APGAR Scoring on the NCLEX
The five APGAR criteria, how to score them, and what the totals mean.
APGAR is scored at 1 and 5 minutes on every newborn. NCLEX asks you to compute a score from findings.
The five criteria, 0-2 points each
Appearance (color): 0 blue/pale, 1 acrocyanotic (blue hands and feet), 2 fully pink. Pulse: 0 absent, 1 under 100, 2 100 or more. Grimace (reflex irritability): 0 no response, 1 grimace, 2 cry or active withdrawal. Activity (tone): 0 flaccid, 1 some flexion, 2 active motion. Respirations: 0 absent, 1 slow or irregular/weak cry, 2 strong cry.
Interpreting the total
7-10: normal, routine care. 4-6: moderately depressed, stimulate, clear the airway, give oxygen as indicated. 0-3: severely depressed, resuscitation. If the 5-minute score is below 7, rescore every 5 minutes up to 20 minutes.
What APGAR is not
Resuscitation decisions never wait for a score. Newborn resuscitation follows the infant's breathing, heart rate, and tone from the moment of birth. APGAR documents the transition; it does not direct it. A common correct answer: begin resuscitation immediately, assign the score at the 1-minute mark.
Frequently asked
Newborn is pink with blue hands, HR 130, crying, actively moving, cries with suction. Score?
- One point off for acrocyanosis, which is normal in the first 24-48 hours.
Does a low 1-minute APGAR predict long-term outcome?
No. It reflects the transition at that moment. The 5-minute score and the trend matter more, and even those are not diagnostic of long-term status.
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