A nurse is collecting data from a client who is at 34 weeks of gestation and has hyperglycemia.
Which of the following manifestations should the nurse expect?

Choice A rationale: Transient hypoglycemia is a common physiologic occurrence in term newborns during the first few hours after birth due to the abrupt cessation of maternal glucose supply. The newborn must transition to endogenous glucose production through glycogenolysis and gluconeogenesis. This transitional dip typically resolves with feeding and thermoregulation, making this statement scientifically accurate and reflective of normal neonatal adaptation.

Choice B rationale: Skin-to-skin contact enhances thermoregulation by reducing heat loss through conduction and evaporation. Maintaining a stable body temperature reduces metabolic demands and conserves glucose stores. Additionally, skin-to-skin contact promotes early breastfeeding, which provides exogenous glucose. These combined effects help stabilize neonatal blood glucose levels, making this an evidence-based intervention for hypoglycemia prevention and management.

Choice C rationale: Clamping the umbilical cord terminates the placental transfer of maternal glucose, which is the fetus’s primary energy source in utero. After birth, the newborn must rely on hepatic glycogen stores and initiate gluconeogenesis to maintain glucose homeostasis. This sudden metabolic shift can lead to transient hypoglycemia, especially in infants with increased glucose demands or limited glycogen reserves.

Choice D rationale: Persistent hypoglycemia, particularly glucose levels consistently below 50 mg/dL despite adequate feeding, may necessitate intravenous glucose administration to prevent neurologic injury. IV dextrose provides immediate correction of hypoglycemia when oral intake is insufficient or symptoms are severe. This intervention is especially critical in symptomatic infants or those at high risk, such as macrosomic newborns or infants of diabetic mothers.

Choice E rationale: The lower limit of normal blood glucose in neonates is generally considered to be 40 mg/dL in the first 4 hours and 45 mg/dL after that. However, stating that 40 to 45 mg/dL is the normal lower limit for up to 72 hours is imprecise. Glucose thresholds vary slightly by institution and age in hours, and levels should ideally rise above 50 mg/dL with feeding. Therefore, this statement lacks full accuracy.

Choice F rationale: Frequent breastfeeding provides a consistent source of glucose and stimulates endogenous insulin regulation. Early and effective feeding is the primary intervention for asymptomatic hypoglycemia in term infants. Breast milk contains lactose, which is metabolized into glucose and galactose, supporting energy needs. Therefore, this statement correctly reflects the role of frequent feeding in stabilizing neonatal glucose levels.

Choice A rationale

Wearing the lap belt high across the abdomen is incorrect and potentially dangerous. The lap belt should be positioned low, across the pelvic bones (hips) and under the pregnant abdomen. This ensures that the force of a collision is distributed across the strong pelvic bones, minimizing direct pressure on the uterus and fetus, thereby reducing the risk of placental abruption or direct fetal trauma.

Choice B rationale

Disabling the vehicle's driver-side airbags is strongly discouraged and unsafe. Airbags are designed to provide crucial protection in a collision by deploying rapidly to cushion the occupant. While pregnant individuals should maintain a safe distance from the steering wheel to mitigate airbag impact on the uterus, disabling the airbag removes a vital safety feature and significantly increases the risk of severe injury to both the mother and the fetus in an accident.

Choice C rationale

Moving the seat as far away as possible from the steering wheel, while still maintaining control of the vehicle, is a crucial safety measure for pregnant individuals. This provides a greater crumple zone and reduces the risk of the steering wheel or dashboard impacting the gravid uterus in the event of a collision. Maintaining a distance of at least 10 inches between the sternum and the steering wheel is generally recommended to maximize safety and minimize potential fetal injury from airbag deployment.

Choice D rationale

Placing the shoulder harness across the gravid uterus is incorrect. The shoulder harness should be positioned snugly between the breasts and across the collarbone. It should never be placed directly over the abdomen or the uterus. Proper placement ensures that the upper body is restrained effectively, preventing forward motion and distributing impact forces across the chest and shoulder, thus protecting the gravid uterus from direct trauma.