wheat bread an inappropriate choice for a child with this condition.

Choice B reason: Pizza and chocolate cake typically contain wheat flour, a gluten source, which damages the intestinal mucosa in celiac disease, leading to inflammation and malabsorption. These foods exacerbate symptoms like diarrhea and abdominal pain, making them unsuitable for a child requiring a strict gluten-free diet to manage the condition.

Choice C reason: Corn tortillas and fresh fruit are naturally gluten-free, safe for celiac disease. Corn lacks the harmful proteins (gliadin) that trigger immune-mediated intestinal damage. Fresh fruit provides nutrients without gluten, supporting healing of the intestinal mucosa and preventing symptoms like diarrhea, making this the best dietary choice.

Choice D reason: Spaghetti and blueberry muffins are made with wheat flour, containing gluten, which causes intestinal villous atrophy in celiac disease. This leads to malabsorption, diarrhea, and growth issues. These foods are contraindicated, as a gluten-free diet is critical to prevent symptoms and promote intestinal healing in affected children.

Choice A reason: Wilms’ tumor, a pediatric kidney malignancy, presents as a painless abdominal mass, often palpable in the flank, due to tumor growth in the renal parenchyma. This disrupts normal kidney structure, causing a firm, non-tender mass. It’s the most common finding, reflecting the tumor’s physical presence in the abdomen.

Choice B reason: Diarrhea is not associated with Wilms’ tumor, which primarily affects the kidney, causing mass effect or hematuria. Gastrointestinal symptoms may occur in other conditions like neuroblastoma, but Wilms’ tumor typically presents with an abdominal mass, making diarrhea an incorrect expected finding in this malignancy.

Choice C reason: Jaundice results from liver dysfunction or biliary obstruction, not Wilms’ tumor, which affects the kidney. While metastasis to the liver is possible, it’s rare and not a primary feature. An abdominal mass is the hallmark sign, making jaundice an incorrect expected manifestation in a 1-year-old.

Choice D reason: Swollen joints suggest rheumatologic or metastatic bone disease, not Wilms’ tumor, which primarily causes a renal mass. Joint involvement is uncommon, as Wilms’ tumor affects the kidney, leading to an abdominal mass. This makes swollen joints an incorrect expected finding in this pediatric malignancy.