A nurse is caring for a child who has otitis media. Which of the following assessment findings should the nurse expect?
Tugging on the affected ear lobe
Erythema and edema of the affected ear
Pain when manipulating the affected ear lobe
Clear drainage from the affected ear
The Correct Answer is A
The correct answer is: A. Tugging on the affected ear lobe.
Choice A reason:
Tugging on the affected ear lobe is a common sign of discomfort in children with otitis media. This behavior indicates that the child is experiencing pain or pressure in the ear, which is a typical symptom of this condition. Children often cannot verbalize their discomfort, so they may tug or pull at their ears to express their pain.
Choice B reason:
Erythema and edema of the affected ear are more indicative of otitis externa (swimmer's ear) rather than otitis media. Otitis media involves inflammation and infection of the middle ear, which is not typically visible externally. The primary signs of otitis media are observed through otoscopic examination, showing a bulging or erythematous tympanic membrane.
Choice C reason:
Pain when manipulating the affected ear lobe is also more characteristic of otitis externa. In otitis media, the pain is usually deeper within the ear and not exacerbated by touching the outer ear. The pain in otitis media is due to the pressure and inflammation in the middle ear space.
Choice D reason:
Clear drainage from the affected ear is not typical of otitis media. If there is drainage, it is usually purulent (pus-like) and indicates a ruptured eardrum due to the infection. Clear drainage is more commonly associated with conditions like otitis externa or a perforated eardrum without infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A: This statement indicates an understanding of the teaching, as washing all recently used clothing, bedding, and towels in hot water can help eliminate lice and nits (eggs). Lice and nits can survive on fabrics for up to two days and can spread from one person to another through direct or indirect contact. Washing items in hot water can kill lice and nits by exposing them to high temperatures.
Choice B: This statement indicates a lack of understanding of the teaching, as nits will not always be present after treatment. Nits are tiny white or yellow oval-shaped eggs that are attached to the hair shaft near the scalp. Nits can hatch into nymphs (young lice) within seven to ten days and mature into adult lice within nine to twelve days. Nits can be removed by using a fine-toothed comb or by applying products that loosen their grip on the hair.
Choice C: This statement indicates a lack of understanding of the teaching, as treating all family members may not be necessary or effective. Treating all family members can expose them to unnecessary chemicals or medications that may have side effects or cause resistance. Treating all family members may also not prevent reinfestation if there are other sources of exposure such as school or daycare. Only family members who have evidence of lice or nits should be treated.
Choice D: This statement indicates a lack of understanding of the teaching, as throwing out toys that can't be dry cleaned or washed may not be required or practical. Throwing out toys can cause emotional distress or financial burden for the child or the parents. Throwing out toys may also not prevent reinfestation if there are other sources of exposure such as clothing or bedding. Toys that can't be dry cleaned or washed can be sealed in plastic bags for two weeks to suffocate the lice and nits.

Correct Answer is ["A","C","E"]
Explanation
Choice A: Allowing the child to keep a toy from home with her can help reduce her fear and anxiety by providing comfort, distraction, and familiarity. This strategy can also enhance the child's sense of control and autonomy by letting her choose what toy to bring.
Choice B: Using mummy restraints during painful procedures can increase the child's fear and anxiety by making her feel trapped, helpless, and powerless. This strategy can also damage the child's trust and cooperation with the nurse and cause psychological trauma.
Choice C: Having a parent stay with the child during procedures can help reduce her fear and anxiety by providing support, reassurance, and security. This strategy can also enhance the child's coping skills and resilience by modeling calm and positive behaviors.
Choice D: Planning invasive procedures whenever possible can increase the child's fear and anxiety by exposing her to unnecessary pain and discomfort. This strategy can also impair the child's physical and emotional development by causing stress and inflammation.
Choice E: Performing the procedure as quickly as possible can help reduce her fear and anxiety by minimizing the duration and intensity of pain. This strategy can also enhance the child's satisfaction and compliance by showing respect and empathy.
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