A nurse is assessing a full-term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider?

Choice A rationale:
Swaddling the newborn with his legs extended is not the appropriate action for a newborn with neonatal abstinence syndrome (NAS). NAS occurs when a baby is born dependent on drugs, usually because the mother used opioids during pregnancy. Swaddling may provide some comfort, but extending the legs could increase discomfort and agitation.

Choice B rationale:
Scheduling larger volume feedings at less frequent intervals is not the correct approach for a newborn with NAS. These infants often have feeding difficulties and may require smaller, more frequent feedings to reduce the risk of aspiration.

Choice C rationale:
Maintaining eye contact with the newborn during feedings may not be well-tolerated by a baby with NAS. They can be irritable and easily overstimulated, and eye contact during feeding may exacerbate their agitation.

Choice D rationale:
Planning care to minimize handling of the newborn is the most appropriate action for a baby with NAS. These infants are sensitive to stimuli and can become agitated easily, so minimizing unnecessary handling helps reduce their distress.

The correct answer is D. Plan care to minimize handling of the newborn.

Here's why:

• Swaddling with legs extended: This is not recommended as it can be uncomfortable for the newborn and may exacerbate withdrawal symptoms.
• Larger volume feedings at less frequent intervals: This can be difficult for newborns with NAS due to their increased metabolic rate and may lead to overfeeding.
• Maintaining eye contact during feedings: While this is important for bonding, it can be overwhelming for newborns with NAS, who often prefer a calm environment.

Minimizing handling is a key intervention in caring for newborns with NAS. Excessive handling can trigger withdrawal symptoms and make the newborn more irritable. Instead, focus on gentle, soothing techniques like swaddling with arms tucked in, rocking, and providing a quiet, dimly lit environment.

Choice A rationale:
Levothyroxine is not a medication used to treat gestational diabetes mellitus. Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism, which is a different medical condition.

Choice B rationale:
Nifedipine is a calcium channel blocker primarily used to manage hypertension and angina. It is not indicated for the treatment of gestational diabetes mellitus.

Choice C rationale:
Chlorpromazine is an antipsychotic medication used to treat conditions like schizophrenia and bipolar disorder. It has no role in the treatment of gestational diabetes mellitus.

Choice D rationale:
Glyburide is the correct medication to expect for administering to a client with gestational diabetes mellitus. Glyburide is an oral antidiabetic agent that helps lower blood glucose levels by increasing insulin secretion from the pancreas. It is often used when dietary and lifestyle modifications are not sufficient in managing gestational diabetes. However, it is essential to follow healthcare provider guidelines and closely monitor the client's blood glucose levels while on this medication. In some cases, insulin may be required if glyburide alone is inadequate in controlling blood sugar levels.