{"id":9953,"date":"2026-05-25T00:05:30","date_gmt":"2026-05-25T08:05:30","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9953"},"modified":"2026-06-30T13:45:32","modified_gmt":"2026-06-30T21:45:32","slug":"pance-question-of-the-day-blue-extremities","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities","title":{"rendered":"PANCE\u00ae Question of the Day: Blue extremities"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities\/#The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-blue-extremities\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for the PANCE\u00ae with this clinical scenario involving a newborn with blue extremities. What are the next immediate steps in this child&#8217;s care? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A newborn boy<\/strong> is evaluated by a pediatrician <strong>immediately after a vaginal delivery at 37 weeks&#8217; gestation.<\/strong> The mother is <strong>33 years old<\/strong>, and the pregnancy was uncomplicated. This is the mother&#8217;s first pregnancy, and she has no significant medical history. The newborn\u2019s <strong>temperature is 36.7\u00b0C (98.1\u00b0F), heart rate is 150\/min, respiratory rate is 40\/min, and oxygen saturation is 93% on room air.<\/strong> The newborn is <strong>dried, stimulated, and his nose and oropharynx are suctioned.<\/strong> He has <strong>blue extremities<\/strong>, <strong>cries and pulls away from the examiner\u2019s touch<\/strong>, <strong>flexes his arms and legs<\/strong>, and has a <strong>strong cry.<\/strong> <strong>Which of the following is the best next step in assessing this patient?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Newborn metabolic screen<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Breastfeeding<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Chest radiograph<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. APGAR score<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Measurement of growth parameters<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!\u00a0<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. APGAR score<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct: <\/strong>See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Newborn metabolic screen<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The newborn metabolic screen is typically collected between 24\u201348 hours of life and is used to test for various genetic conditions. The best initial step in assessing this patient is calculating the APGAR score, a time-sensitive assessment taken at one and five minutes after birth.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Breastfeeding<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Although breastfeeding is a core component of immediate newborn care and is often evaluated by lactation before discharge, the APGAR score is obtained during the initial resuscitation process at one and five minutes of life.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Chest radiograph<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> A chest radiograph is not indicated for this patient due to the absence of respiratory distress and the presence of age-appropriate vital signs and physical examination findings. The best next step is to calculate an APGAR score, which is essential for determining disposition and subsequent management.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Measurement of growth parameters<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> While measurement of growth parameters is a fundamental aspect of the newborn examination, it should not take precedence over performing the APGAR score, which is crucial for determining disposition and subsequent management.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"804\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_424ada.png\" alt=\"Table showing the newborn Apgar score assessed at one and five minutes of life. It evaluates appearance, pulse, grimace, activity, and respiration, with scores from 0 to 2 for each category, ranging from normal findings (pink color, heart rate \u2265100 bpm, strong cry) to severe distress (no pulse, no breathing, no response).\" class=\"wp-image-9956\" style=\"aspect-ratio:1.2126884852638793;width:519px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_424ada.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_424ada.png?resize=300,247 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/05\/image_424ada.png?resize=768,633 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This newborn is evaluated immediately following a vaginal delivery. <strong>A core component of the immediate assessment of a newborn is to calculate an APGAR score, which is based on the infant&#8217;s <em><span style=\"text-decoration: underline;\">Appearance, Pulse, Grimace, Activity<\/span>, and <span style=\"text-decoration: underline;\">Respiration<\/span>.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The score is performed <strong>at one and five minutes of life<\/strong>, and the newborn is assigned a score <strong>out of 10 based on these five factors.<\/strong> <strong>The APGAR score assists in triaging newborn wellness\u2014newborns with scores less than 7 require further monitoring.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In addition to the APGAR score, the evaluation should include <strong>vital signs and growth parameters, followed by a comprehensive physical examination.<\/strong> The history should focus on <strong>prenatal and maternal factors, as well as caregiver concerns and social determinants of health.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Immediate care of the well newborn begins at birth and continues through hospital discharge.<\/strong> It includes the <strong>identification of any abnormalities requiring further investigation<\/strong>, such as a cardiac murmur. Additionally, it should include <strong>feeding support, administration of immunizations (e.g., hepatitis B, respiratory syncytial virus (RSV) antibodies, if indicated), administration of preventive medications (e.g. vitamin K), routine screenings, anticipatory guidance, and optional care, such as circumcision.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A core component of the immediate care of the well newborn involves calculating an APGAR score. This score can be used to triage newborns who may require further monitoring or intervention.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Review this Osmosis Learn page: <\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Immediate_care_of_the_well_newborn:_Clinical_sciences\">Immediate care of the well newborn: Clinical sciences<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>(2022). <strong>Review of care&nbsp;of&nbsp;the&nbsp;well newborn<\/strong>. AAP.&nbsp;<a href=\"https:\/\/doi.org\/10.1542\/pir.2022-005511\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1542\/pir.2022-005511<\/a>&nbsp;&nbsp;<\/li>\n\n\n\n<li>(2017). <strong>Recommendations on newborn health<\/strong>. WHO. WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee&nbsp;&nbsp;<\/li>\n\n\n\n<li>Egge JA, Anderson RH, Schimelpfenig MD. <strong>Care of the Well Newborn.<\/strong>&nbsp;Pediatr&nbsp;Rev. 2022 Dec 1;43(12):676-690.&nbsp;doi: 10.1542\/pir.2022-005511. PMID: 36450636.&nbsp;&nbsp;<\/li>\n\n\n\n<li><strong>WHO recommendations on newborn health: guidelines approved by the WHO&nbsp;&nbsp;<\/strong><\/li>\n\n\n\n<li>Guidelines Review Committee. Geneva: World Health Organization; 2017 (WHO\/MCA\/17.07). License: CC BY-NC-SA 3.0 IGO.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Benitz WE; Committee on Fetus and Newborn, American Academy of Pediatrics. <strong>Hospital stays for healthy term newborn infants.<\/strong> Pediatrics. 2015 May;135(5):948-53.&nbsp;doi: 10.1542\/peds.2015-0699. PMID: 25917993&nbsp;&nbsp;<\/li>\n\n\n\n<li>Lewis ML. <strong>A comprehensive newborn exam:&nbsp;part&nbsp;I. General, head, and neck, cardiopulmonary.<\/strong> Am Fam Physician. 2014 Sep 1;90(5):289-96. PMID: 25251088.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Lewis ML.<strong> A comprehensive newborn exam:&nbsp;part&nbsp;II. Skin, trunk, extremities, neurologic.<\/strong> Am Fam Physician. 2014 Sep 1;90(5):297-302. PMID: 25251089.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Marcdante&nbsp;KJ,&nbsp;Kliegman&nbsp;R, Schuh AM. Nelson <strong>Essentials of Pediatrics<\/strong>. 8th ed. Elsevier; 2023.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/pa\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/03\/Blog_Display_Ads_MOBILE3_2023.png?w=700\" alt=\"\" class=\"wp-image-4433\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/03\/Blog_Display_Ads_MOBILE3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/03\/Blog_Display_Ads_MOBILE3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Want more <strong>PANCE\u00ae-style practice questions<\/strong>? Try <strong>Osmosis by Elsevier<\/strong> today! Access your&nbsp;<a href=\"http:\/\/osmosis.org\/plans\/pa\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a>&nbsp;and discover why millions of current and future <strong>clinicians and caregivers<\/strong> love <strong>learning by Osmosis<\/strong>.<\/em><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Learn how to perform a newborn\u2019s rapid assessment, obtain vital signs, and use a structured scoring approach to guide clinical decisions and determine appropriate next steps in care and disposition for optimal newborn outcomes.<\/p>\n","protected":false},"author":208,"featured_media":9957,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,38,1371,37,1366],"tags":[1460,3008,489,3006,716,3005,1667,3007,462,1646,3009,3004,2808,664,718],"class_list":["post-9953","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-pance","category-pance-questions","category-pa","category-questions","tag-apgar-score","tag-blue-extremities","tag-clinical-reasoning","tag-growth-and-development","tag-neonatal-care","tag-neonatology","tag-newborn-assessment","tag-nursery-care","tag-osmosis","tag-pediatric-education","tag-pediatric-exam","tag-term-newborn","tag-triage","tag-usmle-step-1","tag-vital-signs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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