A nurse is caring for a client who is 12 hours postpartum and has an episiotomy.
Which of the following actions should the nurse take?

Choice A rationale: Skin-to-skin contact, also known as kangaroo care, is scientifically supported to stabilize neonatal autonomic functions such as heart rate, respiratory rate, and temperature. It promotes oxytocin release in both the parent and infant, which reduces stress and enhances bonding. For neonates experiencing neonatal abstinence syndrome (NAS), this contact can reduce irritability and improve feeding behaviors by providing a calming sensory input that mimics the intrauterine environment.

Choice B rationale: Decreasing environmental stimuli such as lighting is a key nonpharmacologic intervention for infants with NAS. Bright lights can exacerbate neurologic excitability, leading to increased irritability, tremors, and poor feeding. Dimming the lights helps reduce sensory overload, allowing the infant’s overstimulated nervous system to settle. This intervention supports autonomic regulation and is consistent with evidence-based care for managing withdrawal symptoms in neonates.

Choice C rationale: Singing to the newborn introduces rhythmic auditory stimulation, which has been shown to soothe infants and promote neurobehavioral organization. In NAS, where infants are hypersensitive to stimuli, soft singing can provide a predictable and calming input that may improve feeding coordination and reduce crying. Auditory bonding also supports maternal-infant attachment, which is critical in the context of maternal substance use and psychosocial stressors.

Choice D rationale: Avoiding a pacifier is contraindicated in NAS care. Non-nutritive sucking via pacifiers is a well-established intervention to soothe irritable neonates and improve feeding coordination. It activates the sucking reflex, which has a calming effect on the central nervous system. Denying this comfort measure may increase distress and worsen symptoms such as tremors and high-pitched crying, making this choice scientifically inappropriate.

Choice E rationale: Swaddling with the legs flexed mimics the fetal position and provides proprioceptive input that helps calm the overstimulated nervous system in NAS. This positioning reduces excessive motor activity and supports neuromuscular control. Flexed swaddling also enhances sleep quality and decreases the frequency of tremors and startle responses, which are hallmark symptoms of opioid withdrawal in neonates.

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.