Zyvox 600 mg IV once a day is ordered for a patient. The Zyvox is dissolved in 300 mL of normal saline and should infuse over 1 hour. Using tubing with a drop factor of 10 gtt/mL, how many drops per minute should the Zyvox be infused?

Choice A reason: Green-blue discharge suggests infection, possibly bacterial (e.g., Pseudomonas), but is not specific to tympanic membrane rupture. In otitis media with effusion, discharge may occur with perforation, but the color is not diagnostic of rupture itself.
Choice B reason: Increased temperature is common in otitis media due to infection but does not specifically indicate tympanic membrane rupture. Fever reflects systemic inflammation, not the mechanical event of perforation, which is better indicated by other symptoms.
Choice C reason: Sudden pain relief in otitis media with effusion occurs when a tympanic membrane rupture releases pressure from fluid buildup in the middle ear. This alleviates the intense pain caused by pressure on the membrane, making it a hallmark sign of perforation.
Choice D reason: A popping sensation when swallowing may occur due to eustachian tube dysfunction but is not specific to tympanic membrane rupture. It reflects pressure changes in the middle ear, not the acute event of perforation.

Choice A reason: Stress fractures result from repetitive microtrauma, common in athletes, not typically associated with abuse. In children, they occur from overuse (e.g., sports), not acute trauma, making them less suspicious for non-accidental injury compared to other fracture types.
Choice B reason: Compound fractures, where bone pierces the skin, result from high-impact trauma (e.g., falls). While possible in abuse, they are less specific, as they occur in accidents, making them less indicative of non-accidental injury than spiral fractures.
Choice C reason: Spiral fractures occur from twisting forces, often seen in abuse when a limb is forcefully twisted (e.g., by an adult). In children, whose bones are flexible, spiral fractures suggest significant force, raising suspicion of non-accidental trauma.
Choice D reason: Greenstick fractures, where the bone bends and partially breaks, are common in children due to pliable bones. They occur in accidents or minor trauma, making them less specific to abuse compared to spiral fractures’ association with twisting mechanisms.