The nurse is caring for a newborn born at 30 weeks' gestation.
Which assessment finding should the nurse anticipate?

The correct answer is Apgar score of 6.

Step 1 is to evaluate each of the five components of the Apgar score at 1 minute:

• Heart rate: 120/min scores 2 points (normal heart rate is ≥100 beats per minute).
• Respiratory effort: Slow and weak cry scores 1 point (normal is a strong cry, scoring 2 points).
• Muscle tone: Some flexion of extremities scores 1 point (normal is active motion, scoring 2 points).
• Reflex irritability: Grimace in response to suctioning scores 1 point (normal is crying or withdrawal, scoring 2 points).
• Color: Body pink with blue extremities scores 1 point (normal is completely pink, scoring 2 points).

Step 2 is to sum up the points. (2 + 1 + 1 + 1 + 1) = Apgar score of 6. .

Choice A rationale

Decreased urine output is not typically associated with patent ductus arteriosus (PDA). PDA causes an abnormal connection between the aorta and pulmonary artery, leading to left-to-right shunting of blood, which predominantly affects the cardiovascular and pulmonary systems rather than renal output directly.

Choice B rationale

Bradycardia is not a hallmark sign of PDA. Instead, PDA commonly leads to increased cardiac workload and tachycardia. The persistent opening between the aorta and pulmonary artery creates volume overload in the heart, which does not slow heart rate but rather increases it to compensate for the extra demand.

Choice C rationale

Cyanosis of the extremities is more typical in conditions involving right-to-left shunting, which is not characteristic of PDA. In PDA, the blood flow is typically left-to-right, meaning oxygenated blood flows back into the pulmonary circulation, which may lead to pulmonary congestion but not peripheral cyanosis.

Choice D rationale

A continuous "machinery-like" heart murmur is a classic sign of PDA due to the turbulent flow of blood between the high-pressure aorta and low-pressure pulmonary artery during both systole and diastole. This characteristic sound is often used diagnostically to identify PDA in newborns.