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: Tachycardia is not a finding that indicates increased intracranial pressure, but rather a sign of shock, dehydration, or pain. Tachycardia is a fast heart rate, which is more than 160 beats per minute in infants. Tachycardia can occur when the body tries to compensate for low blood pressure, fluid loss, or tissue damage.

Choice B: Increased sleeping is a finding that indicates increased intracranial pressure, as it reflects altered level of consciousness, which is one of the earliest and most sensitive signs of increased intracranial pressure. Increased intracranial pressure can compress the brain tissue and affect its function and responsiveness. Increased sleeping can progress to lethargy, stupor, or coma.

Choice C: Brisk pupillary reaction to light is not a finding that indicates increased intracranial pressure, but rather a normal and expected response. A brisk pupillary reaction to light means that the pupils constrict quickly when exposed to bright light and dilate quickly when exposed to dim light. Brisk pupillary reaction to light indicates intact cranial nerve II (optic) and III (oculomotor).

Choice D: Depressed fontanels are not a finding that indicates increased intracranial pressure, but rather a sign of dehydration or malnutrition. Depressed fontanels are sunken or flat areas on the top or back of an infant's head where the skull bones have not yet fused together. Depressed fontanels can occur when there is insufficient fluid or tissue volume in the body.

Choice A: This response is appropriate, as it informs the parent that reporting suspected child abuse is a legal and ethical obligation for nurses, regardless of their personal opinions or feelings. This response also shows respect and honesty by acknowledging the parent's concern and explaining the reason for the nurse's action.

Choice B: This response is not appropriate, as it deflects responsibility and avoids answering the parent's question. This response also shows disrespect and dishonesty by implying that the provider is more qualified or authorized to explain the situation than the nurse.

Choice C: This response is not appropriate, as it denies information and creates confusion for the parent. This response also shows indifference and avoidance by suggesting that the nurse does not want to deal with the issue or communicate with the parent.

Choice D: This response is not appropriate, as it shifts blame and undermines trust between the nurse and the parent. This response also shows defensiveness and insecurity by implying that the nurse did not make the decision or take accountability for their action.