A 7 pound, 14 ounce girl was born to an insulin-dependent type 2 diabetic mother two hours ago. The infant's blood sugar is 45mg/dl. The best nursing action is:
1. Recheck the blood sugar in four hours.
2. Begin an IV of 10% dextrose.
3. Feed the baby one ounce of formula.
4. Document the findings in the chart.
Correct Answer: 4
Rationale 1: Infants of diabetic mothers should be fed frequently and should have their blood sugar assessed frequently. Four hours is too long a time frame.
Rationale 2: 45mg/dl is considered a normal blood sugar reading for a neonate. No IV is needed.
Rationale 3: Feeding would be appropriate if the infant's blood sugar was below 40, but this infant's reading is 45 mg/dl.
Rationale 4: A blood sugar of 45 mg/dl is a normal finding; documentation is an appropriate action.
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