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: This statement is correct, as a fracture of an epiphyseal plate, which is a cartilage layer at the end of a long bone where growth occurs, can impair the normal growth and development of the bone. Depending on the type and severity of the fracture, the epiphyseal plate may close prematurely, stop growing, or grow unevenly, resulting in deformity, shortening, or angular deviation of the affected limb.

Choice B: This statement is incorrect, as a fracture of an epiphyseal plate does not necessarily disrupt the blood supply to the bone unless there is also damage to the periosteum, which is a membrane that covers and nourishes

the bone. A disruption of the blood supply to the bone can cause avascular necrosis, which is a condition that causes bone death due to lack of oxygen and nutrients.

Choice C: This statement is incorrect, as a fracture of an epiphyseal plate does not cause bone marrow loss through the fracture unless there is damage to the medullary cavity, which is a hollow space within the bone that contains bone marrow. Bone marrow loss through the fracture can cause bleeding, infection, or anemia.

Choice D: This statement is incorrect, as a fracture of an epiphyseal plate does not take longer to heal in younger children than in older children. In fact, younger children tend to heal faster than older children due to their higher metabolic rate, greater blood supply, and more active growth factors. The healing time of a fracture depends on various factors, such as the type and location of the fracture, the treatment method, and the presence of complications.

Choice A: This prescription does not need clarification, as medicating the client for pain every 4 hours as needed is appropriate for a child who has suspected appendicitis. Appendicitis is a condition that causes inflammation and infection of the appendix, which is a small pouch attached to the large intestine. Appendicitis can cause severe abdominal pain, nausea, vomiting, fever, or loss of appetite. Pain medication can help relieve the discomfort and reduce inflammation.

Choice B: This prescription does not need clarification, as maintaining NPO status is appropriate for a child who has suspected appendicitis. NPO status means nothing by mouth, which means no food or fluids are given to the client. NPO status can prevent further irritation of the appendix and prepare the client for possible surgery.

Choice C: This prescription does not need clarification, as monitoring oral temperature every 4 hours is appropriate for a child who has suspected appendicitis. Oral temperature is a measure of body temperature taken by placing a thermometer under the tongue. Oral temperature can indicate infection or inflammation in the body. Monitoring oral temperature every 4 hours can help detect changes in the client's condition and guide treatment.

Choice D: This prescription needs clarification, as administering an enema is not appropriate for a child who has suspected appendicitis. An enema is a procedure that involves inserting a tube into the rectum and injecting fluid into the colon to stimulate bowel movement. An enema can cause perforation or rupture of the appendix, which can lead to peritonitis, which is inflammation of the peritoneum, which is the membrane that lines the abdominal cavity. An enema can also increase the risk of bleeding or infection.