A nurse is collecting data from an infant who has otitis media.
Which of the following findings should the nurse identify as manifestations of pain in an infant? (Select all that apply)

Choice A rationale

Lethargy in a child who is 2 days postoperative following the insertion of a ventriculoperitoneal shunt could indicate a serious problem such as shunt malfunction or infection, and should be the priority.

Choice B rationale

A respiratory rate of 20/min is within the normal range for a 4-year-old child and is not typically a cause for concern.

Choice C rationale

Lying flat on the unaffected side is not typically a cause for concern following ventriculoperitoneal shunt surgery.

Choice D rationale

A urine output of 50 mL in 2 hr is within the normal range for a 4-year-old child and is not typically a cause for concern.

Choice A rationale:

Developmental dysplasia of the hip (DDH) is a condition in which the hip joint is not properly formed or is unstable. Asymmetric thigh folds are a common finding in infants with DDH, as the affected hip may be dislocated or subluxated, leading to a difference in thigh fold appearance.

Choice B rationale:

An inwardly turned foot is not a specific indication of DDH. Instead, it may suggest other conditions, such as clubfoot or metatarsus adductus (no reference).

Choice C rationale:

Absent plantar reflexes are not associated with DDH. This finding might indicate a neurological issue or spinal cord injury (no reference).

Choice D rationale:

A lengthened thigh is not a typical finding in DDH. Instead, a shortened thigh on the affected side might be present due to the displacement of the femoral head (no reference).