Calculate the APGAR score of the infant showing the following.

• Complete pink in colour
• Pulse rate - 120 beats per minute
• Cough and sneezing
• Active movement
• Crying

1. A

   5

2. B

   10

3. C

   15

4. D

   20

Appeared in: DSSSB 12 August 2024

Explanation

• The APGAR score is calculated by assessing five criteria: Appearance, Pulse, Grimace, Activity, and Respiration, each scored from 0 to 2.
• The infant is 'completely pink,' which scores 2 for Appearance.
• The pulse rate is '120 beats per minute' (greater than 100), which scores 2 for Pulse.
• The infant is 'coughing and sneezing,' indicating a strong reflex response, which scores 2 for Grimace.
• There is 'active movement,' which scores 2 for Activity (muscle tone).
• The infant is 'crying,' which indicates good respiratory effort and scores 2 for Respiration.

Why Other Options Were Wrong

• Option A: A score of 5 indicates the newborn is in moderate distress. This would correspond to signs such as a slow heart rate (less than 100 bpm), weak cry, some flexion, grimacing, and acrocyanosis (blue extremities), which are not present in this scenario.
• Option C: The maximum possible APGAR score is 10. Each of the five components (Appearance, Pulse, Grimace, Activity, Respiration) can receive a maximum score of 2. Therefore, a score of 15 is impossible.
• Option D: The maximum possible APGAR score is 10. A score of 20 is impossible as it is double the maximum achievable score.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Newborn assessment using the APGAR scoring system as background academic context rather than a clinical decision trigger.
• The APGAR score is a critical tool for nurses to quickly assess a newborn's transition to extrauterine life at 1 and 5 minutes after birth.
• A score of 7-10 is considered normal and indicates the baby is in good condition. A score below 7 may indicate that the baby needs medical attention, such as suctioning the airways or providing oxygen.
• Nurses must accurately and rapidly assess the five components to calculate the score, as it guides the immediate need for resuscitation and further observation.

How to Approach the Question

• First, recall the five components of the APGAR score: Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.
• Next, read the clinical signs provided in the question for the infant.
• Assign a score of 0, 1, or 2 to each of the five components based on the standard APGAR criteria.
• For 'Complete pink in colour', assign 2 points for Appearance.
• For 'Pulse rate - 120 beats per minute', assign 2 points as it's over 100 bpm.
• For 'Cough and sneezing', assign 2 points for Grimace.

Concept Tested & Keywords

• Concept Tested: Newborn assessment using the APGAR scoring system.
• Stem keywords: APGAR score, infant, Complete pink, Pulse rate 120, Cough and sneezing, Active movement, Crying
• Lead-in keywords: Calculate
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QHDAYLbT0RpN3GsD-9sdUQ

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 119-121

E6 Obstetrics Williams p. 3