A nurse is assessing an infant who has acute otitis media. Which of the following findings should the nurse expect? (Select all that apply.)
Enlarged subclavicular lymph node
Fever
Crying
Increased appetite
Restlessness
Correct Answer : B,C,E
Choice A Reason:
Enlarged subclavicular lymph node (A) is not a typical finding associated with acute otitis media. Enlarged lymph nodes in the neck area (cervical lymph nodes) might be observed due to the nearby infection, but the subclavicular lymph nodes are located below the clavicle and are not typically associated with ear infections.
Choice B Reason:
Fever: Infants with acute otitis media often present with a fever. Elevated body temperature is a common symptom of an infection, including ear infections.
Choice C Reason:
Crying: Ear pain is a common symptom of acute otitis media. Infants may express discomfort or pain by crying, especially when lying down due to increased pressure in the middle ear.
Choice D Reason:
Increased appetite is also not a common finding in acute otitis media. Generally, a decrease in appetite might occur due to feeling unwell or discomfort, but increased appetite is not a typical symptom of this condition.
Choice E Reason:
Restlessness: Due to discomfort or pain caused by the ear infection, infants with acute otitis media might exhibit restlessness or irritability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Bradycardia is correct. This is because bradycardia, or a slower than normal heart rate, can indeed be an indicator of digoxin toxicity. Digoxin is a medication that affects the heart's rhythm, and toxicity can lead to an excessively slow heart rate among other symptoms.
Choice B Reason:
Jaundice is incorrect. Jaundice, characterized by yellowing of the skin and eyes due to elevated bilirubin levels, is not commonly associated with digoxin toxicity. It's more indicative of liver-related issues rather than digoxin toxicity.
Choice C Reason:
Diaphoresis is incorrect. Diaphoresis, or excessive sweating, is not typically a primary symptom of digoxin toxicity. While various medications or medical conditions can cause diaphoresis, it's not a common indicator of digoxin toxicity.
Choice D Reason:
Polyuria is incorrect. Polyuria, excessive urination, is not a typical symptom of digoxin toxicity. It's not a direct effect of the medication on the body's systems.
Correct Answer is C
Explanation
Choice A Reason:
"I should dress my child in loose-weave clothing." While wearing clothing that covers the skin is important, loose-weave clothing might not offer adequate protection from UV rays. Tighter weaves and darker colors typically provide better protection.
Choice B Reason:
"I should apply a 10 SPF sunscreen to my child's entire body." SPF 10 sunscreen might not offer sufficient protection, especially for toddlers who are more sensitive to the sun. Sunscreens with a higher SPF (ideally SPF 30 or higher) are recommended for better protection.
Choice C Reason:
"My child should wear a wide-brimmed hat." Wearing a wide-brimmed hat helps protect a toddler's face, neck, and ears from the sun's harmful rays, contributing to sun safety.
Choice D Reason:
"My child should remain under a beach umbrella during morning hours. “While seeking shade under an umbrella is a good practice, it might not offer complete protection, especially during peak sun hours. Additionally, the specific time mentioned (morning hours) doesn't guarantee complete protection from UV exposure.
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