When an infant's temperature drops from 98.7° to 97.4° F (37° to 36.3° C), the nurse should:
a. instruct parents on cold stress.
b. determine time and amount of last feeding.
c. increase the temperature in the mother's room.
d. evaluate infant for the presence of a blood sugar level higher than 50 mg/dL.
ANS: B
Temperature instability in the neonate may be caused by a decrease in blood glucose levels. Infants who do not maintain adequate intake will not have adequate energy to maintain temperature; instructing parents on cold stress and increasing the temperature in the room are interventions to maintain a stable temperature but will not correct the underlying problem. A blood sugar level higher than 50 mg/dL is a normal finding.
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