1.
If a newborn exhibits a heart rate of 80 bpm, the APGAR score should be?
Correct Answer
B. 1
Explanation
The Apgar score is a quick assessment tool used to evaluate the physical condition of a newborn immediately after birth. The score ranges from 0 to 10, with points assigned for various criteria, including heart rate. Each criterion is given a score of 0, 1, or 2, and the scores are then summed.
If a newborn exhibits a heart rate of 80 bpm, the Apgar score for the heart rate criterion would typically be 1. The heart rate criteria often categorize:
0: Absent
1: Below 100 bpm
2: Above 100 bpm
So, a heart rate of 80 bpm falls into the "Below 100 bpm" category and would receive a score of 1 for that criterion. The overall Apgar score considers other factors such as respiratory effort, muscle tone, reflexes, and color.
2.
If a newborn exhibits blue extremities and the body is pink, the APGAR score should be?
A. 0
B. 1
C. 2
D. 3
Correct Answer
B. 1
Explanation
If a newborn exhibits blue extremities and the body is pink, it indicates that the baby may have poor peripheral circulation. This could be due to factors such as cold temperature or respiratory distress. In the APGAR scoring system, a score of 1 is given for color if the body is pink but the extremities are blue. This suggests that the baby's overall condition is relatively stable, but there may be some concerns about circulation.
3.
Erythromycin ointment is administered to the neonate’s eyes shortly after birth to prevent which disorder.
Correct Answer
C. OpHthalmia neonatorum
Explanation
Erythromycin ointment is administered to the neonate's eyes shortly after birth to prevent ophthalmia neonatorum. Ophthalmia neonatorum is an eye infection that can occur in newborns, typically caused by exposure to bacteria during birth. Erythromycin ointment is effective in preventing this disorder by killing the bacteria and reducing the risk of infection. Cataracts, diabetic retinopathy, and strabismus are unrelated to the use of erythromycin ointment in newborns.
4.
A client’s mother asks the nurse why her newborn son is getting an injection of Vit K. Which best explains why this drug is given to neonates?
Correct Answer
A. Vit K assists with coagulation/clotting factor
Explanation
Vitamin K is given to newborns because it assists with coagulation or clotting factor. Newborns have low levels of vitamin K, which puts them at risk for bleeding disorders. Vitamin K helps in the production of clotting factors that are necessary for blood to clot properly, preventing excessive bleeding. By giving newborns a vitamin K injection, the nurse ensures that the baby has enough of this essential nutrient to support normal blood clotting.
5.
Immediately after delivery, the nurse observes that the neonate is whimpering and grimaces when touched. His fingers and toes are bluish, and his HR is 130 beats/min. Active movement with flexed arms and legs and a good cry. Determine the Apgar score:
Correct Answer
A. Assign an Apgar score of 8
Explanation
Based on the given description, the neonate is whimpering and grimacing when touched, which indicates a response to stimuli. His fingers and toes are bluish, suggesting some degree of cyanosis. His heart rate is 130 beats/min, which is within the normal range for a neonate. He also shows active movement with flexed arms and legs and a good cry, indicating good muscle tone and respiratory effort. According to the Apgar scoring system, these signs suggest a score of 8, which indicates that the neonate is in good condition immediately after delivery.
6.
A nurse in a delivery room is assisting with the delivery of a newborn infant. After the delivery, how does the nurse prepare preventing heat loss in the newborn baby resulting from evaporation?
Correct Answer
A. Drying the infant in a warm blanket
Explanation
Drying the infant in a warm blanket helps to prevent heat loss in the newborn baby resulting from evaporation. When a newborn is wet, moisture on their skin can evaporate, causing heat loss. By drying the infant with a warm blanket, the nurse can remove the moisture and create a barrier to prevent further evaporation, helping to keep the baby warm.
7.
Newborn babies don't sleep very much.
Correct Answer
B. False
Explanation
Newborn babies actually sleep a lot, typically around 16 to 17 hours a day. They have irregular sleep patterns and often wake up for feeding or diaper changes, but sleep is a significant part of their daily routine. Therefore, the statement "Newborn babies don't sleep very much" is false.
8.
Vitamin K is prescribed and necessary for a neonate. A nurse prepares to administer the medication in which muscle site?
Correct Answer
C. Vastus lateralis
Explanation
Vitamin K is often given to neonates to prevent bleeding disorders. The nurse would administer the medication in the vastus lateralis muscle. This site is commonly used for intramuscular injections in infants because it has a large muscle mass and is easily accessible. The deltoid and biceps muscles are not typically used for neonatal injections.
9.
A baby is born precipitously in the ER. The nurse’s initial action for the baby should be:
Correct Answer
B. To establish an airway for the baby.
Explanation
The nurse's initial action for the baby should be to establish an airway. This is because a baby born precipitously in the ER may be at risk for airway obstruction or respiratory distress. Establishing an airway will ensure that the baby can breathe properly and receive oxygen. It is the most immediate and crucial action to take in order to support the baby's respiratory function and overall well-being.
10.
The primary critical observation for the Apgar scoring is:
Correct Answer
A. Heart rate
Explanation
The primary critical observation for the Apgar scoring is heart rate. This is because the Apgar score is a quick assessment tool used to evaluate the newborn's overall condition and determine if any immediate medical intervention is required. Heart rate is a vital sign that reflects the newborn's cardiovascular function and can provide important information about their well-being.