RN Nursing · Newborn Complications — Hypoglycemia · Practice question
A nurse is overseeing the care of multiple newborns in a neonatal unit. One newborn, whose mother had poorly controlled gestational diabetes, exhibits lethargy, poor feeding, jitteriness, and a respiratory rate of 72 breaths per minute. Which action should the nurse take first?
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Encourage feeding with formula or breast milk to stabilize energy levels.
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✓
Check the newborn's blood glucose level to assess for hypoglycemia.
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Administer oxygen via nasal cannula to address the rapid respiratory rate.
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Notify the charge nurse immediately about possible neonatal sepsis.
Answer & explanation
Correct: Check the newborn's blood glucose level to assess for hypoglycemia.
In a newborn whose mother had poorly controlled gestational diabetes, the clinical picture of lethargy, poor feeding, jitteriness, and tachypnea is a classic presentation of neonatal hypoglycemia. Infants of diabetic mothers develop hyperinsulinemia in utero in response to elevated maternal glucose levels; after birth, insulin levels remain elevated while the glucose supply is abruptly cut off, causing rapid blood glucose decline. The first action must be to check the blood glucose level because this both confirms the diagnosis and quantifies the severity, guiding the appropriate intervention. A bedside glucose check is fast, non-invasive, and immediately actionable. Encouraging feeding alone would be appropriate for mild or borderline hypoglycemia but should not be done before confirming the glucose level. Administering oxygen might be considered once hypoglycemia is ruled out or treated, but tachypnea in this context is most likely a consequence of the metabolic disturbance rather than a primary respiratory problem. Notifying the charge nurse about possible sepsis is premature when the clinical picture strongly points to a known metabolic risk for this infant population. Establishing the blood glucose value first directs all subsequent interventions and prevents unnecessary or misdirected treatment.
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