A parent calls a clinic and reports to a nurse that his 2-month-old infant is hungry more than usual but is projectile vomiting immediately after eating. Which of the following responses should the nurse make?

Choice A: A 10-year-old child who has sickle cell anemia and reports severe chest pain should be assessed first, as this is a sign of acute chest syndrome, which is a life-threatening complication of sickle cell disease. Acute chest syndrome occurs when sickle-shaped red blood cells block the blood flow to the lungs, causing hypoxia, inflammation, and infection. Acute chest syndrome can lead to respiratory failure, pulmonary hypertension, or stroke.

Choice B: A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016 should be assessed second, as this is a sign of dehydration, which is a common complication of diabetes insipidus. Diabetes insipidus is a condition in which the body does not produce enough antidiuretic hormone (ADH) or does not respond to it properly, resulting in excessive urination and thirst. Dehydration can cause electrolyte imbalance, hypotension, or shock.

Choice C: A 4-year-old child who has asthma and an O2 sat of 97% should be assessed third, as this is a sign of adequate oxygenation, which is a desired outcome of asthma management. Asthma is a condition in which the airways become inflamed, narrow, and produce excess mucus, causing difficulty breathing, wheezing, coughing, or chest tightness. Asthma can be triggered by allergens, irritants, exercise, or infections.

Choice D: A 1-year-old toddler who has roseola and a temperature of 39°C/102.2°F should be assessed last, as this is a sign of a mild viral infection, which is self-limiting and usually resolves within a week. Roseola is a common childhood illness that causes a high fever followed by a pink rash on the trunk, face, and limbs. Roseola can also cause irritability, swollen lymph nodes, or mild diarrhea.

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.