A client at 32 weeks gestation presents with sudden, painless, bright red vaginal bleeding.
An ultrasound reveals that the placenta entirely covers the internal cervical os. The nurse recognizes this as which type of placenta previa?

Choice A rationale

Children with cleft palate have a high incidence of acute otitis media due to dysfunction of the eustachian tube. The tensor veli palatini muscle, which normally opens the tube, is often impaired. This leads to poor drainage of the middle ear and negative pressure, allowing bacteria to migrate from the nasopharynx. Fever and ear pulling are classic signs of infection. Normal body temperature is approximately 36.5 to 37.5 degrees Celsius. The child's symptoms strongly indicate an inflammatory process.

Choice B rationale

While it is true that craniofacial abnormalities can be associated with structural ear issues, the acute onset of fever and ear pulling points toward an infectious or inflammatory process rather than a static hearing deficit. Hearing loss in cleft palate patients is often a result of chronic fluid accumulation (effusion) rather than just coincident structural malformations. The nurse must prioritize assessing for an active infection of the middle ear which requires medical intervention to prevent potential tympanic membrane rupture.

Choice C rationale

This is a psychosocial interpretation of a physical symptom. While a 5-year-old may experience frustration with communication, the physical presentation of a fever cannot be explained by a desire for attention. Fever is a systemic response to pyrogens, typically associated with infection. In a child with a known anatomical predisposition for ear infections, physical symptoms like pulling at the ear must be treated as indicators of pain and underlying pathology rather than behavioral manifestations of communication needs.

Choice D rationale

The Latham device is a pre-surgical orthopedic appliance used to align palatal segments. While any intraoral device can cause discomfort or irritation, it would not typically cause a systemic fever or lead the child to pull at their ear. Ear pulling is specifically indicative of referred pain from the middle ear or direct otalgia. The nurse should focus on the most likely clinical complication for this population, which is middle ear disease, rather than mechanical irritation from an appliance. .

Choice A rationale

Developmental research indicates that infant crying behavior typically follows a predictable curve, peaking at approximately 6 to 8 weeks of age. This peak corresponds with significant neurological maturation and the processing of external stimuli. During this period, infants may experience periods of inconsolable crying, often referred to as the period of PURPLE crying. Understanding this timeline helps parents manage expectations and recognize that this intense phase is a normal, temporary developmental milestone.

Choice B rationale

At 1 week of age, neonates are primarily in a recovery phase following the physiological stress of birth. Their crying is generally limited to basic survival needs such as hunger, discomfort, or the need for sleep. The central nervous system is still highly immature, and the infant has not yet reached the stage of heightened environmental sensitivity that triggers the increased crying duration observed later in the second month of life.

Choice C rationale

By 12 weeks of age, most infants have moved past the peak crying phase and are beginning to develop better self-regulation and social interaction skills. At 3 months, infants often start to show more predictable patterns of behavior and improved circadian rhythms. While they still cry to communicate, the frequency and intensity of crying episodes typically decrease significantly compared to the developmental peak that occurs around the 2-month mark.

Choice D rationale

While crying starts to increase after the first two weeks of life, it has not yet reached its maximum frequency at 4 weeks. The fourth week marks the transition into more alert states, but the physiological and neurological peak of crying is still a few weeks away. Suggesting 4 weeks as the peak would be premature, as data consistently shows the upward trend continues until roughly the middle of the second month.