A nurse is reinforcing teaching about the correct use of infant car seats with the parent of a newborn.
Which of the following statements by the parent indicate an understanding of the teaching?

Heel warming increases capillary blood flow, improving sample accuracy and reducing hemolysis risk. Capillary glucose testing requires adequate perfusion for reliable results. Breastfeeding provides immediate glucose substrate to correct mild hypoglycemia. Normal neonatal blood glucose is >40–45 mg/dL; this newborn’s initial level of 35 mg/dL is below threshold, but responsive to feeding. Breast milk contains lactose, metabolized to glucose and galactose, supporting cerebral energy demands.

Rationale for incorrect Response 1 options: Administer glucose gel is appropriate only if feeding fails or glucose remains <25 mg/dL in asymptomatic or <40 mg/dL in symptomatic neonates. This newborn improved with feeding. Start IV fluids is reserved for persistent hypoglycemia or symptomatic neonates unresponsive to oral intake. The newborn stabilized post-breastfeeding. Phototherapy treats hyperbilirubinemia, not hypoglycemia. No bilirubin levels or jaundice signs were reported.

Rationale for incorrect Response 2 options: Supplement with formula is secondary to breastfeeding unless maternal milk is unavailable or ineffective. Breastfeeding was successful post-latch correction. Administer insulin is contraindicated; insulin lowers glucose and is used only in hyperglycemia. Monitor for jaundice is unrelated to hypoglycemia management unless bilirubin levels are elevated. No clinical jaundice was noted.

Take-home points:

• Neonatal hypoglycemia is defined as glucose <40–45 mg/dL; early feeding is first-line intervention.
• Macrosomic infants (birth weight >4,000 g) are at risk due to hyperinsulinemia post-placental glucose withdrawal.
• Differentiate hypoglycemia from sepsis, hypothermia, and metabolic disorders—all may present with jitteriness and hypotonia.
• Capillary sampling requires heel warming to ensure perfusion and accurate glucose measurement.

Choice A rationale

A nonstress test (NST) is a non-invasive prenatal test that monitors the fetal heart rate (FHR) in response to fetal movement. Accelerations of the FHR (increase of ≥ 15 beats per minute lasting ≥ 15 seconds) with movement over 20 minutes (reactive NST) indicate an intact fetal central nervous system and well-oxygenated fetus.

Choice B rationale

A typical NST usually takes about 20 to 40 minutes to complete. A prolonged duration of 2 to 4 hours is usually not necessary unless the fetus is initially inactive, requiring stimulation or extended monitoring to obtain a conclusive tracing. This duration suggests a misunderstanding of the expected procedure length.

Choice C rationale

An NST is generally performed for pregnancies deemed high-risk (e.g., post-dates, diabetes, hypertension, decreased fetal movement), not simply because it is the client's first pregnancy (primigravida). This statement indicates a misconception about the clinical indication for undergoing this specific fetal surveillance test.

Choice D rationale

The primary purpose of an NST is to assess fetal heart rate reactivity; it does not measure the strength or intensity of uterine contractions. Uterine contractions are measured by the tocodynamometer but their strength would be assessed using an internal uterine pressure catheter, which is not part of the standard NST procedure.