A nurse is assisting in the care of a newborn following birth. At 1 min after birth, the nurse notes the following: heart rate 110/min; slow, weak cry; some flexion of extremities; responds to suctioning of the nares with respiration of 20; body pink in color with blue extremities.

What should the nurse document as the newborn's 1-min Apgar score?

10.

Answer and Explanation

The Correct Answer is A

A nurse is assisting in the care of a newborn following birth. At 1 min after birth, the nurse notes the following: heart rate 110/min; slow, weak cry; some flexion of extremities; responds to suctioning of the nares with respiration of 20; body pink in color with blue extremities. What should the nurse document as the newborn's 1-min Apgar score? The correct answer is choice B: 7.
Choice A rationale:

Apgar scores are determined by assessing five vital signs in a newborn at 1 and 5 minutes after birth. The vital signs are heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each category is scored from 0 to 2, with 2 being the best score. In this case, the heart rate is 1, the respiratory effort is 1, muscle tone is 1, reflex irritability is 2 (as the newborn responds to suctioning), and color is 2 (as the body is pink). Therefore, the total Apgar score is 7 (1 + 1 + 1 + 2 + 2 = 7).

Choice B rationale:

The heart rate at 1 minute is 110 beats per minute, which is considered normal for a newborn. A slow, weak cry suggests some respiratory effort, which is given a score of 1 on the Apgar scale. Some flexion of extremities also indicates moderate muscle tone and receives a score of 1. Responding to suctioning with respiration indicates good reflex irritability, which is given a score of 2. The body being pink in color is a positive sign for oxygenation and receives a score of 2. Adding up these scores (1 + 1 + 2 + 2) equals 7, which is the 1-minute Apgar score.

Choice C rationale:

Apgar scores are not determined based on gestational age; they focus on the newborn's immediate condition. While gestational age can influence a newborn's health, it is not directly factored into the Apgar score.

Choice D rationale:

The Apgar score is not related to the mother's condition or complications during pregnancy, such as placenta previa. It solely evaluates the newborn's condition at 1 and 5 minutes after birth.

Choice E rationale:

The Apgar score is a quick assessment of the newborn's physical condition and does not consider issues like the mother's gestational diabetes. It focuses on the baby's vital signs and physical appearance to gauge overall well-being.

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Correct Answer is A

Explanation

Choice A rationale:

Maternal hypertension is the most common risk factor for placental abruption. Placental abruption is a serious condition where the placenta partially or completely separates from the uterine wall before the baby is born. This separation can lead to significant bleeding, which is a medical emergency. Hypertension, also known as high blood pressure, can cause damage to the blood vessels in the placenta, making it more likely for placental abruption to occur. High blood pressure can lead to decreased blood flow to the placenta, increasing the risk of separation.

Choice B rationale:

Maternal battering, while a concerning issue during pregnancy, is not the most common risk factor for placental abruption. Placental abruption is primarily associated with maternal medical conditions and factors that affect the uterine environment.

Choice C rationale:

Maternal cigarette smoking can have adverse effects on pregnancy, but it is not the most common risk factor for placental abruption. Smoking is more commonly associated with other complications such as low birth weight and preterm birth.

Choice D rationale:

Maternal cocaine use is a risk factor for placental abruption, but it is not the most common one. Cocaine can constrict blood vessels and reduce blood flow to the placenta, increasing the risk of abruption. However, hypertension remains the most prevalent risk factor.

A. 0.5 B. 1.0 C. 2.0 D. 0.6

Correct Answer is A

Explanation

Choice A rationale:

To calculate the amount of vitamin K (1 mg) to administer, you need to use the given concentration (1 mg/0.5 mL). This means that 1 mg is present in every 0.5 mL of the solution. To determine how many milliliters (mL) you should administer to get 1 mg, you can set up a proportion: 1 mg / X mL = 1 mg / 0.5 mL Cross-multiply and solve for X: X = (1 mg * 0.5 mL) / 1 mg X = 0.5 mL Therefore, the nurse should administer 0.5 mL, which can be rounded to 2.0 mL to the nearest tenth of a milliliter. Now, let's move on to the next question.

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who is at 34 weeks of gestation and at risk for placental abruption.The nurse recognizes that which of the following is the most common risk factor for a placental abruption?

Correct Answer is A

Explanation

A nurse is preparing to administer vitamin K 1mg IM to a newborn. Available is vitamin K injection 1 mg/0.5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.).

Correct Answer is A

Explanation

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