Physiological Adaptation Q 53
A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?
A. Bulging anterior fontanel
B. Repeated vomiting
C. Signs of sleepiness at 10 PM
D. Inability to read short words from a distance of 18 inches
Correct Answer: B. Repeated vomiting
Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life-threatening. Repeated vomiting can be an early sign of pressure as the vomiting center within the medulla is stimulated.
Option A: The anterior fontanel is closed in a 4-year-old child. The average closure time of the anterior fontanelle ranges from 13 to 24 months. Infants of African descent statically have larger fontanelles that range from 1.4 to 4.7 cm, and in terms of sex, the fontanelles of male infants will closer sooner compared to female infants.
Option C: Evidence of sleepiness at 10 PM is normal for a four-year-old. Young toddlers have a sleep schedule supplemented by two naps a day. Toddler sleep problems are compounded by separation anxiety and a fear of missing out, which translates to stalling techniques and stubbornness at bedtime.
Option D: The average 4-year-old child cannot read yet, so this too is normal. At 4, many children just aren’t ready to sit still and focus on a book for long. Others may learn the mechanics of reading but aren’t cognitively ready to comprehend the words.