The advanced practice registered nurse (APRN) is documenting their physical exam findings for a patient with acute outs media. Which of the following statements most accurately describes otoscope findings of acute otitis media?

A. Murmur intensity decreases with sitting is correct because innocent (or physiologic) murmurs often become softer or disappear when the patient sits upright. This helps differentiate them from pathologic murmurs, which may remain unchanged or become louder with positional changes.

B. Normal splitting of S2 with inspiration is correct because physiologic splitting of the second heart sound is a normal finding and is consistent with a healthy cardiac examination. An innocent murmur is typically not associated with abnormal heart sounds.

C. Absence of a diastolic murmur is correct because innocent murmurs are exclusively systolic. The presence of a diastolic murmur would suggest a pathologic valvular lesion, such as aortic or mitral regurgitation, rather than an innocent murmur.

D. Murmur intensity increases with sitting is incorrect because an increase in murmur intensity with sitting or standing is more consistent with pathologic conditions, such as hypertrophic cardiomyopathy, rather than a benign or innocent murmur.

A. Chest pain is incorrect because it is a subjective finding. Subjective findings are symptoms that the client experiences and reports, but the nurse cannot directly measure or observe them. Chest pain is based on the client’s description of discomfort, pressure, or tightness in the chest, making it reliant on self-report rather than objective assessment.

B. Palpitations is incorrect because it is also subjective. Clients may describe sensations of their heart racing, skipping beats, or fluttering, but these sensations cannot be observed directly without using diagnostic tools such as an electrocardiogram (ECG) or heart rate monitoring.

C. Shortness of breath is incorrect because it is subjective. Although the nurse can measure respiratory rate, oxygen saturation, and work of breathing, the client’s feeling of being “unable to breathe adequately” is a symptom reported by the client and is therefore subjective, not an observable sign.

D. Tenderness on palpation of anterior chest is correct because it is an objective finding. Objective findings are observable or measurable by the nurse through physical assessment, laboratory tests, or imaging. When a nurse palpates the chest and notes tenderness, this can be directly verified and documented, making it a concrete, measurable sign rather than a self-reported symptom.