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 WBC count of 17,000/mm³ is an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates leukocytosis, which is an increase in white blood cells. Leukocytosis can occur in a child who has cystic fibrosis (CF), which is a condition that causes thick mucus to block the airways and lungs and causes respiratory infections and inflammation. A normal WBC count for children is 5,000 to 10,000/mm³.

Choice B: A neutrophil count of 3,000/mm³ is not an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates normal neutrophil levels. Neutrophils are a type of white blood cell that fight bacterial infections. A normal neutrophil count for children is 1,500 to 8,000/mm³.

Choice C: A lymphocyte count of 3,000/mm³ is not an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates normal lymphocyte levels. Lymphocytes are a type of white blood cell that fight viral infections. A normal lymphocyte count for children is 1,500 to 4,000/mm³.

Choice D: An RBC count of 4.2 million/mm³ is not an abnormal result that the nurse should anticipate when reviewing this client's laboratory values, as it indicates normal red blood cell levels. Red blood cells carry oxygen and carbon dioxide throughout the body. A normal RBC count for children is 4 to 5.5 million/mm³.

Choice A: Iron deficiency anemia is a condition in which the body does not have enough iron to produce hemoglobin, the protein that carries oxygen in the blood. Toddlers who drink too much milk and eat too few solid foods may not get enough iron from their diet, as milk is a poor source of iron. Iron deficiency anemia can cause fatigue, weakness, pale skin, and increased susceptibility to infections.

Choice B: Diabetes mellitus is a condition in which the body does not produce enough insulin or use it properly, resulting in high blood glucose levels. Toddlers who drink too much milk and eat too few solid foods are not at increased risk for diabetes mellitus, as milk does not contain glucose and does not affect insulin secretion or action.

Choice C: Obesity is a condition in which the body has excess fat that can impair health and increase the risk of chronic diseases. Toddlers who drink too much milk and eat too few solid foods may be at risk for obesity, as milk is high in calories and fat and can displace other nutritious foods from their diet. However, obesity is not a disorder but a risk factor for other disorders.

Choice D: Rickets is a condition in which the bones become soft and weak due to a lack of vitamin D or calcium. Toddlers who drink too much milk and eat too few solid foods are not at risk for rickets, as milk is a good source of vitamin D and calcium and can prevent rickets.