A nurse is collecting data from a client who is 48 hours postpartum.
Which of the following findings reported by the client should the nurse identify as a postpartum psychosocial concern?

Choice A rationale: Rechecking the newborn’s temperature is essential because the earlier reading of 36.3°C (97.3°F) was below the normal range of 36.5–37.5°C. Hypothermia in neonates can exacerbate hypoglycemia by increasing metabolic demands. Monitoring temperature ensures thermoregulation is maintained, which is critical for stabilizing glucose levels and preventing further complications in the early neonatal period.

Choice B rationale: Scheduling a lactation consult is appropriate due to the newborn’s initial difficulty latching. Effective breastfeeding is crucial for maintaining adequate glucose levels, especially in a macrosomic infant at risk for hypoglycemia. A lactation consultant can assess latch technique, feeding cues, and milk transfer to ensure the newborn receives sufficient nutrition and to support maternal confidence and bonding.

Choice C rationale: Rechecking the glucose level is warranted because the newborn previously had a hypoglycemic reading of 35 mg/dL, followed by a borderline normal value of 50 mg/dL. Continued monitoring is necessary to ensure glucose stability, especially in a macrosomic infant who may have persistent hyperinsulinemia. Serial glucose checks help detect recurrent hypoglycemia and guide further interventions.

Choice D rationale: Reinforcing hourly breastfeeding is not evidence-based and may lead to feeding fatigue for both the newborn and parent. Newborns typically feed every 2 to 3 hours. Overfeeding attempts can cause stress and interfere with effective feeding. Instead, feeding should be based on hunger cues and guided by lactation support to ensure quality rather than quantity of feeds.

Choice E rationale: Ensuring the newborn is tightly swaddled helps maintain body temperature and provides a calming, secure environment. Swaddling reduces energy expenditure, which is important in preventing further glucose depletion. It also helps soothe jitteriness and supports neuromuscular tone, both of which are affected in hypoglycemic states. Proper swaddling is a key nonpharmacologic intervention in neonatal care.

Choice F rationale: Encouraging skin-to-skin contact promotes thermoregulation, stabilizes glucose levels, and enhances breastfeeding success. This practice stimulates oxytocin release, improves maternal-infant bonding, and reduces stress responses in the newborn. For infants at risk of hypoglycemia, skin-to-skin contact is a first-line supportive measure that complements nutritional and metabolic interventions.

Choice G rationale: Maintaining an intravenous catheter for glucose administration is not indicated at this time. The newborn’s glucose level improved to 50 mg/dL after feeding, and the infant is now stable, alert, and feeding. IV glucose is reserved for symptomatic hypoglycemia unresponsive to feeding or when glucose levels remain critically low. In this case, noninvasive measures are sufficient.

Choice A rationale

During long trips, remaining stationary for extended periods can increase the risk of venous stasis and deep vein thrombosis (DVT) in pregnant individuals due to hypercoagulability and venous compression. Taking breaks and walking every hour promotes circulation, reducing the likelihood of clot formation and improving overall comfort and blood flow.

Choice B rationale

Positioning the lap belt across the navel is incorrect and can pose a significant risk to the fetus in the event of a sudden stop or collision. The lap belt should be positioned low across the bony pelvis, under the pregnant abdomen, to distribute forces safely across the mother's strong pelvic bones, protecting the uterus and fetus.

Choice C rationale

Moving the car seat forward, close to the steering wheel, is unsafe for a pregnant client. There should be adequate space, ideally at least 10 inches, between the sternum and the steering wheel to allow for airbag deployment without direct impact to the abdomen. This prevents potential injury to the pregnant uterus.

Choice D rationale

Wearing the shoulder harness snug across the stomach is incorrect and potentially harmful. The shoulder harness should be positioned snugly across the clavicle and between the breasts, extending across the center of the chest. It should never cross directly over the pregnant abdomen, as this could cause fetal injury during impact.