A nurse in a prenatal clinic is reinforcing teaching with a group of women about the use of acupressure to relieve discomfort during labor.
Which of the following instructions should the nurse include in the teaching?

Choice A rationale

Chicken breast is a rich source of heme iron, which is highly bioavailable and easily absorbed by the body. During pregnancy, the increased maternal blood volume and fetal erythropoiesis significantly increase the demand for iron to support hemoglobin synthesis. Consuming iron-rich animal protein like chicken helps prevent iron-deficiency anemia, a common complication of gestation.

Choice B rationale

Carrots are a good source of beta-carotene, a precursor to vitamin A, and other vitamins and minerals. However, they are not a significant source of dietary iron. While a healthy part of a balanced diet, carrots would not be recommended as the best source for a client needing increased iron intake during pregnancy.

Choice C rationale

Feta cheese is a dairy product that is a good source of calcium and protein. However, dairy products generally contain minimal amounts of iron, and the calcium in dairy can actually inhibit the absorption of non-heme iron from other food sources if consumed simultaneously. Therefore, feta cheese is not an optimal choice for increasing iron intake.

Choice D rationale

Apples are a good source of dietary fiber and vitamin C, which can enhance the absorption of non-heme iron when consumed concurrently with iron-rich plant foods. However, apples themselves contain very little iron. Thus, while beneficial for overall nutrition, apples are not a primary source of iron for a client requiring increased intake.

? Rationale for Correct Answers

Glucose level is the priority because the newborn’s blood glucose is 35 mg/dL, which is below the normal threshold of 40–45 mg/dL. Neonatal hypoglycemia can lead to seizures, apnea, and brain injury if untreated. Immediate intervention is critical to prevent neurologic damage.

Feeding difficulties are the next concern because they contribute to poor caloric intake and perpetuate hypoglycemia. The newborn exhibits poor latch, uncoordinated suck, and loose stools—hallmarks of neonatal abstinence syndrome (NAS), which impair feeding and weight gain.

❌ Rationale for Incorrect Response 1 Options

Respiratory rate (65/min) is mildly elevated but within the upper limit of normal for newborns (30–60/min). No signs of respiratory distress (e.g., nasal flaring, retractions, grunting) are present, making this a lower priority.

Heart rate (165/min) is within the normal neonatal range (120–160/min). Mild tachycardia can be attributed to irritability or crying and is not immediately life-threatening.

Temperature (37.5°C) is within the normal range for newborns (36.5–37.5°C). There is no evidence of fever or hypothermia requiring urgent intervention.

❌ Rationale for Incorrect Response 2 Options

Skin findings such as mottling are nonspecific and often seen in NAS or immature autonomic regulation. They are not immediately dangerous.

Cry characteristics like high-pitched crying are typical of NAS but are not life-threatening and do not require urgent intervention.

Tremors are a common NAS symptom but are not acutely harmful unless associated with seizures, which are not reported here.

? Take-Home Points

• Neonatal hypoglycemia (<40 mg/dL) is a medical emergency requiring prompt correction to prevent neurologic injury.
• Feeding difficulties in NAS exacerbate hypoglycemia and must be addressed to ensure adequate caloric intake.
• NAS presents with autonomic, gastrointestinal, and neurologic symptoms; diagnosis is clinical and supported by maternal and neonatal drug screens.
• NAS must be differentiated from neonatal sepsis, hypoxic-ischemic encephalopathy, and metabolic disorders, which may present similarly.