An infant is assessed for vomiting and increasing head circumference. The nurse repeats the fontanelle examination under the conditions shown. Click the observation that supports a truly bulging fontanelle requiring urgent evaluation rather than transient positional or crying-related fullness.

D. D remains convex while the infant has been quiet and upright, unlike transient fullness during crying.

Position and behavior can temporarily alter the appearance. Persistent bulging when calm and head-up is concerning, particularly with the symptoms in this case. Arrange urgent assessment; the drawing alone does not establish a specific cause.

The observations are fictional teaching data. Apply the stated context; the selected feature does not by itself replace a complete bedside assessment.

Reassess fontanelle fullness with the infant calm and head-up.

Reassess fontanelle fullness with the infant calm and head-up.

A shows fullness while supine and crying, which can be transient. B is flat when upright and quiet. C is slightly depressed during sleep, not a convex fontanelle. D persists in a condition that removes the transient explanation.

• Persistent fontanelle fullness after position and behavior change — Reassess fontanelle fullness with the infant calm and head-up.
• Comparison with context — A has the same convex shape as D, but the examination conditions differ.