OB
A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breasts are swollen, warm, and tender upon palpation. What action should the nurse take? A) Apply cold compresses to both breasts for comfort. B) Instruct the client run warm water on her breasts. C) Wear a loose-fitting bra to prevent nipple irritation. D) Express small amounts of milk to relieve pressure.
A) Apply cold compresses to both breasts for comfort. Rationale: The client is experiencing engorgement even though she is bottle-feeding her infant, and cold compresses (A) may help reduce discomfort. Lactation begins about the third day after delivery, so the mother should avoid any breast stimulation, such as (B or D), which further stimulates milk production. To aid in suppressing lactation, a well-fitting bra, not (C), should be worn to support and bind the breasts.
A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse perform first? A) Bathe the infant with an antimicrobial soap. B) Measure the head and chest circumference. C) Obtain the infant's footprints. D) Administer vitamin K (AquaMEPHYTON).
A) Bathe the infant with an antimicrobial soap. Rationale: To reduce direct contact with the human immuno-virus in blood and body fluids on the newborn's skin, a bath (A) with an antimicrobial soap should be administered first. (B, C, and D) should be implemented after the neonate's skin is cleansed of blood and body fluids.
A multigravida client at 41-weeks gestation presents in the labor and delivery unit after a non-stress test indicated that the fetus is experiencing some difficulties in utero. Which diagnostic test should the nurse prepare the client for additional information about fetal status? A) Biophysical profile (BPP). B) Ultrasound for fetal anomalies. C) Maternal serum alpha-fetoprotein (AF) screening. D) Percutaneous umbilical blood sampling (PUBS).
A) Biophysical profile (BPP). Rationale: BPP (A) provides data regarding fetal risk surveillance by examining 5 areas: fetal breathing movements, fetal movements, amniotic fluid volume, and fetal tone and heart rate. The client's gestation has progressed past the estimated date of confinement, so the major concern is fetal well-being related to an aging placenta, not screening for fetal anomalies (B). Maternal serum AF screening is generally checked between 15 and 22 weeks to detect neural tube defects (C). Although PUBS is performed to determine a number of at-risk fetal conditions, the BPP determines current fetal risk (D).
A client at 28-weeks gestation calls the antepartal clinic and states that she is experiencing a small amount of vaginal bleeding which she describes as bright red. She further states that she is not experiencing any uterine contractions or abdominal pain. What instruction should the nurse provide? A) Come to the clinic today for an ultrasound. B) Go immediately to the emergency room. C) Lie on your left side for about one hour and see if the bleeding stops. D) Bring a urine specimen to the lab tomorrow to determine if you have a urinary tract infection.
A) Come to the clinic today for an ultrasound. Rationale: Third trimester painless bleeding is characteristic of a placenta previa. Bright red bleeding may be intermittent, occur in gushes, or be continuous. Rarely is the first incidence life-threatening, nor cause for hypovolemic shock. Diagnosis is confirmed by transabdominal ultrasound (A). Bleeding that has a sudden onset and is accompanied by intense uterine pain indicates abruptio placenta, which IS life-threatening to the mother and fetus--then (B) would be appropriate. (C) does not take the symptoms seriously. The woman is not describing symptoms of a UTI (D).
The healthcare provider prescribes terbutaline (Brethine) for a client in preterm labor. Before initiating this prescription, it is most important for the nurse to assess the client for which condition? A) Gestational diabetes. B) Elevated blood pressure. C) Urinary tract infection. D) Swelling in lower extremities.
A) Gestational diabetes. Rationale: The nurse should evaluate the client for gestational diabetes (A) because terbutaline (Brethine) increases blood glucose levels. (B) could be related to the client being in preterm labor, however, terbutaline (Brethine) can cause a decrease in blood pressure. (C) can cause uterine irritability, which can result in preterm labor that should be treated by first resolving the infection rather than by administering a tocolytic agent such as terbutaline (Brethine). (D) is a common pregnancy complaint.
Which action should the nurse implement when preparing to measure the fundal height of a pregnant client? A) Have the client empty her bladder. B) Request the client lie on her left side. C) Perform Leopold's maneuvers first. D) Give the client some cold juice to drink.
A) Have the client empty her bladder. Rationale: To accurately measure the fundal height, the bladder must be empty (A) to avoid elevation of the uterus. Fundal height is not measured with the client lying on her side (B). Leopold's maneuvers are performed to assess fetal position and the expected location of the point of maximal impulse (PMI) for fetal heart rate (C). Cold juice (D) does not affect the fundal height measurement, but may be given to arouse the fetus if the fetus appears to be sleeping during a non-stress test.
Which nursing intervention is most helpful in relieving postpartum uterine contractions or "afterpains?" A) Lying prone with a pillow on the abdomen. B) Using a breast pump. C) Massaging the abdomen. D) Giving oxytocic medications.
A) Lying prone with a pillow on the abdomen. Rationale: Lying prone (A) keeps the fundus contracted and is especially useful with multiparas, who commonly experience afterpains due to lack of uterine tone. (B and D) stimulate uterine contractions. (C) may contract the uterus temporarily and then encourage more afterpains later.
On admission to the prenatal clinic, a 23-year-old woman tells the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. This client's expected date of delivery (EDD) is A) November 22. B) November 8. C) December 22. D) October 22.
A) November 22. Rationale: (A) correctly applies Nägele's rule for estimating the due date by counting back 3 months from the first day of the last menstrual period (January, December, November) and adding 7 days (15+7=22).
Client teaching is an important part of the maternity nurse's role. Which factor has the greatest influence on successful teaching of the gravid client? A) The client's readiness to learn. B) The client's educational background. C) The order in which the information is presented. D) The extent to which the pregnancy was planned.
A) The client's readiness to learn. Rationale: When teaching any client, readiness to learn (A) is the most important criterion. For example, the client with severe morning sickness in the first trimester may not be "ready to learn" about labor and delivery, but is probably very "ready to learn" about ways to relieve morning sickness. (B and C) are factors that may influence learning, but they are not as influential as (A). Even if a pregnancy is planned and very desirable (D), the client must be ready to learn the content presented.
During labor, the nurse determines that a full-term client is demonstrating late decelerations. In which sequence should the nurse implement these nursing actions? (Arrange in order.) A) Reposition the client. B) Call the healthcare provider. C) Increase IV fluid. D) Provide oxygen via face mask.
A:1, B:4, C:3, D:2 Rationale: To stabilize the fetus, intrauterine resuscitation is the first priority, and to enhance fetal blood supply, the laboring client should be repositioned (1) to displace the gravid uterus and improve fetal perfusion. Secondly, to optimize oxygenation of the circulatory blood volume, oxygen via face mask (2) should be applied to the mother. Next, the IV fluids should be increased (3) to expand the maternal circulating blood volume. Then, the primary healthcare provider should be notified (4) for additional interventions to resolve the fetal stress.
A 23-year-old client who is receiving Medicaid benefits is pregnant with her first child. Based on knowledge of the statistics related to infant mortality, which plan should the nurse implement with this client? A) Refer the client to a social worker to arrange for home care. B) Recommend perinatal care from an obstetrician, not a nurse-midwife. C) Teach the client why keeping prenatal care appointments is important. D) Advise the client that neonatal intensive care may be needed.
C) Teach the client why keeping prenatal care appointments is important. Rationale: Regular prenatal visits should begin early in pregnancy to monitor health of the mother and development of the fetus (C). Based on the client's information, (A, B, and D) are not indicated.
The nurse caring for a laboring client encourages her to void at least q2h, and records each time the client empties her bladder. What is the primary reason for implementing this nursing intervention? A) Emptying the bladder during delivery is difficult because of the position of the presenting fetal part. B) An over-distended bladder could be traumatized during labor as well as prolong the progress of labor. C) Urine specimens for glucose and protein must be obtained at certain intervals throughout labor. D) Frequent voiding minimizes the need for catheterization which increases the chance of bladder infection.
B) An over-distended bladder could be traumatized during labor as well as prolong the progress of labor. Rationale: A full bladder can impair the efficiency of the uterine contractions and impede descent of the fetus during labor (B). Also, because of the close proximity of the bladder to the uterus, the bladder can be traumatized by the descent of the fetus. It is not difficult to empty the bladder during delivery (A). Urine specimens are obtained only by special order (C). There is danger of infection due to catheterization (D), but this is not the primary reason for encouraging the client to void during labor.
A client with gestational hypertension is in active labor and receiving an infusion of magnesium sulfate. Which drug should the nurse have available for signs of potential toxicity? A) Oxytocin (Pitocin). B) Calcium gluconate. C) Terbutaline (Brethine). D) Naloxone (Narcan).
B) Calcium gluconate. Rationale: The antidote for magnesium sulfate is calcium gluconate (B), which should be readily available if the client manifest signs of toxicity. (A, C, and D) are not effective in the reversal of magnesium sulfate.
A client who has an autosomal dominant inherited disorder is exploring family planning options and the risk of transmission of the disorder to an infant. The nurse's response should be based on what information? A) Males inherit the disorder with a greater frequency than females. B) Each pregnancy carries a 50% chance of inheriting the disorder. C) The disorder occurs in 25% of pregnancies. D) All children will be carriers of the disorder.
B) Each pregnancy carries a 50% chance of inheriting the disorder. Rationale: According to the laws of inheritance, an autosomal dominant disorder has a 50% chance of being transmitted with each pregnancy (B), and if transmitted, the disorder will appear in the child. Males do not inherit autosomal dominant disorders more frequently than females (A). There is a 25% chance of receiving an affected gene in autosomal recessive (C), not autosomal dominant disorders. (D) is incorrect.
A client in active labor complains of cramps in her leg. What intervention should the nurse implement? A) Ask the client if she takes a daily calcium tablet. B) Extend the leg and dorsiflex the foot. C) Lower the leg off the side of the bed. D) Elevate the leg above the heart.
B) Extend the leg and dorsiflex the foot. Rationale: Dorsiflexing the foot by pushing the sole of the foot forward or by standing (if the client is capable) (B), and putting the heel of the foot on the floor is the best means of relieving leg cramps. (A) is not related to leg cramps caused by reduced circulation to the foot. (C) is not likely to be helpful. (D) is used to promote venous return, but is not indicated for leg cramps.
A primigravida at 40-weeks gestation is receiving oxytocin (Pitocin) to augment labor. Which adverse effect should the nurse monitor for during the infusion of Pitocin? A) Dehydration. B) Hyperstimulation. C) Galactorrhea. D) Fetal tachycardia.
B) Hyperstimulation. Rationale: Pitocin causes the uterine myofibril to contract, so unless the infusion is closely monitored, the client is at risk for hyperstimulation (B) which can lead to tetanic contractions, uterine rupture, and fetal distress or demise. Dehydration (A) and galactorrhea (C) are not adverse effects associated with the administration of Pitocin. Fetal tachycardia (D) is an initial response to any stressor, including an increase in maternal temperature or intrauterine infection, but fetal decelerations indicate distress following tetanic contractions.
A client who is attending antepartum classes asks the nurse why her healthcare provider has prescribed iron tablets. The nurse's response is based on what knowledge? A) Supplementary iron is more efficiently utilized during pregnancy. B) It is difficult to consume 18 mg of additional iron by diet alone. C) Iron absorption is decreased in the GI tract during pregnancy. D) Iron is needed to prevent megaloblastic anemia in the last trimester.
B) It is difficult to consume 18 mg of additional iron by diet alone. Rationale: Consuming enough iron-containing foods to facilitate adequate fetal storage of iron and to meet the demands of pregnancy is difficult (B) so iron supplements are often recommended. Dietary iron (A) is just as "good" as iron in tablet form. Iron absorption occurs readily during pregnancy, and is not decreased within the GI tract (C). Megaloblastic anemia (D) is caused by folic acid deficiency.
The nurse is preparing a client with a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside? (Select all that apply.) A) Litmus paper. B) Fetal scalp electrode. C) A sterile glove. D) An amnihook. E) Sterile vaginal speculum. F) Lubricant.
C) A sterile glove. D) An amnihook. F) Lubricant. Rationale: A single sterile glove (C), an amnihook (D), and lubricant (F) are the necessary equipment for performing an amniotomy. Litmus paper (A) is used to assess for the presence of amniotic fluid. A fetal scalp probe (B) is used to assess fetal heart rates. A sterile vaginal speculum (E) is used to visualize the cervix.
The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/dl. Based on this finding, which intervention should the nurse implement? A) Provide phototherapy for 30 minutes q8h. B) Feed the newborn sterile water hourly. C) Encourage the mother to breastfeed frequently. D) Assess the newborn's blood glucose level.
C) Encourage the mother to breastfeed frequently. Rationale: The normal total bilirubin level is 6 to 12 mg/dl after Day 1 of life. This infant's bilirubin is beginning to climb and the infant should be monitored to prevent further complications. Breast milk provides calories and enhances GI motility, which will assist the bowel in eliminating bilirubin (C). (A) is not indicated at this level. (B) would limit caloric intake, which is essential in preventing jaundice. (D) is not related to bilirubin levels.
The nurse is teaching breastfeeding to prospective parents in a childbirth education class. Which instruction should the nurse include as content in the class? A) Begin as soon as your baby is born to establish a four-hour feeding schedule. B) Resting helps with milk production. Ask that your baby be fed at night in the nursery. C) Feed your baby every 2 to 3 hours or on demand, whichever comes first. D) Do not allow your baby to nurse any longer than the prescribed number of minutes.
C) Feed your baby every 2 to 3 hours or on demand, whichever comes first. Rationale: Breastfeeding infants should be kept in the room with the mother and fed every 2 to 3 hours or on demand--whichever comes first (C). Rigid scheduling (A) can be detrimental to breastfeeding and impede milk production. While (B) does promote milk production, not feeding at night will decrease the amount of milk produced. The infant should be allowed to decide when to stop breastfeeding rather than breaking suction and pulling the infant off the breast (D) after a set number of minutes since the infant tells the breast how much milk to produce by sucking at the breast.
The nurse is teaching care of the newborn to a group of prospective parents and describes the need for administering antibiotic ointment into the eyes of the newborn. Which infectious organism will this treatment prevent from harming the infant? A) Herpes. B) Staphylococcus. C) Gonorrhea. D) Syphilis.
C) Gonorrhea. Rationale: Erythromycin ointment is instilled into the lower conjunctiva of each eye within 2 hours after birth to prevent ophthalmica neonatorum, an infection caused by gonorrhea, and inclusion conjunctivitis, an infection caused by chlamydia (C). The infant may be exposed to these bacteria when passing through the birth canal. Ophthalmic ointment is not effective against (A, B, and D).
The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement? A) Insert an internal fetal monitor. B) Assess for cervical changes q1h. C) Monitor bleeding from IV sites. D) Perform Leopold's maneuvers.
C) Monitor bleeding from IV sites. Rationale: Monitoring bleeding from peripheral sites (C) is the priority intervention. This client is presenting with signs of placental abruption. Disseminated intravascular coagulation (DIC) is a complication of placental abruptio, characterized by abnormal bleeding. Invasive vaginal procedures (A and B) or (D) can increase the abruption and bleeding, so these interventions are contraindicated.
A client is admitted with the diagnosis of total placenta previa. Which finding is most important for the nurse to report to the healthcare provider immediately? A) Heart rate of 100 beats/minute. B) Variable fetal heart rate. C) Onset of uterine contractions. D) Burning on urination.
C) Onset of uterine contractions. Rationale: Total (complete) placenta previa involves the placenta covering the entire cervical os (opening). The onset of uterine contractions (C) places the client at risk for dilation and placental separation, which causes painless hemorrhaging. Although (A, B, and D) should be reported, the risk of hemorrhage is the priority.
A couple, concerned because the woman has not been able to conceive, is referred to a healthcare provider for a fertility workup and a hysterosalpingography is scheduled. Which postprocedure complaint indicates that the fallopian tubes are patent? A) Back pain. B) Abdominal pain. C) Shoulder pain. D) Leg cramps.
C) Shoulder pain. Rationale: If the tubes are patent (open), pain is referred to the shoulder (C) from a subdiaphragmatic collection of peritoneal dye/gas. (B) could be caused from uterine cramping, but might also be indicative of gas/dye collecting in the uterus due to occluded tubes. Abdominal pain should be further evaluated; it would not be normal after hysterosalpingography. (A and D) are not related to the procedure.
The nurse is preparing to give an enema to a laboring client. Which client requires the most caution when carrying out this procedure? A) A gravida 6, para 5 who is 38 years of age and in early labor. B) A 37-week primigravida who presents at 100% effacement, 3 cm cervical dilatation, and a -1 station. C) A gravida 2, para 1 who is at 1 cm cervical dilatation and a 0 station admitted for induction of labor due to post dates. D) A 40-week primigravida who is at 6 cm cervical dilatation and the presenting part is not engaged.
D) A 40-week primigravida who is at 6 cm cervical dilatation and the presenting part is not engaged. Rationale: When the presenting part is ballottable (D), it is floating out of the pelvis. In such a situation, the cord can descend before the fetus causing a prolapsed cord, which is an emergency situation. (A, B, and C) do not present problems with administration of an enema.
A primigravida client who is 5 cm dilated, 90% effaced, and at 0 station is requesting an epidural for pain relief. Which assessment finding is most important for the nurse to report to the healthcare provider? A) Cervical dilation of 5 cm with 90% effacement. B) White blood cell count of 12,000/mm3. C) Hemoglobin of 12 mg/dl and hematocrit of 38%. D) A platelet count of 67,000/mm3.
D) A platelet count of 67,000/mm3. Rationale: Thrombocytopenia (low platelet count) (D) should be reported to the healthcare provider because it places the client at risk for bleeding when an epidural is administred. (A, B, and C) are within the normal parameters for a client in active labor and is not contraindicated for the placement of an epidural.
The nurse is assessing a client who is having a non-stress test (NST) at 41-weeks gestation. The nurse determines that the client is not having contractions, the fetal heart rate (FHR) baseline is 144 bpm, and no FHR accelerations are occurring. What action should the nurse take? A) Check the client for urinary bladder distention. B) Notify the healthcare provider of the nonreactive results. C) Have the mother stimulate the fetus to move. D) Ask the client if she has felt any fetal movement.
D) Ask the client if she has felt any fetal movement. Rationale: The client should be asked if she has felt the fetus move (D). An NST is used to determine fetal well-being, and is often implemented when postmaturity is suspected. A "reactive" NST occurs if the FHR accelerates 15 bpm for 15 seconds in response to the fetus' own movement, and is "nonreactive" if no FHR acceleration occurs in response to fetal movement. The client should empty her bladder before starting the test, but bladder distention does not impede fetal movement (A). The client should be quizzed about fetal movement before determining that the NST is nonreactive (B). If no movement has occurred in the last 20 to 30 minutes, it is likely that the fetus is sleeping--providing the mother with orange juice often wakes the infant, and then the NST should be conducted again.
One hour after giving birth to an 8-pound infant, a client's lochia rubra has increased from small to large and her fundus is boggy despite massage. The client's pulse is 84 beats/minute and blood pressure is 156/96. The healthcare provider prescribes Methergine 0.2 mg IM × 1. What action should the nurse take immediately? A) Give the medication as prescribed and monitor for efficacy. B) Encourage the client to breastfeed rather than bottle feed. C) Have the client empty her bladder and massage the fundus. D) Call the healthcare provider to question the prescription.
D) Call the healthcare provider to question the prescription. Rationale: Methergine is contraindicated for clients with elevated blood pressure, so the nurse should contact the healthcare provider and question the prescription (D). (A) compromises patient safety. While (B) releases endogenous oxytocin, and (C) promotes uterine contraction, questioning the administration of Methergine is a higher priority because it concerns medication safety.
An expectant father tells the nurse he fears that his wife "is losing her mind." He states she is constantly rubbing her abdomen and talking to the baby, and that she actually reprimands the baby when it moves too much. What recommendation should the nurse make to this expectant father? A) Reassure him that these are normal reactions to pregnancy and suggest that he discuss his concerns with the childbirth education nurse. B) Help him to understand that his wife is experiencing normal symptoms of ambivalence about the pregnancy and no action is needed. C) Ask him to observe his wife's behavior carefully for the next few weeks and report any similar behavior to the nurse at the next prenatal visit. D) Let him know that these behaviors are part of normal maternal/fetal bonding which occur once the mother feels fetal movement.
D) Let him know that these behaviors are part of normal maternal/fetal bonding which occur once the mother feels fetal movement. Rationale: These behaviors are positive signs of maternal/fetal bonding (D) and do not reflect ambivalence (B). No intervention is needed. Quickening, the first perception of fetal movement, occurs at 17 to 20 weeks gestation and begins a new phase of prenatal bonding during the second trimester. Although (A) is not wrong, it dismisses the father's concerns. (C) is not indicated.
Just after delivery, a new mother tells the nurse, "I was unsuccessful breastfeeding my first child, but I would like to try with this baby." Which intervention is best for the nurse to implement first? A) Assess the husband's feelings about his wife's decision to breastfeed their baby. B) Ask the client to describe why she was unsuccessful with breastfeeding her last child. C) Encourage the client to develop a positive attitude about breastfeeding to help ensure success. D) Provide assistance to the mother to begin breastfeeding as soon as possible after delivery.
D) Provide assistance to the mother to begin breastfeeding as soon as possible after delivery. Rationale: Infants respond to breastfeeding best when feeding is initiated in the active phase soon after delivery (D). (A and B) might provide interesting data, but gathering this information is not as important as providing support and instructions to the new mother. While (C) is also true, this response by the nurse might seem judgmental to a new mother.
While breastfeeding, a new mother strokes the top of her baby's head and asks the nurse about the baby's swollen scalp. The nurse responds that the swelling is caput succedaneum. Which additional information should the nurse provide this new mother? A) The infant should be positioned to reduce the swelling. B) The swelling is a subperiosteal collection of blood. C) The pediatrician will aspirate the blood if it gets larger. D) The scalp edema will subside in a few days after birth.
D) The scalp edema will subside in a few days after birth. Rationale: Caput succedaneum is edema of the fetal scalp that crosses over the suture lines and is caused by pressure on the fetal head against the cervix during labor; it subside in a few days after birth without treatment (D). (B) describes a cephalohematoma, a subperiosteal collection of blood that does not cross the suture lines and is a common benign birth injury. (A and C) are not necessary for caput or cephalohematoma.
A new mother is afraid to touch her baby's head for fear of hurting the "large soft spot." Which explanation should the nurse give to this anxious client? A) Some care is required when touching the large soft area on top of your baby's head until the bones fuse together. B) That's just an 'old wives' tale' so don't worry, you can't harm your baby's head by touching the soft spot. C) The soft spot will disappear within 6 weeks and is very unlikely to cause any problems for your baby. D) There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb his/her hair.
D) There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb his/her hair. Rationale: (D) provides correct information and attempts to alleviate anxiety related to knowledge deficit. The anterior fontanel or "large soft spot" has a strong epidermal membrane present, which can be touched (A). (B) dismisses the client's concerns. The anterior fontanel normally closes at 12 to 18 months of age, not 6 weeks (C). The posterior fontanel closes at 8 to 12 weeks of age.
A couple has been trying to conceive for nine months without success. Which information obtained from the clients is most likely to have an impact on the couple's ability to conceive a child? A) Exercise regimen of both partners includes running four miles each morning B) History of having sexual intercourse 2 to 3 times per week. C) The woman's menstrual period occurs every 35 days. D) They use lubricants with each sexual encounter to decrease friction.
D) They use lubricants with each sexual encounter to decrease friction. Rationale: The use of lubricants (D) has the potential to affect fertility because some lubricants interfere with sperm motility. While excessive heat can affect sperm production, bicycling, rather than running (A) is more likely to concentrate heat in the groin area. While having intercourse too frequently has been implicated as a cause for decreased numbers of sperm, 2 to 3 times per week (B) is not considered excessive. (C) should not affect fertility.
In developing a teaching plan for expectant parents, the nurse plans to include information about when the parents can expect the infant's fontanels to close. The nurse bases the explanation on knowledge that for the normal newborn, the A) anterior fontanel closes at 2 to 4 months and the posterior by the end of the first week. B) anterior fontanel closes at 5 to 7 months and the posterior by the end of the second week. C) anterior fontanel closes at 8 to 11 months and the posterior by the end of the first month. D) anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month.
D) anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month. Rationale: In the normal infant the anterior fontanel closes at 12 to 18 months of age and the posterior fontanel by the end of the second month (D). These growth and development milestones should be memorized to prepare for the NCLEX.