A nurse is caring for a child who has otitis media with effusion. The nurse should identify which of the following manifestations indicates a tympanic membrane rupture.

Choice A: A 10-year-old child who has sickle cell anemia and reports severe chest pain should be assessed first, as this is a sign of acute chest syndrome, which is a life-threatening complication of sickle cell disease. Acute chest syndrome occurs when sickle-shaped red blood cells block the blood flow to the lungs, causing hypoxia, inflammation, and infection. Acute chest syndrome can lead to respiratory failure, pulmonary hypertension, or stroke.

Choice B: A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016 should be assessed second, as this is a sign of dehydration, which is a common complication of diabetes insipidus. Diabetes insipidus is a condition in which the body does not produce enough antidiuretic hormone (ADH) or does not respond to it properly, resulting in excessive urination and thirst. Dehydration can cause electrolyte imbalance, hypotension, or shock.

Choice C: A 4-year-old child who has asthma and an O2 sat of 97% should be assessed third, as this is a sign of adequate oxygenation, which is a desired outcome of asthma management. Asthma is a condition in which the airways become inflamed, narrow, and produce excess mucus, causing difficulty breathing, wheezing, coughing, or chest tightness. Asthma can be triggered by allergens, irritants, exercise, or infections.

Choice D: A 1-year-old toddler who has roseola and a temperature of 39°C/102.2°F should be assessed last, as this is a sign of a mild viral infection, which is self-limiting and usually resolves within a week. Roseola is a common childhood illness that causes a high fever followed by a pink rash on the trunk, face, and limbs. Roseola can also cause irritability, swollen lymph nodes, or mild diarrhea.

Choice A: This statement is correct, as the mother should notify the doctor if the child's temperature is not controlled with acetaminophen, which is an antipyretic and analgesic medication that can lower fever and relieve pain. A high fever can increase the child's metabolic rate and insulin requirements, which can lead to hyperglycemia or ketoacidosis.

Choice B: This statement is incorrect, as the mother should check the child's blood sugar more frequently than two times every day, especially when the child is sick. An upper respiratory infection can cause inflammation and stress hormones, which can increase the child's blood sugar levels and insulin needs. The mother should monitor the child's blood sugar at least four times a day or more often if indicated by symptoms or ketone testing.

Choice C: This statement is correct, as the mother should encourage the child to drink half a cup of water or sugar-free fluids every 30 minutes, which can prevent dehydration and flush out excess glucose and ketones from the body. Dehydration can worsen hyperglycemia and ketoacidosis, which are serious complications of diabetes.

Choice D: This statement is correct, as the mother should report a change in the child's breathing or any signs of confusion, which can indicate respiratory distress or cerebral edema. Respiratory distress can occur due to hypoxia or acidosis, which can impair oxygen delivery and carbon dioxide elimination. Cerebral edema can occur due to fluid shifts or electrolyte imbalances, which can cause increased intracranial pressure and neurological impairment.