A nurse is caring for a newborn who has macrosomia and whose mother has diabetes mellitus. The nurse should recognize which of the following newborn complications as the priority focus of care?

Choice A reason: Hypoglycemia is a low blood sugar level that can affect newborns, especially those who are premature, small for gestational age, or have diabetic mothers. However, hypoglycemia does not explain the high FHR, the low Apgar scores, or the pale and tachypneic appearance of the newborn.

Choice B reason: Phrenic nerve injury is a rare complication of cesarean section that can cause diaphragmatic paralysis and respiratory distress in the newborn. However, phrenic nerve injury usually affects only one side of the chest, and does not cause high FHR, low Apgar scores, or pallor.

Choice C reason: Sepsis is a serious infection that can affect newborns, especially those who are exposed to prolonged rupture of membranes, as in this case. Sepsis can cause high FHR, low Apgar scores, pale and tachypneic appearance, and other signs of shock and organ failure.

Choice D reason: Meconium aspiration syndrome is a condition where the newborn inhales meconium-stained amniotic fluid into the lungs, causing respiratory distress. However, meconium aspiration syndrome usually occurs in term or post-term infants, and is associated with low FHR, not high FHR. Meconium aspiration syndrome also causes cyanosis, not pallor.

Choice A reason: Assisting the client with transferring to the gynecology unit is not the first action that the nurse should take, as it does not address the client's emotional needs or preferences. The nurse should first assess the client's coping and grieving process, and provide support and comfort.

Choice B reason: Offering the mother private time with the newborn is the first action that the nurse should take, as it can facilitate the bonding and closure process, and help the client express her feelings and emotions. The nurse should respect the client's wishes and cultural beliefs regarding the viewing and holding of the stillborn infant, and provide a quiet and private environment.

Choice C reason: Administering alprazolam 0.5 mg PO is not the first action that the nurse should take, as it is a pharmacological intervention that requires a prescription and an assessment of the client's condition and history. The nurse should first use nonpharmacological methods, such as active listening, therapeutic communication, and counseling, to help the client cope and manage her anxiety and grief.

Choice D reason: Contacting the health care facility's clergy is not the first action that the nurse should take, as it may not be appropriate or desired by the client. The nurse should first ask the client if she wants any spiritual or religious support, and respect her decision and beliefs.