A nurse is teaching a new mother how to care for her infant’s fontanelles.
Which of the following statements by the mother indicates a need for further teaching?
“I should gently wash and dry the fontanelles when I bathe my baby.”
“I should report any signs of bulging or sunken fontanelles to the doctor.”
“I should avoid touching the fontanelles because they are very sensitive.”
“I should expect the fontanelles to close by the time my baby is 2 years old.”.
The Correct Answer is C
The mother should avoid touching the fontanelles because they are very sensitive.
This statement indicates a need for further teaching because it is a misconception. The fontanelles are not sensitive and can be gently touched and washed without causing any harm to the infant.
Choice A is correct because the fontanelles should be gently washed and dried when bathing the baby to prevent infection.
Choice B is correct because signs of bulging or sunken fontanelles can indicate increased or decreased intracranial pressure, which requires medical attention.
Choice D is correct because the fontanelles usually close by 18 months of age, but some variation is normal.
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Correct Answer is B
Explanation
Document the finding and monitor for resolution.Caput succedaneum is a harmless condition that causes swelling of the scalp due to pressure during delivery.It does not indicate any damage to the brain or the skull and usually resolves on its own within a few days.
Therefore, the nurse should document the finding and monitor for resolution.
Choice A is wrong because there is no need to notify the physician immediately.Caput succedaneum is not a medical emergency and does not require any intervention.
Choice C is wrong because applying ice packs to reduce swelling is not recommended.Ice packs can cause skin irritation, infection, or hypothermia in newborns.
Choice D is wrong because performing a neurological assessment is not necessary.Caput succedaneum does not affect the brain or the nervous system and does not cause any neurological symptoms.
Correct Answer is ["B","C","D","E"]
Explanation
The fontanelles are soft spots on a baby’s head that have two main functions:
• They allow forrapid growth of the brainduring infancy
• They allow forpassage of the head through the birth canalby enabling the bony plates of the skull to flex
Choice A is wrong because the fontanelles do not allow for passage of blood from the scalp to the brain.The blood supply to the brain is provided by the internal carotid and vertebral arteries, which enter the skull through different openings
The fontanelles also allow forassessment of hydration statusandintracranial pressurein infants by palpating their size and shape.A sunken fontanelle may indicate dehydration, while a bulging fontanelle may indicate increased pressure within the skull
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