NORCET 3 - 2022 (Shif…: A 19 months baby visited to paediatric clinic with his parents. On the examination which clinical findings is…

NORCET 3 - 2022 (Shift-2)

Child Health Nursing (Pediatrics)

Easy

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

The posterior fontanel, which is triangular, typically closes by 6-8 weeks of age (around 2-3 months).
The anterior fontanel, which is diamond-shaped, usually closes between 12 and 18 months of age, although it can remain open up to 24 months in some healthy children.
Given the patient's age of 19 months, it is a normal and expected finding for both the anterior and posterior fontanels to be closed.
This finding indicates normal skull development and brain growth for the child's age.

Option A: This is incorrect because the posterior fontanel should be closed by 2-3 months of age. Finding it open at 19 months is a significant deviation from the norm and warrants further investigation.
Option C: This is incorrect because both fontanels should be closed by 19 months. An open posterior fontanel is abnormal, and while a slightly open anterior fontanel might be a normal variant, having both open is a cause for concern.
Option D: This is incorrect because a sunken fontanel is a clinical sign of dehydration, which is an abnormal condition, not a normal finding. The term 'dense' is not standard terminology for fontanel assessment.

Clinical Relevance

Nursing practice connection: Knowing Normal pediatric developmental milestones, specifically the timeline for fontanel closure helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Assessing fontanels is a fundamental nursing skill in pediatrics. It provides critical information about hydration status and intracranial pressure.
A sunken fontanel is a red flag for dehydration, prompting the nurse to assess for other signs like poor skin turgor, dry mucous membranes, and decreased urine output.
A bulging or tense fontanel is a neurological emergency, suggesting increased intracranial pressure. The nurse's priority is to minimize stimuli, elevate the head of the bed, and notify the provider immediately.

How to Approach the Question

First, identify the key information in the question stem: the patient is a 19-month-old baby, and the question asks for a 'normal' clinical finding.
Next, recall the standard developmental milestones for fontanel closure. Remember the posterior fontanel closes much earlier than the anterior one.
Posterior fontanel closure: ~2-3 months.
Anterior fontanel closure: ~12-18 months.
Evaluate each option based on the 19-month age.
Option A: Posterior open is abnormal.

Concept Tested & Keywords

Concept Tested: Normal pediatric developmental milestones, specifically the timeline for fontanel closure.
Stem keywords: 19 months baby, paediatric clinic, clinical findings, normal
Lead-in keywords: which clinical findings is normal
Clinical cues: Patient age of 19 months is the critical detail for determining the expected developmental stage.

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