A nurse observes that a newborn has a pink trunk and head, bluish hands and feet, and flexed extremities 5 min after delivery.
He has a weak and slow cry, a heart rate of 130/min, and cries in response to suctioning. The nurse should document what APGAR Score for this infant?
5.
6.
7.
8.
8.
The Correct Answer is C
Choice A rationale
An APGAR score of 5 indicates significant distress and poor adjustment to extrauterine life, which is not consistent with the provided description of the infant's condition.
Choice B rationale
An APGAR score of 6 suggests moderate difficulty with extrauterine adaptation, which is still not entirely consistent with the overall assessment of the infant.
Choice C rationale
An APGAR score of 7 aligns with the described observations of the newborn: pink trunk and head, bluish extremities, active movement, heart rate of 130/min, and a response to
suctioning, which suggest the infant is in reasonably good condition with some minor issues that need monitoring.
Choice D rationale
An APGAR score of 8 would indicate that the newborn is in very good condition with only slight adjustments needed, which does not fully match the infant's description with the noted
issues like a weak cry and bluish extremities.
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Correct Answer is B
Explanation
Choice A rationale
Placing a baby’s crib next to a heater can pose a risk of overheating or burns. Newborns should be kept at a safe distance from heaters to prevent accidents.
Choice B rationale
Removing extra blankets from the crib is recommended to reduce the risk of suffocation and sudden infant death syndrome (SIDS). This choice reflects an understanding of crib safety.
Choice C rationale
Padding the mattress can pose suffocation risks and is not recommended. A firm mattress without any padding is the safest option for newborns.
Choice D rationale
Placing a baby on their stomach to sleep increases the risk of SIDS. The recommended sleeping position for newborns is on their back, as this significantly reduces the risk.
Correct Answer is B
Explanation
Choice A rationale
A front-facing car seat for an infant does not provide adequate protection in the event of a collision. Infants should always be in a rear-facing car seat to support their head, neck, and spine.
Choice B rationale
Using an infant model car seat designed specifically for the car ensures that the seat meets safety standards and is appropriate for the child's size and developmental needs, providing optimal protection.
Choice C rationale
Being able to fit a hand between the baby and the car seat harness indicates the harness is too loose. The harness should be snug enough that only one or two fingers can fit between the strap and the baby's chest to provide secure restraint.
Choice D rationale
A rear-facing car seat should not be placed in the front passenger seat due to the risk of injury from airbags. The safest position for a rear-facing car seat is in the back seat, away from active airbags.