A newborn has an APGAR Score of 6 at 5 minutes.
Which of the following is the priority?
Obtaining umbilical blood gases.
Beginning resuscitative measures.
Promoting kangaroo care.
Initiating IV fluid therapy.
The Correct Answer is B
Choice A rationale
Obtaining umbilical cord blood gases provides an objective measure of the acid-base status at birth, reflecting the severity and duration of peri-natal asphyxia; however, an APGAR score of 6 at 5 minutes indicates moderate distress and a need for immediate intervention, not just diagnosis, as the priority. While informative, this step is secondary to stabilization efforts. Normal umbilical arterial pH is 7.25-7.40.
Choice B rationale
An APGAR score of 6 at 5 minutes indicates moderate cardio-respiratory depression, requiring active intervention to prevent further decline and potential injury, thus beginning resuscitative measures is the highest priority. Initial steps often include tactile stimulation and positive pressure ventilation (PPV) if necessary, aiming to rapidly improve vital signs and oxygenation which are the direct parameters affecting the APGAR score.
Choice C rationale
Promoting kangaroo care (skin-to-skin contact) is beneficial for thermoregulation, bonding, and stabilization in stable newborns; however, a score of 6 suggests the infant is not fully stable and requires closer monitoring and potential intervention, making it inappropriate as the initial priority over addressing the compromised respiratory and cardiac status.
Choice D rationale
Initiating IV fluid therapy may be necessary for hypovolemia or to administer medications, but it is not the immediate priority for a newborn with an APGAR score of 6, whose primary needs are establishing effective respiration and circulation. Establishing intravenous access would follow the stabilization of the airway and breathing if necessary. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Rho(D) immune globulin, or Rhogam, is crucial for preventing Rh sensitization in an Rh-negative mother carrying an Rh-positive fetus. Sensitization can occur during delivery when fetal Rh-positive red blood cells enter the maternal circulation. Rhogam must be administered postpartum to destroy these fetal cells before the mother's immune system can produce permanent anti-D antibodies, regardless of the timing of the delivery.
Choice B rationale
The Rh-negative mother is at risk of isoimmunization when her newborn is Rh-positive, as is the case here. Rho(D) immune globulin works by suppressing the mother's antibody response to the Rh-positive fetal red blood cells. To be effective, this passive immunity must be provided by administering the medication, typically a full 300 mcg dose, within 72 hours of birth to prevent permanent sensitization.
Choice C rationale
The newborn's A-positive blood type means the infant possesses the Rh (or D) antigen, which is the indication for Rhogam administration to the Rh-negative mother. There is no mention of a prior dose or second dose; this would be the necessary first postpartum dose. The presence of the Rh antigen in the newborn makes this a required intervention to protect future pregnancies.
Choice D rationale
Rho(D) immune globulin must be administered within 72 hours postpartum irrespective of the mother's plans for future pregnancies. Once sensitization occurs, it is permanent and will put all subsequent Rh-positive fetuses at risk for severe hemolytic disease of the newborn. Protecting the current and future fetuses is the clinical imperative, making the dose mandatory. —.
Correct Answer is A
Explanation
Choice A rationale
Estrogen-containing contraceptives significantly increase the risk of venous thromboembolism (VTE), which includes DVT, by altering the balance of the coagulation cascade. Estrogen promotes the synthesis of clotting factors while simultaneously decreasing the levels of antithrombin, thereby creating a hypercoagulable state. For women with a prior history of DVT, this elevated VTE risk makes all estrogen-containing contraceptives absolutely contraindicated to prevent recurrence.
Choice B rationale
This statement is scientifically incorrect and potentially harmful. Estrogen-containing birth control pills increase, not lower, the risk of DVT, typically 3-to-9-fold compared to non-users, especially in individuals with pre-existing risk factors like a DVT history. The synthetic estrogen component directly contributes to blood hypercoagulability by increasing liver production of pro-thrombotic proteins.
Choice C rationale
While barrier methods like condoms are safe as they have no systemic hormonal effects, they are not the only safe contraceptive option. Progestin-only contraceptives (e.g., progestin-only pills, depot injection, hormonal IUDs) and non-hormonal IUDs are also considered safe and effective alternatives because progestins alone do not carry the same significant thrombogenic risk as estrogen.
Choice D rationale
This is a dangerous and incorrect statement. A personal history of DVT is a definitive contraindication for the use of any combined oral contraceptive (COC) or any method containing estrogen, due to the high risk of VTE recurrence. The potential for a life-threatening pulmonary embolism outweighs the benefits, necessitating the exclusive use of non-estrogen methods. —. ##
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