A nurse is collecting data from a newborn who has an infection of Candida albicans.
Which of the following findings should the nurse expect?

Choice A rationale

A blood pressure (BP) of 105/62 mm Hg, while slightly on the lower side of what might be considered a typical adult range (e.g., 120/80 mm Hg), is often within acceptable limits for a postoperative adolescent, especially considering potential mild vasodilation from opioid use. A normal range for adolescent blood pressure can vary, but generally, hypotension is defined as a systolic BP less than 90 mm Hg or symptomatic drop. This finding, while noted, is not immediately life-threatening compared to compromised respiratory function.

Choice B rationale

Urinary retention is a common adverse effect of opioid analgesics due to their anticholinergic-like effects on bladder detrusor muscle contractility and increased sphincter tone. While uncomfortable and requiring intervention (e.g., straight catheterization), it is not an immediate life-threatening concern compared to respiratory depression. A normal bladder capacity is approximately 300-500 mL, and the urge to void typically occurs at 150-200 mL. Persistent urinary retention can lead to bladder distention, pain, and increased risk of urinary tract infection, but it doesn't pose the same acute physiological threat as respiratory depression.

Choice C rationale

A respiratory rate of 11/min is a finding that warrants immediate attention and is the nurse's priority. Opioid analgesics, such as morphine, are known to cause respiratory depression by acting on opioid receptors in the brainstem, decreasing the sensitivity of the respiratory center to carbon dioxide. A normal respiratory rate for an adolescent typically ranges from 12 to 20 breaths per minute. A rate of 11/min is considered bradypnea and indicates potential hypoventilation, which can lead to hypoxemia and hypercapnia, posing a significant risk to the patient's oxygenation and overall physiological stability.

Choice D rationale

Blurred vision can be an adverse effect of opioid medications, often related to miosis (pupil constriction) or effects on accommodation. While it can impair the patient's comfort and ability to ambulate safely, it is not a life-threatening priority in the immediate postoperative period compared to respiratory compromise. This visual disturbance typically resolves as the medication is metabolized and excreted. Normal visual acuity is typically 20/20. .

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.