A nurse is caring for a child who has otitis media. Which of the following assessment findings should the nurse expect?

Tugging on the aﬀected ear lobe

Erythema and edema of the aﬀected ear

Pain when manipulating the aﬀected ear lobe

Clear drainage from the aﬀected ear

Answer and Explanation

The Correct Answer is A

The correct answer is: A. Tugging on the affected ear lobe.

Choice A reason:

Tugging on the affected ear lobe is a common sign of discomfort in children with otitis media. This behavior indicates that the child is experiencing pain or pressure in the ear, which is a typical symptom of this condition. Children often cannot verbalize their discomfort, so they may tug or pull at their ears to express their pain.

Choice B reason:

Erythema and edema of the affected ear are more indicative of otitis externa (swimmer's ear) rather than otitis media. Otitis media involves inflammation and infection of the middle ear, which is not typically visible externally. The primary signs of otitis media are observed through otoscopic examination, showing a bulging or erythematous tympanic membrane.

Choice C reason:

Pain when manipulating the affected ear lobe is also more characteristic of otitis externa. In otitis media, the pain is usually deeper within the ear and not exacerbated by touching the outer ear. The pain in otitis media is due to the pressure and inflammation in the middle ear space.

Choice D reason:

Clear drainage from the affected ear is not typical of otitis media. If there is drainage, it is usually purulent (pus-like) and indicates a ruptured eardrum due to the infection. Clear drainage is more commonly associated with conditions like otitis externa or a perforated eardrum without infection.

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Correct Answer is C

Explanation

Choice A: Reducing environmental stimuli can help decrease the discomfort and agitation of a child who has meningitis, as they may experience headache, photophobia, and neck stiﬀness. However, this action is not the priority, as it does not address the cause of the infection or prevent complications.

Choice B: Documenting intake and output can help monitor the ﬂuid balance and hydration status of a child who has meningitis, as they may have fever, vomiting, and decreased oral intake. However, this action is not the priority, as it does not address the cause of the infection or prevent complications.

Choice C: Administering antibiotics when available can help treat the bacterial infection that causes meningitis and prevent serious complications such as brain damage, hearing loss, or death. This action is the priority, as it can save the child's life and improve their outcome.

Choice D: Maintaining seizure precautions can help protect the child from injury and provide safety measures in case of a seizure, as meningitis can cause increased intracranial pressure and seizures. However, this action is not the priority, as it does not address the cause of the infection or prevent complications.

A. Lice can survive for 2 weeks away from the host. B. Washing your child's hair daily will prevent lice. C. Lice can jump from one child to another. D. Encourage your child to avoid sharing hats with other children.

Correct Answer is D

Explanation

Choice A: Lice cannot survive for more than 48 hours away from the host. This statement is false and should not be included in the teaching, as it can cause unnecessary anxiety or confusion.

Choice B: Washing your child's hair daily will not prevent lice, as lice do not depend on hair cleanliness or hygiene.
This statement is false and should not be included in the teaching, as it can create a false sense of security or stigma.

Choice C: Lice cannot jump or ﬂy from one child to another, as they only crawl. This statement is false and should not be included in the teaching, as it can cause unnecessary fear or panic.

Choice D: Encouraging your child to avoid sharing hats with other children can prevent lice, as lice can be transmitted by direct contact or by sharing personal items. This statement is true and should be included in the teaching, as it can help prevent lice infestation or spread.

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A nurse is caring for a child who has otitis media. Which of the following assessment findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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Correct Answer is D

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