The nurse reinforces teaching regarding newborn hypoglycemia.
Which of the following client statements indicate understanding of newborn hypoglycemia? Select all that apply.
Glucose levels of 40 to 45 mg/dL are considered the normal lower limit for up to 72 hours after birth.
If my baby's blood glucose keeps going below 50 mg/dL in the next 24 hours, they will need intravenous glucose.
When my umbilical cord was clamped, my baby lost its source of glucose.
As long as I breastfeed my baby frequently, their blood glucose levels should improve.
It is common for term newborns to experience transient hypoglycemia within the first few hours of life.
The skin-to-skin contact immediately after birth promotes thermoregulation and stabilizes glucose levels.
Correct Answer : C,D,E,F
Choice A rationale
Neonatal hypoglycemia is typically defined as a blood glucose concentration below 40 mg/dL in the first 4 hours of life, or below 45 mg/dL between 4 and 24 hours. Glucose levels of 40 to 45 mg/dL are generally considered the goal range to prevent neurological injury, not the normal lower limit for up to 72 hours post-birth.
Choice B rationale
If a newborn's blood glucose levels remain persistently below 40 mg/dL after initial management (like feeding) or if they develop symptomatic hypoglycemia, intravenous dextrose will be required. A value persistently below 50 mg/dL is concerning, but the 40 mg/dL threshold is often the critical point for initiating IV glucose when oral methods fail.
Choice C rationale
The umbilical cord provides the fetus with a continuous supply of glucose via the placenta from the mother. Upon umbilical cord clamping, this maternal glucose supply is abruptly interrupted, requiring the newborn's immature metabolic systems to take over glucose homeostasis. This sudden loss of exogenous glucose is a primary factor in transient newborn hypoglycemia.
Choice D rationale
Frequent breastfeeding provides the newborn with a readily available source of lactose, which is metabolized into glucose, thereby promoting the stability of their blood glucose levels. Early and frequent feeding is the primary intervention for transient hypoglycemia in newborns who are able to feed, utilizing the oral route for caloric intake.
Choice E rationale
Transient hypoglycemia is a common and expected physiological adaptation in term newborns during the initial hours after birth. The abrupt cessation of maternal glucose supply necessitates the newborn's activation of gluconeogenesis and glycogenolysis, which may temporarily be insufficient, leading to a mild, self-limiting drop in blood glucose.
Choice F rationale
Skin-to-skin contact immediately after birth is vital as it prevents cold stress. When a newborn is cold, they must expend energy (calories) to produce heat, which consumes glucose, potentially leading to or exacerbating hypoglycemia. Thermoregulation thus indirectly stabilizes blood glucose levels by conserving energy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Explanation
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.
Correct Answer is D
Explanation
Choice A rationale
. Instructing a pregnant client to move their car seat close to the steering wheel is unsafe. The steering wheel poses a significant trauma risk to the abdomen and uterus, especially in the event of airbag deployment or a collision. The ideal distance is at least 10 inches between the chest and the steering wheel to prevent blunt abdominal trauma and protect the fetus.
Choice B rationale
. Advising the client to wear the shoulder harness snug across their stomach is incorrect and potentially dangerous. The shoulder harness must be positioned above the pregnant abdomen, across the middle of the chest and between the breasts, to distribute crash forces across the bony structures (clavicle and sternum) and away from the fetus and the uterus.
Choice C rationale
. Directing the client to position the lap belt across their navel is incorrect and must be avoided. The lap belt should be worn snugly and low, under the pregnant abdomen, across the bony pelvis (hips and pubic bone), not the soft tissue of the abdomen. This prevents the forces of a collision from being directed toward the uterus and fetus.
Choice D rationale
. Encouraging frequent breaks and walking is crucial during long car trips to promote venous return and prevent venous stasis. The gravid uterus compresses the inferior vena cava, impairing blood flow from the lower extremities, which increases the risk of developing a deep vein thrombosis (DVT), a life-threatening complication, making this an essential safety instruction.
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