A nurse continues to care for a 3-year-old preschooler client with Wilms tumor on the pediatric unit. Select all that apply. Which of the following actions should the nurse take to prepare the child for surgery?

Brief Introduction Preparing a child for a nephrectomy involves balancing physiological stabilization with psychosocial support for the family. Knowledge of preoperative safety protocols, including the strict avoidance of abdominal palpation and the importance of age-appropriate education, is essential to minimize surgical risks and reduce perioperative anxiety. Choice A rationale: Bowel decompression via a nasogastric tube or clear liquid diet may be ordered to minimize abdominal distension and improve surgical visualization. Reducing the contents of the gastrointestinal tract prevents postoperative ileus and reduces the risk of aspiration during anesthesia. Choice B rationale: Palpating the abdomen is strictly contraindicated in cases of Wilms tumor. Excessive manipulation or pressure can cause the fragile tumor capsule to rupture, leading to the seeding of cancer cells throughout the peritoneal cavity and increasing the cancer stage. Choice C rationale: Wilms tumor often causes hypertension due to excessive renin production by the affected kidney. Monitoring blood pressure is a critical preoperative action to ensure the child is hemodynamically stable and to identify the need for antihypertensive medications before surgery. Choice D rationale: Obtaining informed consent and discussing the surgical risks is the legal and ethical responsibility of the surgeon, not the nurse. The nurse’s role is to witness the signature and ensure the caregiver’s questions have been addressed by the provider. Choice E rationale: Providing age-appropriate education helps reduce fear and anxiety for both the child and caregiver. Explaining what to expect before, during, and after the procedure promotes coping mechanisms and ensures the family is prepared for the postoperative recovery process.