A nurse is assessing an infant who has acute otitis media.
Which of the following findings should the nurse expect? (Select all that apply.).
Increased appetite.
Crying.
Restlessness.
Fever.
Enlarged subclavicular lymph node.
Correct Answer : B,C,D
An infant with acute otitis media may exhibit crying, restlessness and fever.

Choice A is wrong because an infant with acute otitis media may have a decreased appetite.
Choice E is not the best answer because an enlarged subclavicular lymph node is not a common finding in acute otitis media.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C. Elevate the infant’s head to a 10° angle during feedings.
This position can help prevent milk from coming out of the infant’s nose and reduce the risk of choking.
Choice A is wrong because watery eyes are not an indication to discontinue feeding.
Choice B is wrong because babies with cleft palate should be burped more frequently, but not so often as to interrupt good feeding behaviors.
Choice D is wrong because the amount of formula an infant needs varies and should be determined by a pediatrician.
Correct Answer is D
Explanation
An increased respiratory rate is a sign of severe dehydration in infants.
Dehydration occurs when an infant loses so much body fluid that they are not able to maintain ordinary function.
Choice A is wrong because hypertension is not a sign of severe dehydration in infants.
Choice B is wrong because increased urine output is not a sign of severe dehydration in infants.
In fact, decreased urine output is a sign of dehydration 2.
Choice C is wrong because a capillary refill of 2 seconds is normal and not a sign of severe dehydration in infants.
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