NSG 3500 Exam 4 Questions with Correct
Answers
APGAR Score
A rapid assessment of transition evaluating 5 areas: heart rate, respiratory effort, muscle tone,
reflex irritability, and generalized skin color.
Primary goal of APGAR
To assist in the transition to extrauterine life.
Timing for APGAR assessment
Assess at 1 minute (before cord clamping) and 5 minutes. May be reassessed at 10 minutes if
the score is <7.
Score Interpretation for APGAR <4
Severe Distress: Requires NRP (neonatal resuscitation).
Score Interpretation for APGAR 5-6
Mild Distress: Stimulate, warm, and breastfeed (assess what is wrong).
Score Interpretation for APGAR >7
Great: No interventions needed (watch and breastfeed).
Appearance (Generalized skin color) score breakdown
No blue = 2; Blue extremities (acrocyanosis) = 1; Blue all over = 0.
Pulse (Heart Rate) score breakdown
>100 = 2; <100 = 1; Absence = 0.
,Grimace (Reflex irritability) score breakdown
Cry on stimulation = 2; Grimace on stimulation = 1; No response to stimulation = 0.
Activity (Muscle Tone) score breakdown
Flexed = 2; Some flexion = 1; Limp = 0.
Respiration (Respiratory Rate) score breakdown
Strong cry = 2; Weak, Irregular = 1; Absence = 0.
Teacher Note on APGAR assessment
Done by the most credentialed person in the room; if there is a disagreement, there must be a
conversation of why they feel that way.
Teacher Note on Pulse assessment
Start with positive pressure respirations to slowly expand lungs. If after that it still doesn't go
up, start resuscitations.
What chemical factors influence the initiation of breathing in newborns?
Hypercarbia, Acidosis, and Hypoxia.
How does increased carbon dioxide affect newborn respiration?
It prompts the medulla to initiate breathing.
What is the significance of drawing an ABG from the umbilical cord after birth?
It helps determine the pH and assess for prolonged asphyxia.
What sensory factors aid in initiating a newborn's first cry?
Increased stimulation during birthing, including visual and auditory stimuli.
, How does thermal change influence a newborn's first breath?
A drastic temperature change prompts the newborn to cry, initiating respiration.
What mechanical factor assists in clearing fluid from a newborn's lungs?
Compression of the fetal chest during passage through the birth canal.
What role does surfactant play in newborn respiration?
It decreases surface tension in the alveoli, preventing collapse and allowing gas exchange.
What is considered a normal apnea duration for newborns?
5-15 seconds.
What is acrocyanosis, and is it normal in newborns?
It is blue extremities, which is normal for the first 24 hours after birth.
What are the signs of respiratory distress in newborns?
Apnea >20 seconds, Grunting, Nasal Flaring, and Sternal Retractions.
What does circumoral cyanosis indicate in newborns?
It is not normal and indicates a potential cardiac issue.
What is the correct suctioning technique for newborns?
Use bulb suction starting with the mouth, then the nose, avoiding the roof of the mouth.
What position should a newborn be in if gagging or vomiting during suctioning?
Position the head to the side or downward.
What happens to intrathoracic pressure during delivery?
Recoil of the chest wall creates negative pressure, aiding in fluid expulsion from the lungs.
Answers
APGAR Score
A rapid assessment of transition evaluating 5 areas: heart rate, respiratory effort, muscle tone,
reflex irritability, and generalized skin color.
Primary goal of APGAR
To assist in the transition to extrauterine life.
Timing for APGAR assessment
Assess at 1 minute (before cord clamping) and 5 minutes. May be reassessed at 10 minutes if
the score is <7.
Score Interpretation for APGAR <4
Severe Distress: Requires NRP (neonatal resuscitation).
Score Interpretation for APGAR 5-6
Mild Distress: Stimulate, warm, and breastfeed (assess what is wrong).
Score Interpretation for APGAR >7
Great: No interventions needed (watch and breastfeed).
Appearance (Generalized skin color) score breakdown
No blue = 2; Blue extremities (acrocyanosis) = 1; Blue all over = 0.
Pulse (Heart Rate) score breakdown
>100 = 2; <100 = 1; Absence = 0.
,Grimace (Reflex irritability) score breakdown
Cry on stimulation = 2; Grimace on stimulation = 1; No response to stimulation = 0.
Activity (Muscle Tone) score breakdown
Flexed = 2; Some flexion = 1; Limp = 0.
Respiration (Respiratory Rate) score breakdown
Strong cry = 2; Weak, Irregular = 1; Absence = 0.
Teacher Note on APGAR assessment
Done by the most credentialed person in the room; if there is a disagreement, there must be a
conversation of why they feel that way.
Teacher Note on Pulse assessment
Start with positive pressure respirations to slowly expand lungs. If after that it still doesn't go
up, start resuscitations.
What chemical factors influence the initiation of breathing in newborns?
Hypercarbia, Acidosis, and Hypoxia.
How does increased carbon dioxide affect newborn respiration?
It prompts the medulla to initiate breathing.
What is the significance of drawing an ABG from the umbilical cord after birth?
It helps determine the pH and assess for prolonged asphyxia.
What sensory factors aid in initiating a newborn's first cry?
Increased stimulation during birthing, including visual and auditory stimuli.
, How does thermal change influence a newborn's first breath?
A drastic temperature change prompts the newborn to cry, initiating respiration.
What mechanical factor assists in clearing fluid from a newborn's lungs?
Compression of the fetal chest during passage through the birth canal.
What role does surfactant play in newborn respiration?
It decreases surface tension in the alveoli, preventing collapse and allowing gas exchange.
What is considered a normal apnea duration for newborns?
5-15 seconds.
What is acrocyanosis, and is it normal in newborns?
It is blue extremities, which is normal for the first 24 hours after birth.
What are the signs of respiratory distress in newborns?
Apnea >20 seconds, Grunting, Nasal Flaring, and Sternal Retractions.
What does circumoral cyanosis indicate in newborns?
It is not normal and indicates a potential cardiac issue.
What is the correct suctioning technique for newborns?
Use bulb suction starting with the mouth, then the nose, avoiding the roof of the mouth.
What position should a newborn be in if gagging or vomiting during suctioning?
Position the head to the side or downward.
What happens to intrathoracic pressure during delivery?
Recoil of the chest wall creates negative pressure, aiding in fluid expulsion from the lungs.
