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.)

✅ Anticipated Orders – Rationales

• Initiate morphine per protocol Morphine is commonly used to manage moderate to severe symptoms of NAS. It helps reduce central nervous system irritability and autonomic overactivity by binding to opioid receptors, thereby easing withdrawal symptoms.
• Encourage breastfeeding Breastfeeding is encouraged unless contraindicated (e.g., maternal HIV or ongoing illicit drug use). Breast milk may contain small amounts of opioids if the mother is on medication-assisted treatment (e.g., methadone or buprenorphine), which can help ease withdrawal symptoms in the newborn.
• Offer small, frequent feedings Infants with NAS often have poor feeding due to uncoordinated suck and gastrointestinal symptoms. Small, frequent feedings help maintain adequate nutrition and prevent hypoglycemia.
• Consult social services Given the maternal history of opioid use disorder and lack of stable housing, social services involvement is essential for discharge planning, ensuring a safe environment, and connecting the family with community resources.
• Monitor using the eat, sleep, console scoring tool This tool is a functional assessment method used to evaluate NAS severity and guide treatment. It focuses on the infant’s ability to eat, sleep, and be consoled rather than just symptom counting.

❌ Not Anticipated Order – Rationale

• Administer naloxone Naloxone is contraindicated in neonates with NAS because it can precipitate acute, severe withdrawal. It is only used in cases of life-threatening opioid overdose, not for withdrawal management.

Choice A rationale

Discussing a desire for more children is a normal manifestation of a positive postpartum adjustment. This indicates a healthy attachment to the current child and an optimistic outlook on future family expansion, reflecting psychological well-being and a positive coping mechanism in the postpartum period, not a concern.

Choice B rationale

Fatigue and a desire to sleep are common physiological and psychological responses to the physical demands of labor, delivery, and the initial postpartum period, as well as the demands of newborn care. This is a normal physiological recovery process and not indicative of a psychosocial concern.

Choice C rationale

Acknowledging similarities between the newborn and oneself as an infant indicates a healthy process of identification and bonding. This self-referential observation fosters a sense of connection and continuity within the family unit, signifying normal maternal-infant attachment and psychological integration, not a concern.

Choice D rationale

A client's reluctance to feed the newborn can be a significant indicator of potential psychosocial concerns such as postpartum depression, anxiety, or difficulties with maternal-infant bonding. This behavior may suggest a diminished capacity for engaging in essential caregiving activities, warranting further assessment and intervention.