A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take?

Choice A rationale
Limiting the length of breastfeeding to 5 minutes per breast is not typically recommended. It’s important for the baby to empty each breast completely, as the fat content of the milk increases as the breast empties.
Choice B rationale
Assessing the newborn’s latch while breastfeeding is crucial. A poor latch can cause sore nipples. The baby should take as much of the areola into their mouth as possible, with more areola showing at the top lip than the bottom.
Choice C rationale
Waiting 4 hours between daytime feedings is not typically recommended for a breastfeeding newborn. Newborns typically need to feed every 2-3 hours, or 8-12 times in 24 hours.
Choice D rationale
Offering supplemental formula between the newborn’s feedings can interfere with establishing a good milk supply and should be avoided unless medically necessary.

Choice A rationale
Administering an IV bolus of lactated Ringer’s is not the best action for a client with peripartum cardiomyopathy. This condition is a form of heart failure that occurs during the last month of pregnancy or up to five months postpartum. It can lead to fluid overload, so giving an IV bolus of lactated Ringer’s could exacerbate the client’s condition.
Choice B rationale
Assessing blood pressure twice daily is important for any postpartum client, but it is not the most critical action for a client with peripartum cardiomyopathy. This condition can lead to fluid overload and heart failure, so while monitoring blood pressure is important, it is not the primary intervention.
Choice C rationale
Restricting daily oral fluid intake is the correct action. Peripartum cardiomyopathy can lead to fluid overload and heart failure. Restricting fluid intake can help manage the client’s fluid status and prevent exacerbation of heart failure.
Choice D rationale
Obtaining a prescription for misoprostol is not relevant in this context. Misoprostol is a medication used to prevent stomach ulcers in patients taking NSAIDs and to induce labor or cause an abortion. It has no role in the management of peripartum cardiomyopathy.