The nurse notes that a newborn, who is 5 minutes old, exhibits the following characteristics: pink body with blue hands and feet, heart rate 108 bpm. respiratory rate 36 per minute, some flexion, and a vigorous cry with stimulation. What does the nurse determine the baby's APGAR score to be?

Answer and Explanation

The Correct Answer is D

A. Heart Rate: 108 bpm = 2 points, Respiratory Effort: Regular rate with a cry = 2 points, Muscle Tone: Some flexion = 1 point, Reflex Irritability: Vigorous cry with stimulation = 2 points, Color: Pink body, blue extremities (acrocyanosis) = 1 point: Total APGAR Score: 8
B. A. Heart Rate: 108 bpm = 2 points, Respiratory Effort: Regular rate with a cry = 2 points, Muscle Tone: Some flexion = 1 point, Reflex Irritability: Vigorous cry with stimulation = 2 points, Color: Pink body, blue extremities (acrocyanosis) = 1 point: Total APGAR Score: 8
C. A. Heart Rate: 108 bpm = 2 points, Respiratory Effort: Regular rate with a cry = 2 points, Muscle Tone: Some flexion = 1 point, Reflex Irritability: Vigorous cry with stimulation = 2 points, Color: Pink body, blue extremities (acrocyanosis) = 1 point: Total APGAR Score: 8
D. A. Heart Rate: 108 bpm = 2 points, Respiratory Effort: Regular rate with a cry = 2 points, Muscle Tone: Some flexion = 1 point, Reflex Irritability: Vigorous cry with stimulation = 2 points, Color: Pink body, blue extremities (acrocyanosis) = 1 point: Total APGAR Score: 8

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}

Explanation

Prolactin: This hormone, released by the anterior pituitary gland, stimulates the alveolar cells in the mammary glands to produce breast milk. Prolactin levels increase significantly after birth in response to the infant's suckling.

Oxytocin: Released by the posterior pituitary gland, oxytocin triggers the contraction of the myoepithelial cells surrounding the alveoli, causing milk to be ejected from the ducts, a process known as the let-down reflex.

A. It is an abnormal finding called seborrheic dermatitis. B. It is a normal finding called Epstein pearls. C. It is an abnormal finding indicating congenital syphilis infection. D. It is a normal finding called erythema toxicum.

Correct Answer is D

Explanation

A. Seborrheic dermatitis presents with greasy, yellow scales on the scalp, not pustules.
B. Epstein pearls are white cystic lesions found on the gums or roof of the mouth.
C. Congenital syphilis presents with more severe systemic signs and not just a pustular rash.
D. Erythema toxicum is a common, benign, self-limiting newborn rash that appears as firm pustules on a red base, typically seen on the face and trunk.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse notes that a newborn, who is 5 minutes old, exhibits the following characteristics: pink body with blue hands and feet, heart rate 108 bpm. respiratory rate 36 per minute, some flexion, and a vigorous cry with stimulation. What does the nurse determine the baby's APGAR score to be?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Complete the following sentence by using the list of options There are two main hormones that have a significant role in lactation. ______ is responsible for the stimulation of breastmilk production and ______ triggers the let-down reflex.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}

Explanation

The nurse is assessing a term newborn and finds a rash of firm pustules with a red base on the face and trunk. Based on the assessment findings, the nurse determines this about the rash:

Correct Answer is D

Explanation

A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide?

A nurse places a newborn under a radiant heat warmer after birth. The purpose of this action is to prevent which of the following in the newborn?

The nurse is caring for a 26-week-gestation infant diagnosed with periventricular hemorrhage and currently intubated. What is the most appropriate nursing action(s) for this infant?

The nurse completing a gestational exam using the Ballard assessment tool understands that this assesses which two maturity components?

The nurse is assessing a 4-hour old newborn. The nurse's findings include an irregular respiratory rate at 58, heart rate of 138 with a regular rhythm, and axillary temperature of 97.4 °F. Based on these assessments which intervention(s) should the nurse perform first?

A nurse is providing teaching about comfort measures for breast engorgement to a client who is postpartum and is breastfeeding. Which of the following statements by the client indicates a need for further teaching?

A nurse is assisting a healthcare provider during an infant's circumcision. Which action by the nurse demonstrates the nurse is acting as the infant's client care advocate?

A 1-day old newborn was born to a mother who had positive vaginal cultures for Group Beta Strep. The mother was only in labor for 1 hour prior to birth. What findings would indicate possible neonatal sepsis?