# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=581186&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

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.

![](https://mymerci.kr/data/nclex/hotspot/regen_20260908_2350/HSR523.svg)

## Explanation

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

## In-depth explanation

Quick answer
D. D remains convex while the infant has been quiet and upright, unlike transient fullness during crying.
Why this is the best choice
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.
Clinical picture
The observations are fictional teaching data. Apply the stated context; the selected feature does not by itself replace a complete bedside assessment.
Memory hook
Reassess fontanelle fullness with the infant calm and head-up.
Decision rule
Reassess fontanelle fullness with the infant calm and head-up.
Why the other regions do not fit
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.
**Sources**
- Fullness that resolves when calm and upright is not true bulging; persistent bulging needs urgent assessment.

## Key concepts

- **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.

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