Exhibits

The nurse is reviewing the assessment data.

Which are the 3 most likely reasons that the infant is crying?

A. Describe genetic testing protocols. Genetic testing is useful for identifying hereditary conditions, but it does not address the immediate health concerns of a pregnant client with opioid use disorder. Early prenatal care is more critical for monitoring fetal development and reducing complications associated with substance use.
B. Sign up for group therapy sessions. Group therapy can provide emotional support and coping strategies, but it is not the most immediate or essential step for ensuring a healthy pregnancy. While therapy is beneficial, comprehensive prenatal care should be prioritized to monitor fetal growth and manage opioid withdrawal safely.
C. Start a prenatal care plan as soon as possible. Early prenatal care is essential for monitoring the effects of methadone therapy on both the mother and fetus, ensuring appropriate fetal development, and managing potential complications such as neonatal abstinence syndrome (NAS). Prenatal visits will also provide guidance on nutrition, lifestyle modifications, and necessary medical interventions.
D. Discontinue the methadone right away. Abruptly stopping methadone can cause severe withdrawal symptoms in both the mother and fetus, increasing the risk of miscarriage, preterm labor, or stillbirth. Methadone maintenance therapy is the recommended treatment for opioid addiction during pregnancy, as it stabilizes maternal opioid levels and reduces harm to the fetus.

A. Hunger – The infant is NPO postoperatively but is accustomed to regular feedings. Hunger-related distress is common in infants after surgery, especially when oral intake is restricted. Since the infant has a history of GERD and fundoplication surgery, feedings are likely delayed to prevent complications, contributing to crying.
B. Opioid withdrawal – There is no indication that the infant has been on chronic opioid therapy before surgery. Opioid withdrawal symptoms typically occur in infants exposed to opioids for prolonged periods (e.g., neonatal abstinence syndrome), which is not relevant in this case.
C. Hemorrhage – The surgical dressing is clean and dry, meaning there are no visible signs of bleeding at the incision site. If significant internal bleeding were occurring, the infant would likely show signs of pallor, tachycardia, and hypotension, which are not present.
D. Separation anxiety – Separation anxiety typically develops around 6–9 months of age, when infants become more aware of their caregivers' presence. At 4 months, infants can recognize caregivers but do not yet exhibit true separation distress, making this an unlikely reason for crying.
E. Pain – Postoperative pain is a common cause of crying in infants after surgery. Signs of pain in nonverbal infants include crying, facial grimacing, irritability, and body tension. Since the infant has just undergone fundoplication surgery, pain is a likely contributing factor.
F. Hypovolemia – The infant is receiving IV fluids (Dextrose 5% with sodium chloride 0.45%), but fluid deficits can still occur postoperatively due to preoperative fasting, surgical fluid losses, or inadequate replacement. Hypovolemia can cause discomfort, irritability, tachycardia, and crying.
G. Hypoxia – The infant is described as pink and well-perfused with clear breath sounds, which rules out respiratory distress as a likely cause of crying. If hypoxia were present, signs such as cyanosis, increased work of breathing, or abnormal breath sounds would be expected.