CMS CMS Newborn Assessment & Neonatal Care 1 — Questions and Answers
Question 1: The Apgar score is assessed at 1 minute and 5 minutes after birth. Which five criteria are evaluated?
- Heart rate, respiratory effort, muscle tone, reflex irritability, color (Correct answer)
- Heart rate, blood pressure, temperature, color, cry
- Respiratory rate, oxygen saturation, color, tone, reflexes
- Fontanelle tension, cry, color, heart rate, blood pressure
Correct answer: Heart rate, respiratory effort, muscle tone, reflex irritability, color
Apgar score assesses heart rate, respiratory effort, muscle tone, reflex irritability, and skin color, each scored 0–2 for a maximum of 10.
Question 2: A newborn has an Apgar score of 4 at 1 minute. Which immediate action is most appropriate?
- Begin positive-pressure ventilation (Correct answer)
- Administer epinephrine IV
- Perform chest compressions
- Transfer to NICU without further intervention
Correct answer: Begin positive-pressure ventilation
An Apgar score of 4–6 indicates moderate depression; positive-pressure ventilation is initiated if the newborn is not breathing adequately.
Question 3: Which finding on newborn physical exam is considered a normal variant requiring no intervention?
- Epstein pearls on the hard palate (Correct answer)
- Bulging fontanelle
- Central cyanosis at 10 minutes of life
- Absent red reflex
Correct answer: Epstein pearls on the hard palate
Epstein pearls are benign inclusion cysts on the hard palate that resolve spontaneously within weeks.
Question 4: A term newborn's blood glucose is 38 mg/dL at 2 hours of life. What is the first-line management?
- Early breastfeeding or formula supplementation (Correct answer)
- IV dextrose bolus
- Glucagon injection
- Transfer to NICU immediately
Correct answer: Early breastfeeding or formula supplementation
For symptomatic-free newborns with glucose 36–45 mg/dL, the first step is early oral feeding before considering IV glucose.
Question 5: Which newborn reflex disappears by 4–6 months of age and its persistence may indicate neurological pathology?
- Moro reflex (Correct answer)
- Rooting reflex
- Palmar grasp
- Babinski reflex
Correct answer: Moro reflex
The Moro (startle) reflex normally disappears by 4–6 months; its persistence beyond this suggests possible neurological abnormality.
Question 6: A newborn is born at 38 weeks with respiratory distress syndrome. Which surfactant-related factor is most likely responsible?
- Immature type II pneumocytes producing insufficient surfactant (Correct answer)
- Excess surfactant causing airway obstruction
- Meconium aspiration blocking surfactant action
- Pneumothorax from forceful breathing
Correct answer: Immature type II pneumocytes producing insufficient surfactant
Respiratory distress syndrome results from immature type II pneumocytes failing to produce adequate surfactant, leading to alveolar collapse.
CMS CMS Newborn Assessment & Neonatal Care 1
The Apgar score is assessed at 1 minute and 5 minutes after birth.
Which five criteria are evaluated?