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 reason: This choice is incorrect because the BCG vaccine is not recommended for adolescents in the United States. The BCG vaccine is a vaccine that protects against tuberculosis (TB), a bacterial infection that affects the lungs and other organs. It may be used for children who live in countries where TB is common or who have a high risk of exposure to TB, but it is not routinely given in the United States because of the low incidence of TB and the possibility of false-positive results on TB skin tests.

Choice B reason: This choice is incorrect because the pneumococcal polysaccharide vaccine is not recommended for adolescents unless they have certain medical conditions. The pneumococcal polysaccharide vaccine is a vaccine that protects against pneumococcal disease, a bacterial infection that can cause pneumonia, meningitis, or sepsis. It may be used for adults who are 65 years or older or who have chronic diseases, immunosuppression, or cochlear implants, but it is not routinely given to adolescents who are healthy.

Choice C reason: This choice is incorrect because the influenza vaccine is recommended for adolescents every year, not just before college. The influenza vaccine is a vaccine that protects against influenza, a viral infection that affects the respiratory system. It may be given as an injection or a nasal spray, and it may prevent or reduce the severity of influenza and its complications. It is recommended for everyone who is 6 months or older, especially those who have a high risk of influenza-related complications.

Choice D reason: This choice is correct because the meningococcal polysaccharide vaccine is recommended for adolescents before college. The meningococcal polysaccharide vaccine is a vaccine that protects against meningococcal disease, a bacterial infection that can cause meningitis, septicemia, or death. It may be given as a single dose or a booster dose, and it may prevent outbreaks of meningococcal disease in crowded settings such as dormitories or military barracks. It is recommended for adolescents who are 11 to 12 years old, with a booster dose at 16 years old, or for those who are entering college and have not been previously vaccinated.

Choice A reason: This choice is incorrect because bradycardia is not a common finding in a child who is in a sickle cell crisis. Bradycardia is a condition in which the heart rate is slower than normal (less than 60 beats per minute). It may be caused by various factors such as hypothermia, hypothyroidism, or medication side effects, but it does not indicate a sickle cell crisis.

Choice B reason: This choice is incorrect because constipation is not a common finding in a child who is in a sickle cell crisis. Constipation is a condition in which the bowel movements are infrequent, hard, or difficult to pass. It may be caused by various factors such as dehydration, a low-fiber diet, or lack of physical activity, but it does not indicate a sickle cell crisis.

Choice C reason: This choice is correct because pain is a common finding in a child who is in a sickle cell crisis. Sickle cell crisis is a condition in which the red blood cells become sickle-shaped and clump together, blocking the blood flow and oxygen delivery to the organs and tissues. It may cause severe pain in the chest, abdomen, joints, or bones, as well as symptoms such as pallor, jaundice, fatigue, or shortness of breath.

Choice D reason: This choice is incorrect because high fever is not a specific finding in a child who is in a sickle cell crisis. High fever may indicate infection, inflammation, or dehydration, but it does not indicate sickle cell crisis. However, the infection can trigger or worsen the sickle cell crisis, so it should be treated promptly with antibiotics and fluids.