The anterior fontanelle is bulging and tense when the newborn cries.This is an abnormal finding that should be reported to the provider as it may indicate increased intracranial pressure or intracranial and extracranial tumors.

Choice A is wrong because the anterior fontanelle is normally diamond-shaped and 2 cm wide.

Choice B is wrong because the posterior fontanelle is normally triangular and 0.5 cm wide.

Choice D is wrong because the posterior fontanelle normally closes by 8 weeksand may not be palpable at six weeks.

Milia are caused by blocked sebaceous glands and will go away on their own.They are tiny, white bumps on a newborn’s nose, cheeks, chin and forehead.

Choice B is wrong because Mongolian spots are not a sign of bruising and should not be reported to the provider.They are blue or purple-colored splotches on the baby’s lower back and buttocks that are caused by a concentration of pigmented cells.They are more common in dark-skinned babies of all races and usually fade by age 5.

Choice C is wrong because head circumference should be about 2 cm larger than the chest circumference, not smaller.

A smaller head circumference may indicate a problem with brain development.

Choice D is wrong because fontanelles should be flat and soft to indicate adequate hydration.Sunken and firm fontanelles may indicate dehydration or increased intracranial pressure.Fontanelles are the soft spots on a baby’s head where the skull bones have not yet fused together.

5. The APGAR score is a method of assessing the health of a newborn based on five criteria: appearance (skin color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (breathing rate and effort).

Each criterion is scored from 0 to 2, with a total score ranging from 0 to 10.

A higher score indicates a better condition of the newborn.

The newborn in the question has a score of 1 for appearance (pale or blue extremities), 1 for pulse (heart rate below 160/min), 1 for grimace (minimal response to stimulation), 1 for activity (some flexion of extremities), and 1 for respiration (slow or irregular breathing).

The sum of these scores is 5.

Choice A is wrong because a score of 4 would mean that the newborn has a score of 0 for one of the criteria, which is not the case.

Choice C is wrong because a score of 6 would mean that the newborn has a score of 2 for one of the criteria, which is not the case.

Choice D is wrong because a score of 7 would mean that the newborn has a score of 2 for two of the criteria, which is not the case.

The normal ranges for each criterion are:

• Appearance: 0 (blue or pale all over), 1 (pink body but blue extremities), or 2 (pink all over).

• Pulse: 0 (absent), 1 (below 100/min), or 2 (above 100/min).

• Grimace: 0 (no response to stimulation), 1 (grimace or weak cry), or 2 (vigorous cry).

• Activity: 0 (limp or flaccid), 1 (some flexion of extremities), or 2 (active movement).

• Respiration: 0 (absent), 1 (slow or irregular), or 2 (good and regular).

The correct answer is choice A, B, C and E.The New Ballard Scale is a scale that estimates the gestational age of a newborn infant based on physical and neuromuscular characteristics.The physical characteristics include skin texture, lanugo, plantar surface, breast tissue, eye/ear and genitals.The neuromuscular characteristics include posture, square window, arm recoil, popliteal angle, scarf sign and heel to ear.

The nurse should evaluate all these characteristics and assign a score for each one.The total score determines the gestational maturity in weeks.

Choice D is wrong because hair pattern is not one of the physical characteristics used in the New Ballard Scale.

Hair pattern may vary depending on genetic factors and is not a reliable indicator of gestational age.

The normal ranges for each characteristic are given in the table below:

Presence of subconjunctival haemorrhages.

Subconjunctival haemorrhages are small blood spots on the white part of the eye that is caused by pressure during delivery.They are harmless and usually disappear within a few weeks.

Choice A is wrong because the absence of a red reflex is a sign of a serious eye problem, such as a cataract or retinoblastoma.

The red reflex test is done by shining a light into the baby’s eyes and looking for a red reflection from the retina.It is part of the newborn physical screening examination.

Choice C is wrong because the inability to track objects is not expected in a newborn.Babies can usually follow objects with their eyes by 2 to 3 months of age.

Choice D is wrong because unequal pupil sizes can indicate a neurological problem or an eye injury.Pupil sizes should be checked and measured during the newborn physical examination.