A nurse is calculating the estimated date of delivery for a patient who reports that the first day of her last menstrual period was August 10. Using Nägele’s Rule, what is the patient’s estimated date of delivery?

Choice A rationale: Swaddling the newborn with flexed extremities can provide a sense of security and help soothe the newborn. This is a common practice in managing neonates with Neonatal Abstinence Syndrome (NAS) as it can help reduce irritability and promote sleep.

Choice B rationale: Naloxone is not typically used in the treatment of NAS. Naloxone is an opioid antagonist and can precipitate withdrawal symptoms in opioid-dependent individuals. In a neonate with NAS due to maternal opioid use, naloxone can cause severe and immediate withdrawal.

Choice C rationale: Maintaining a low stimulation environment is crucial in managing neonates with NAS. These neonates are often hypersensitive to stimuli, and a quiet, dimly lit environment can help reduce irritability and promote sleep.

Choice D rationale: Breastfeeding is usually encouraged in mothers who are stable on their opioid replacement therapy, are not using illicit drugs, and have no other contraindications for breastfeeding. The benefits of breastfeeding include the passage of maternal antibodies and the promotion of mother-infant bonding.

Choice E rationale: The Ballard newborn screening is a tool used to estimate gestational age using physical and neuromuscular characteristics. It is typically performed shortly after birth and may not need to be performed each shift in a neonate with NAS.

Choice F rationale: Weighing the newborn daily is important in the management of NAS. Weight can provide information about feeding and hydration status, and any significant or sudden changes in weight can indicate a need for further evaluation.

Choice G rationale: Eye contact during feeding can promote bonding between the parent and the newborn. There is no need to avoid eye contact during feeding in a neonate with NAS.

Choice A rationale
While assessing the client’s kidney function is important in general, it is not the best way to evaluate medication adherence. Kidney function can affect the metabolism and excretion of medications, but it does not directly indicate whether the client is taking their medication as prescribed.
Choice B rationale

Correct answer. Checking the client’s serum medication level is the most direct and reliable way to evaluate medication adherence. If the client is taking the medication as prescribed, the serum medication level should be within the therapeutic range.
Choice C rationale
Determining the client’s apical pulse rate can provide information about the client’s overall cardiovascular status and can indicate certain drug effects or side effects, but it does not directly measure medication adherence.
Choice D rationale
Asking the client if they are taking the medication as prescribed can provide useful information, but it relies on self-report, which may not be reliable. Some clients might forget doses or not take the medication exactly as prescribed.