APGAR Scoring System

Notes

The APGAR Scoring System was developed by Dr. Virginia APGAR as a method of assessing the newborn’s adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.


Assess	0	1	2
Appearance (Skin color)	Blue all over	Body pink, extremities blue	Pink all over
Pulse (Heart Rate)	Absent	Below 100	Above 100
Grimace (Reflex Irritability)	No Response	Grimace	Vigorous cry
Activity (Muscle Tone)	Flaccid	Some flexion	Active motion
Respiration (Breathing)	Absent	Slow	Good crying

SCORE:

7-10 Good adjustment, vigorous
Moderately depressed infant, needs airway clearance
Severely depressed infant, in need of resuscitation

Source: Outline in Obstetrics, 2004 Edition by Maria Loreto J. Evangelista-Sia

Exam

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Question 1

A nurse in a newborn nursery receives a phone call to prepare for the admission of a 43-week-gestation newborn with Apgar scores of 1 and 4. In planning for the admission of this infant, the nurse’s highest priority should be to:

A	Connect the resuscitation bag to the oxygen outlet
B	Turn on the apnea and cardiorespiratory monitors
C	Set up the intravenous line with 5% dextrose in water
D	Set the radiant warmer control temperature at 36.5* C (97.6*F)

Question 1 Explanation:

The highest priority on admission to the nursery for a newborn with low Apgar scores is airway, which would involve preparing respiratory resuscitation equipment. The other options are also important, although they are of lower priority.

Question 2

You are assessing the one minute APGAR score for a newborn. She is pink all over and has a pulse of 130. As you dry her off she begins to cry vigorously and kick her legs. Her APGAR score is

A	7
B	8
C	9
D	10

Question 3

It has been 5 minutes since your patient delivered her baby. The infant is crying weakly and is curling his arms and legs. He is pink all over with a pulse of 90 and weak respirations. What is his APGAR score

A	4
B	5
C	6
D	7

Question 4

The primary critical observation for Apgar scoring is the:

A	Heart rate
B	Respiratory rate
C	Presence of meconium
D	Evaluation of the Moro reflex

Question 4 Explanation:

The heart rate is vital for life and is the most critical observation in Apgar scoring. Respiratory effect rather than rate is included in the Apgar score; the rate is very erratic.

Question 5

Starting at which number on the APGAR score should you need to start resuscitation efforts

A	4
B	5
C	6
D	7

Question 6

When performing a newborn assessment. the nurse should measure the vital signs in the following sequence:

A	Pulse. respirations. temperature
B	Temperature. pulse. respirations
C	Respirations. temperature. pulse
D	Respirations. pulse. temperature

Question 6 Explanation:

This sequence is least disturbing. Touching with the stethoscope and inserting the thermometer increase anxiety and elevate vital signs.

Question 7

The expected respiratory rate of a neonate within three (3) minutes of birth may be as high as:

A	50
B	60
C	80
D	100

Question 7 Explanation:

The respiratory rate is associated with activity and can be as rapid as 60 breaths per minute; over 60 breaths per minute are considered tachypneic in the infant.

Question 8

You just delivered a baby boy. His body is pink, but his hands and feet are blue. Vital signs are P110, R rapid and irregular. He has a weak cry when stimulated and resists attempts to straighten his legs. His APGAR score is

A	7
B	8
C	9
D	10

Question 9

After assisting in the delivery of a newborn the infant is pale and limp, has a slow heartbeat but shows some respiratory effort. What APGAR score would you give this infant

A	1
B	2
C	3
D	4

Question 10

One minute after birth, your newborn patient is actively crying in response to your bulb syringe. His body is pink, and he is moving his extremities which are blue. His heart rate is 110. What is the newborns APGAR score

A	7
B	8
C	9
D	10

Question 11

A neonatal patient has a pink color, a pulse rate of 102, and a respiration rate of 27. She grimaces in response to stimuli, has limited muscle movement. This patient has an APGAR score of

A	6
B	7
C	8
D	9

Question 12

A newborn has a strong cry and is actively moving his blue extremities when stimulated. Vital signs are P140, R48. What is his APGAR score

A	7
B	8
C	9
D	10

Question 13

A newly delivered infant has a pink trunk and blue hands and feet, pulse rate of 60 and does not respond to your attempts to stimulate her. She also appears to be limp and taking slow, gasping breaths. What is her APGAR score

A	3
B	4
C	5
D	6

Question 14

What is a typical one minute APGAR score for a newborn

A	4-6
B	5-7
C	7-9
D	8-10

Question 15

Within three (3) minutes after birth the normal heart rate of the infant may range between:

A	100 and 180
B	130 and 170
C	120 and 160
D	100 and 130

Question 15 Explanation:

The heart rate varies with activity; crying will increase the rate. whereas deep sleep will lower it; a rate between 120 and 160 is expected.

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APGAR Scoring System Practice Exam (PM)*

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