A sign indicating VP shunt dysfunction is:

AIIMS Delhi NO-2016

Child Health Nursing (Pediatrics)

Medium

Appeared in: AIIMS Delhi NO-2016

Explanation

VP shunt dysfunction leads to the accumulation of cerebrospinal fluid (CSF), causing increased intracranial pressure (ICP).
In infants, the signs of increased ICP are classic and include a tensed or bulging fontanelle, as the skull sutures have not yet closed.
Irritability and a high-pitched cry are common manifestations of the headache and discomfort caused by elevated ICP.
Feeding difficulties, poor suck, and vomiting arise from pressure on the brainstem's vomiting center.
Because all the individual options are correct and recognized signs, the most complete answer is 'All the above'.

Option A: While a tensed fontanelle is a primary sign of VP shunt dysfunction in an infant, it is not the only sign. Choosing this option alone would be incomplete.
Option B: Crying (irritability) is a valid sign of discomfort from increased ICP, but it is a non-specific symptom. It is more significant when combined with other neurological signs. It is not the sole indicator.
Option C: Feeding difficulty is a common sign of increased ICP, but like crying, it can have many causes. It is part of a larger clinical picture of shunt malfunction, not the only sign.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Signs and symptoms of ventriculoperitoneal (VP) shunt dysfunction in infants as background academic context rather than a clinical decision trigger.
Early recognition of VP shunt malfunction is a critical nursing responsibility. Prompt reporting of these signs can prevent irreversible brain damage or death from untreated hydrocephalus.
Parental education is a key nursing role. Nurses must teach caregivers to identify these signs at home and to seek immediate medical attention if they appear.
What if? If the patient were an older child or adult with fused cranial sutures, a tensed fontanelle would not be a sign. Instead, the nurse would prioritize assessing for headache, changes in vision (papilledema), vomiting, and a decline in consciousness or cognitive function.

How to Approach the Question

First, identify the core of the question: it asks for signs of a malfunctioning VP shunt.
Note the keyword 'fontanelle'. This immediately tells you the patient is an infant, as fontanelles close as a child grows.
Recall the pathophysiology: a VP shunt drains excess CSF. If it fails, CSF builds up, causing increased intracranial pressure (ICP).
Evaluate each option as a potential sign of increased ICP in an infant.
Option A (Tensed fontanelle): Yes, this is a classic sign of high ICP in an infant.
Option B (Crying): Yes, irritability and crying are signs of pain/discomfort from ICP.

Concept Tested & Keywords

Concept Tested: Signs and symptoms of ventriculoperitoneal (VP) shunt dysfunction in infants.
Stem keywords: VP shunt dysfunction, sign
Lead-in keywords: indicating
Clinical cues: The mention of 'fontanelle' is a key clinical cue that the patient is an infant, as fontanelles are present before the cranial sutures fuse.
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1385-1387, 1386-1388