A nurse is assessing a toddler at a well-child visit. At what point in the physical examination should the nurse examine the child's tympanic membrane?

A. Before examining the head and neck: Examining the tympanic membrane at the start may increase the child’s anxiety and make the remainder of the examination more difficult. Toddlers are often fearful of invasive procedures early in the visit. B. At the beginning: Early examination of sensitive areas can lead to resistance and stress, reducing cooperation. Physical assessments are typically structured to start with less invasive, non-threatening procedures first. C. Before auscultating the chest and abdomen: Timing before chest and abdominal auscultation does not take into account the toddler’s developmental ability to cooperate. Exposing the child to uncomfortable procedures early may compromise the entire examination. D. At the end: Examining the tympanic membrane at the end is recommended because otoscopy is often uncomfortable or distressing for toddlers. Performing it last allows the nurse to build trust, complete other assessments without interference, and minimize anxiety, improving cooperation and accuracy of the findings.