The parents of a 6-week-old boy come to the clinic for evaluation because the infant has been vomiting. The parents report that the vomiting has been increasing in frequency and forcefulness over the last week. The mother says, "Sometimes, it seems like it just bursts out of his mouth." A diagnosis of hypertrophic pyloric stenosis is suspected. When performing the physical examination, what would the nurse most likely find?

A. Infants with congenital deformities have an increased risk for ear infections: Certain congenital anomalies, such as cleft palate or Down syndrome, can predispose children to recurrent otitis media due to structural or functional impairments of the eustachian tube. While this is clinically relevant, it applies to a specific subset of infants rather than the general mechanism of infection in all children.

B. Ear infections typically increase as the child gets older: The incidence of otitis media actually decreases with age as the child’s immune system matures and the eustachian tube elongates and becomes more vertical, improving drainage. Older children generally have fewer episodes of middle ear infections compared with infants and toddlers.

C. The shorter and wider eustachian tubes of an infant increase the risk: Infants have eustachian tubes that are shorter, wider, and more horizontal than in older children and adults, which allows bacteria and secretions from the nasopharynx to enter the middle ear more easily. This anatomical factor, combined with immature immune responses, significantly contributes to the high incidence of otitis media in infants.

D. Adenoids shrink as the child grows, allowing more bacteria to enter: Adenoids actually tend to hypertrophy in early childhood and regress after age 5–7 years. Enlarged adenoids can contribute to eustachian tube obstruction and recurrent infections, so their shrinkage does not increase bacterial entry; instead, adenoid regression typically reduces infection risk.

A. 16-hour-old newborn who has not passed any meconium: It is typical for a newborn to pass meconium within the first 24 hours of life. A 16-hour-old who has not yet passed meconium is still within normal limits and does not require immediate reporting.

B. 16-hour-old newborn whose glucose level is 55 mg/dL: A glucose level of 55 mg/dL in a healthy term newborn is within the normal range (45–90 mg/dL) and does not indicate hypoglycemia that requires urgent intervention.

C. 12-day-old newborn who is breathing irregularly at 70 breaths/minute: A respiratory rate of 70 breaths per minute exceeds the normal range for a newborn (30–60 breaths/min) and may indicate respiratory distress or underlying pathology. This finding warrants immediate reporting to the healthcare provider for further assessment.

D. 2-day-old newborn who is excreting a milky discharge from both nipples: Transient neonatal breast discharge, sometimes called “witch’s milk,” is common due to maternal hormone influence and typically resolves without intervention. It is not a reportable concern.