A nurse is preparing to administer acyclovir 400 mg tablet PO three times per day. Available are 800 mg tablets.

How many tablets should the nurse administer with each dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

? Rationale for Correct Answers

Glucose level is the priority because the newborn’s blood glucose is 35 mg/dL, which is below the normal threshold of 40–45 mg/dL. Neonatal hypoglycemia can lead to seizures, apnea, and brain injury if untreated. Immediate intervention is critical to prevent neurologic damage.

Feeding difficulties are the next concern because they contribute to poor caloric intake and perpetuate hypoglycemia. The newborn exhibits poor latch, uncoordinated suck, and loose stools—hallmarks of neonatal abstinence syndrome (NAS), which impair feeding and weight gain.

❌ Rationale for Incorrect Response 1 Options

Respiratory rate (65/min) is mildly elevated but within the upper limit of normal for newborns (30–60/min). No signs of respiratory distress (e.g., nasal flaring, retractions, grunting) are present, making this a lower priority.

Heart rate (165/min) is within the normal neonatal range (120–160/min). Mild tachycardia can be attributed to irritability or crying and is not immediately life-threatening.

Temperature (37.5°C) is within the normal range for newborns (36.5–37.5°C). There is no evidence of fever or hypothermia requiring urgent intervention.

❌ Rationale for Incorrect Response 2 Options

Skin findings such as mottling are nonspecific and often seen in NAS or immature autonomic regulation. They are not immediately dangerous.

Cry characteristics like high-pitched crying are typical of NAS but are not life-threatening and do not require urgent intervention.

Tremors are a common NAS symptom but are not acutely harmful unless associated with seizures, which are not reported here.

? Take-Home Points

• Neonatal hypoglycemia (<40 mg/dL) is a medical emergency requiring prompt correction to prevent neurologic injury.
• Feeding difficulties in NAS exacerbate hypoglycemia and must be addressed to ensure adequate caloric intake.
• NAS presents with autonomic, gastrointestinal, and neurologic symptoms; diagnosis is clinical and supported by maternal and neonatal drug screens.
• NAS must be differentiated from neonatal sepsis, hypoxic-ischemic encephalopathy, and metabolic disorders, which may present similarly.

Choice A rationale

Lubricating the bulb syringe with sterile water is unnecessary and could introduce fluid into the newborn's airway or mouth, potentially causing aspiration. The bulb syringe is designed for mechanical suctioning and does not require lubrication for effective and safe use in clearing secretions from the newborn's mouth and nose.

Choice B rationale

Depressing the bulb prior to insertion creates a negative pressure or vacuum within the syringe. This action allows for effective suctioning of secretions when the bulb is released after insertion into the newborn's mouth or nose, ensuring that mucus is drawn into the syringe for removal.

Choice C rationale

Placing the bulb in the center of the newborn's mouth could stimulate the gag reflex, potentially causing vomiting or aspiration of secretions. The bulb syringe should be inserted into the side of the newborn's mouth, between the cheek and gums, to facilitate effective suctioning without triggering an adverse response.

Choice D rationale

Suctioning the newborn's nose first, then the mouth, is an incorrect sequence. The mouth should always be suctioned first to prevent the newborn from aspirating any oral secretions into the lungs if they gasp or inhale after nasal suctioning, ensuring a clear airway before nasal passages are addressed.