Exam questions: Apgar scoring, newborn care, jaundice, NAS

A term infant at 1 minute has: HR 120/min, weak cry, some flexion, grimace only with suction, body pink with blue feet, irregular respirations. What is the most accurate Apgar score?

• 6

• 7

• 8

• 9

A newborn’s Apgar is 3 at 1 minute: HR 55/min, gasping respirations, limp, no response, generalized cyanosis. What is the priority action?

• Begin chest compressions immediately

• Provide positive pressure ventilation for 30 seconds

• Administer naloxone

• Obtain arterial blood gas and glucose

A vigorous term newborn has acrocyanosis, HR 150/min, strong cry, and good tone. Which actions are appropriate? Select all that apply.

• Place skin-to-skin for thermoregulation

• Dry and stimulate

• Initiate supplemental O2 via mask

• Assess pulses in all extremities during routine exam

• Start chest compressions if acrocyanosis persists

A 5-minute Apgar is 5. Which sequence aligns with neonatal resuscitation priorities?

• Clear airway, PPV, reassess HR; compressions if HR <60

• Intubate, administer naloxone, begin chest compressions

• Provide blow-by oxygen, delay PPV to avoid gastric distention

• Transfer to NICU without interventions

A term infant at 10 minutes: HR 95/min, weak cry, minimal flexion, grimace only to stimulation, cyanotic body. What is the Apgar and first intervention?

• 4; chest compressions

• 5; PPV and reassess

• 7; routine care

• 6; erythromycin ointment

Why is erythromycin ophthalmic ointment given within hours of birth?

• Prevents gonococcal ophthalmia neonatorum

• Treats group B streptococcal sepsis

• Prevents physiologic jaundice

• Improves tear film in preterm infants

A depressed infant is born through thick meconium. What is the correct immediate airway management?

• Routine suctioning followed by stimulation

• Intubate and tracheal suction before PPV

• PPV immediately to raise oxygen saturation

• Delay interventions to avoid vagal stimulation

Which sequence of standard newborn medications is appropriate in a stable infant?

• Vitamin K IM, erythromycin ointment, hepatitis B vaccine

• Hepatitis B vaccine, naloxone, erythromycin ointment

• Naloxone, vitamin K IM, erythromycin ointment

• Erythromycin ointment, carboprost, vitamin K IM

Which best explains physiologic neonatal jaundice?

• Increased conjugation due to mature hepatic enzymes

• Decreased conjugation due to immature hepatic UGT activity

• Increased urinary excretion of conjugated bilirubin

• Hemolysis from maternal iron deficiency anemia

Which infants are at highest risk for significant hyperbilirubinemia? Select all that apply.

• Late-preterm with cephalohematoma

• Term infant with early breastfeeding difficulties

• Infant of O+ mother and A+ infant with positive Coombs

• Infant receiving erythromycin ophthalmic ointment

• Rh− mother sensitized in prior pregnancy; infant Rh+