NCLEX-RN® Question of the Day: Ballard score

Today’s NCLEX-RN® question of the day focuses on indications of low neuromuscular maturity using the Ballard Score.

When determining a newborn’s gestational age using the Ballard Score, which of these findings would indicate low neuromuscular maturity?

A. 30 degree flexion of the wrist

B. Frog-like posture

C. Arm pulled across midline of chest

D. A brisk 90 degree arm recoil

Scroll down for the correct answer!

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The correct answer to today’s NCLEX-RN® Question is…

C. Arm pulled across midline of chest

Rationale: With decreasing neuromuscular maturity, the arm is easily pulled across the chest, with the elbow crossing midline.

Main takeaway

When gently pulling the baby’s arm across the chest and around the neck (like a scarf), a more mature infant will demonstrate increasing resistance and the elbow will not approach midline. With decreasing neuromuscular maturity, the arm is easily pulled across the chest, crossing midline. Flexion increases with advancing gestational age, so a frog-like posture, a brisk 90 degree arm recoil, and a 30 degree flexion of the wrist all indicate increased neuromuscular maturity.

Incorrect answer explanations

A. 30 degree flexion of the wrist

Rationale: This is the “square window” maneuver where the baby’s hands are flexed against the forearm. The angle decreases with advancing gestational age and neuromuscular maturity. An angle greater than 90 degrees indicates extreme immaturity whereas a score of zero degrees indicates a high degree of maturity.

B. Frog-like posture

Rationale: Flexion increases with advancing gestational age and neuromuscular maturity. A frog-like posture (flexion of the arms, knees, and hips) is found when there is a high degree of neuromuscular maturity.

D. A brisk 90-degree arm recoil

Rationale: When evaluating arm recoil, a sluggish response with little or no flexion indicates low neuromuscular maturity, whereas a brisk response with flexion indicates a higher degree of maturity.

References

London, M. L., Ladewig, P. A.W., Davidson, M.R., Ball, J. W., Bindler, R. C. M. & Cowen, K. J. (2017). Maternal & Child Nursing Care (5th ed.). New York, NY: Pearson.