Neonatal Nurse Practitioner Practice Exam

Which condition should be evaluated in a neonate with a firm, fluctuating mass over the cranial bone that does not cross suture lines?

1. A linear skull fracture

2. Increased intracranial pressure

3. Subdural hemorrhage

4. Cephalohematoma

The correct answer is: A linear skull fracture

The condition in question is best represented by the presence of a firm, fluctuating mass over the cranial bone that does not cross suture lines, which aligns with a cephalohematoma. Cephalohematoma occurs as a result of bleeding between the periosteum and the skull bone, typically due to trauma during delivery. The blood accumulation is localized to the area over the affected bone and does not cross suture lines because of the rigid nature of the skull sutures in neonates. When evaluating the characteristics of the mass, it exhibits firmness and fluctuation, which are typical findings in a cephalohematoma. The fluctuation indicates the presence of fluid, while firmness implies there's a significant quantity of coagulated blood involved. Other options such as increased intracranial pressure, subdural hemorrhage, or linear skull fractures would present differently. For instance, increased intracranial pressure may lead to clinical symptoms and signs (such as high-pitched crying or seizures) rather than a simple mass. Subdural hemorrhage usually presents with more diffuse symptoms and may not have the same localized characteristics. Linear skull fractures typically do not form a mass and rather present on imaging rather than as a palpable mass. In summary,