A nurse is collecting data from an infant who has otitis media. The nurse should expect which of the following findings?

Choice A rationale Tugging on the affected ear lobe is a classic behavioral sign of otitis media in infants. Because they cannot verbalize pain, they often reach for or pull at the ear that is experiencing pressure and inflammation. This action is a physical response to the discomfort caused by fluid accumulation and pressure against the tympanic membrane. Other associated signs often include irritability, crying while lying down, and disrupted sleep patterns due to the ear pain. Choice B rationale Erythema and edema of the affected auricle are typically associated with otitis externa, also known as swimmer's ear, rather than otitis media. Otitis media involves inflammation of the middle ear space behind the eardrum. The external structures like the auricle or pinna usually appear normal in middle ear infections unless there is a secondary skin infection. Pain when pulling on the auricle is a diagnostic feature of external canal inflammation, not middle ear infection. Choice C rationale Bluish-green discharge from the ear canal is not a standard finding for otitis media. If the tympanic membrane ruptures, purulent discharge may be present, but it is typically yellow, clear, or blood-tinged. Greenish discharge often suggests a specific bacterial colonization like Pseudomonas, which is more common in chronic otitis externa. In uncomplicated acute otitis media, the fluid remains trapped behind an intact eardrum, so no discharge would be visible in the external ear canal. Choice D rationale An increase in appetite is unlikely in an infant with otitis media. Infants usually experience a decrease in appetite because the act of sucking and swallowing changes the pressure within the middle ear via the eustachian tube. This pressure change increases the intensity of the pain, making feeding a distressing experience. Furthermore, systemic symptoms like fever and general malaise associated with the infection naturally lead to lethargy and a diminished interest in consuming fluids or formula.