Maternity Nursing Q 122
While performing a physical assessment of a 12 month-old, the nurse notes that the infant’s anterior fontanel is still slightly open. Which of the following is the nurse’s most appropriate action?
A. Notify the physician immediately because there is a problem.
B. Perform an intensive neurological examination.
C. Perform an intensive developmental examination.
D. Do nothing because this is a normal finding for the age.
Correct Answer: D. Do nothing because this is a normal finding for the age.
The anterior fontanelle typically closes anywhere between 12 to 18 months of age. Thus, assessing the anterior fontanelle as still being slightly open is a normal finding requiring no further action. Because it is a normal finding for this age, notifying the physician or performing additional examinations is inappropriate.
Option A: The average size of the anterior fontanel is 2.1 cm, and the median time of closure is 13.8 months. The most common causes of a large anterior fontanel or delayed fontanel closure are achondroplasia, hypothyroidism, Down syndrome, increased intracranial pressure, and rickets.
Option B: During a neurological exam, the child’s healthcare provider will test the functioning of the nervous system. The nervous system is very complex and controls many parts of the body. The nervous system consists of the brain, spinal cord, 12 nerves that come from the brain, and the nerves that come from the spinal cord. The nervous system regulates the muscles. The circulation to the brain, arising from the arteries in the neck, is also frequently examined. In infants and younger children, a neurological exam includes the measurement of the head circumference.
Option C: The newborn’s skull is molded during birth. The frontal bone flattens, the occipital bone is pulled outward, and the parietal bones override. These changes aid delivery through the birth canal and usually resolve after three to five days. The newborn’s skull should be evaluated for shape, circumference, suture ridges, and size of anterior and posterior fontanels. Size is calculated by the average of the anteroposterior and transverse dimensions.