Author Question: The perinatal nurse completes the Ballard Gestational Age by Maturity rating tool. The nurse ... (Read 77 times)

codyclark · **on:** Jun 28, 2018

The perinatal nurse completes the Ballard Gestational Age by Maturity rating tool. The nurse assesses which components as part of this tool? (Select all that apply.)

A.
Behavioral
B.
Neuromuscular
C.
Physical
D.
Psychological
E.
Reflexive

Question 2

The perinatal nurse teaches the student nurse about conditions that may require immediate investigation during the transitional period. These conditions include which of the following? (Select all that apply.)

A.
Grunting and sternal retractions
B.
Heart rate of 112 beats/minute
C.
Infant born at 36 + 2 weeks' gestation
D.
Respiratory rate of 62 breaths/minute
E.
The presence of nasal flaring

nyrave · **Reply #1 on:** Jun 28, 2018

Answer to Question 1

ANS: B, C
With the Ballard assessment system, the infant examination yields a score of neuromuscular and physical maturity that can be extrapolated onto a corresponding age scale to reveal the infant's gestational age in weeks.

Answer to Question 2

ANS: A, B, C, E
For infants, the normal heart rate is between 120 and 160 beats/minute. An infant who is less than 38 completed weeks' gestational age is considered preterm and should be assessed more frequently. An increased respiratory rate (60-70 breaths/minute) may represent a transitional period of adjustment to extrauterine life. However, the development of other symptoms such as nasal flaring, grunting, or intercostal retractions is indicative of respiratory distress.