A charge nurse is assisting a newly licensed nurse with the preoperative care of a 2-year-old toddler who has a Wilms tumor. Which of the following actions by the newly licensed nurse indicates an understanding of the needed care?

Choice A rationale Asking the parents to leave the waiting room is not an appropriate action. Parental presence, especially for a young child, helps reduce anxiety and stress, which can positively impact the child's physiological response to surgery. The parents' presence provides comfort and security, which is essential for a positive perioperative experience and helps maintain the child's emotional stability. Choice B rationale Palpating the abdomen of a child with a Wilms tumor is contraindicated because this action can cause the tumor to rupture. A Wilms tumor is a nephroblastoma, which is a highly vascular and fragile malignancy of the kidney. A rupture could lead to the spillage of cancerous cells into the abdominal cavity, increasing the risk of metastasis and complicating the surgical procedure. Choice C rationale Discontinuing clear liquids 1 hour prior to surgery is incorrect and poses a risk for aspiration. The typical NPO (nothing by mouth) guideline for clear liquids is at least 2 hours before the procedure for a child to ensure adequate gastric emptying. This reduces the risk of vomiting and aspiration during induction of anesthesia, which could lead to severe pulmonary complications such as aspiration pneumonia. Choice D rationale Monitoring the child's blood pressure continuously is an important action because hypertension is a common clinical manifestation of Wilms tumor. The tumor can secrete renin, leading to increased blood pressure. Continuous monitoring allows for early detection of significant changes, which may require medical intervention to stabilize the child's condition before and during surgery.