A nurse is reinforcing teaching to a student nurse about Apgar scores in newborns.
Which of the following statements by the student demonstrates effective reinforcement?
An Apgar score evaluates how the newborn is transitioning to extrauterine life.
There are five components included in the Apgar score that are each given a number of 1 or 2.
It is unexpected for a newborn to receive a score of 1 for color.
Resuscitation interventions should not be started until after the 1-minute Apgar.
The Correct Answer is A
Choice A rationale
The Apgar score is a rapid assessment tool utilized at 1 and 5 minutes after birth to evaluate a newborn's physiological adjustment to extrauterine life. It assesses five critical parameters that reflect the newborn's cardiorespiratory and neurological status.
Choice B rationale
While there are five components in the Apgar score (Appearance, Pulse, Grimace, Activity, Respiration), each component can be scored 0, 1, or 2, not just 1 or 2. This scoring system allows for a more nuanced assessment of the newborn's condition.
Choice C rationale
It is not unexpected for a newborn to receive a score of 1 for color, especially at the 1-minute Apgar, as acrocyanosis (bluish discoloration of the hands and feet) is common due to immature peripheral circulation. This finding alone does not typically indicate significant distress.
Choice D rationale
Resuscitation interventions should be initiated based on the newborn's immediate clinical assessment, regardless of the Apgar score. If a newborn exhibits signs of distress, such as apnea or bradycardia, resuscitation should commence promptly without waiting for the 1-minute Apgar score.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is E
Explanation
Choice A rationale
Living in a women's shelter indicates a lack of stable housing, which can be a significant psychosocial stressor. Chronic stress during pregnancy can elevate cortisol levels, potentially impacting fetal development and increasing the risk of preterm birth or low birth weight. Resource scarcity might also limit access to adequate nutrition and consistent prenatal care, both vital for healthy pregnancy outcomes.
Choice B rationale
Unemployment can lead to financial strain, contributing to increased stress and anxiety. This economic insecurity may hinder access to nutritious food, adequate housing, and transportation to prenatal appointments. Chronic psychosocial stress can trigger physiological responses like increased heart rate and blood pressure, potentially impacting maternal and fetal well-being throughout gestation.
Choice C rationale
Being 25 years of age is generally considered within the optimal reproductive age range. Biologically, women in this age group typically have lower risks of chromosomal abnormalities, gestational hypertension, and gestational diabetes compared to adolescents or women of advanced maternal age. This demographic often experiences fewer pregnancy-related complications due to mature physiological systems.
Choice D rationale
White non-Hispanic race does not inherently increase the risk of pregnancy complications. While racial disparities exist in healthcare outcomes, these are primarily attributed to socioeconomic factors, systemic biases, and access to quality care rather than biological predisposition based on race itself. This demographic factor alone is not a direct physiological risk.
Choice E rationale
A history of depression is a significant risk factor for pregnancy complications. Untreated or poorly managed depression can lead to poor self-care, including inadequate nutrition and non-adherence to prenatal care. Furthermore, peripartum depression can recur or worsen, impacting maternal-infant bonding and potentially leading to adverse developmental outcomes for the child due to altered neurochemical environments.
Correct Answer is C
Explanation
Choice A rationale
The passageway refers to the birth canal, including the pelvis and soft tissues. While an adequate passageway is essential for labor progression, the client's current cervical dilation (7 cm) and effacement (80%) indicate that the passageway is accommodating fetal descent, and there is no direct evidence from the scenario suggesting an issue with this factor.
Choice B rationale
The passenger refers to the fetus, including its size, presentation, lie, and attitude. There is no information in the scenario to suggest any concerns with the fetus itself, such as malpresentation or distress. The focus of the client's statement is on their emotional state rather than a physical aspect of the baby.
Choice C rationale
Psyche refers to the client's psychological and emotional state during labor. The client's statement "I am really afraid of giving birth" and subsequent crying directly indicate significant fear and anxiety. This emotional distress can negatively impact labor progression by increasing catecholamine release, potentially hindering uterine contractions and increasing pain perception, thus requiring immediate attention.
Choice D rationale
Powers refer to the uterine contractions (primary power) and the mother's pushing efforts (secondary power). While effective powers are crucial for labor progression, the scenario does not provide information to suggest that the client's contractions are inadequate or that there's an issue with her ability to push. The immediate concern presented is her emotional state.
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