A nurse is assessing an infant who has hydrocephalus. Which of the following clinical manifestations should the nurse expect?

Choice A rationale Depressed scalp veins are not a typical manifestation of hydrocephalus. In fact, due to the increased intracranial pressure (ICP) associated with hydrocephalus, the veins on the scalp may appear distended and prominent as they become engorged with blood, reflecting the difficulty of venous return from the brain. The pressure buildup pushes against these superficial veins. Choice B rationale The anterior fontanel is a soft spot on an infant's head where the skull bones have not yet fused. In hydrocephalus, the buildup of cerebrospinal fluid (CSF) increases intracranial pressure, causing the fontanels to bulge outward and feel tense, not sunken. Sunken fontanels are typically a sign of dehydration due to a decrease in fluid volume. Choice C rationale Bulging eyes are not a specific or expected finding for hydrocephalus. Instead, the increased intracranial pressure can cause the eyes to deviate downward, a phenomenon known as the "setting sun" sign. This is caused by the pressure on the cranial nerves that control eye movement, specifically the superior gaze, not a physical bulging of the eyes themselves. Choice D rationale Hydrocephalus is characterized by an excessive accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased intracranial pressure. In infants, whose cranial sutures are not yet fused, this pressure causes the sutures to separate and the head circumference to increase significantly. The separation of sutures is a direct mechanical result of the internal pressure pushing the skull plates apart.