S.T.A.B.L.E. PROGRAM 6TH
EDITION 2026 | Complete
Solutions | Neonatal Stabilization
Exam Guide | Pass Guaranteed -
A+ Graded
### **Sugar Module (Q1–10)**
* *Q1:** A 2-hour old term infant, born to a diabetic mother, has a point-of-care glucose of 38
mg/dL (2.1 mmol/L). The infant is asymptomatic. What is the most appropriate initial
intervention?
. Begin a continuous infusion of D10W at 60 mL/kg/day
A
B. Administer 2 mL/kg of D10W IV push over 1–2 minutes
C. Feed the infant formula or breast milk
D. Give 1 mL/kg of D25W IV push
**[CORRECT]** C
* Rationale: Per S.T.A.B.L.E. 6th Edition, for asymptomatic hypoglycemia (glucose 25–45
mg/dL), oral feeding (breast milk or formula) is first-line intervention. Option B is reserved for
symptomatic or severe hypoglycemia (<25 mg/dL). D25W (Option D) is too hyperosmolar for
neonates and can cause IV infiltration injury and rebound hypoglycemia. Test tip: Always assess
for symptoms first—"asymptomatic low glucose gets feeding, symptomatic gets IV."*
---
* *Q2:** Which of the following infants is at HIGHEST risk for developing neonatal hypoglycemia
in the first 6 hours of life?
. Term infant, appropriate for gestational age (AGA), born to a mother with well-controlled
A
gestational diabetes
B. 34-week preterm infant, small for gestational age (SGA), with birth weight 1,600 g
, . Term infant, large for gestational age (LGA), born to a mother with type 1 diabetes mellitus
C
D. 38-week infant with polycythemia (hematocrit 68%)
**[CORRECT]** B
* Rationale: Per S.T.A.B.L.E. 6th Edition, SGA and preterm infants have the highest risk due to
depleted glycogen stores, impaired gluconeogenesis, and increased metabolic demands. While
IDM-LGA infants (Option C) are high-risk, the combination of prematurity + SGA (Option B)
represents the most vulnerable population with minimal substrate reserves. Option A is lower
risk due to "well-controlled" diabetes. Option D (polycythemia) can cause hypoglycemia via
glucose consumption but is less common than prematurity/SGA.*
---
* *Q3:** A 3-hour old, 28-week gestation infant weighing 1,100 g has a glucose of 22 mg/dL (1.2
mmol/L) and is jittery with a weak cry. What is the correct management sequence?
. Feed 5 mL of breast milk via gavage tube, then recheck in 30 minutes
A
B. Administer 2 mL/kg of D10W IV push over 1–2 minutes, then start D10W continuous infusion
at 80 mL/kg/day
C. Give 2 mL/kg of D25W IV push, then begin D5W at 60 mL/kg/day
D. Apply dextrose gel 0.5 mL/kg to buccal mucosa and observe for 1 hour
**[CORRECT]** B
* Rationale: S.T.A.B.L.E. 6th Edition specifies that symptomatic hypoglycemia or glucose <25
mg/dL requires IV dextrose: 2 mL/kg D10W IV push (200 mg/kg) over 1–2 minutes, followed by
continuous D10W infusion. Option A is inappropriate for a preterm infant who is NPO and
symptomatic. Option C uses dangerous D25W (causes phlebitis, hyperosmolality) and
inadequate D5W concentration. Option D (dextrose gel) is for asymptomatic, term/near-term
infants per AAP guidelines—not for symptomatic preterm infants.*
---
* *Q4:** After treating hypoglycemia with IV dextrose, how frequently should point-of-care
glucose be monitored until stable?
. Every 5 minutes for the first hour
A
B. Every 30–60 minutes until three consecutive readings are within target range
C. Every 2 hours for 24 hours
D. Only when the infant becomes symptomatic again
**[CORRECT]** B
,* Rationale: S.T.A.B.L.E. 6th Edition recommends rechecking glucose every 30–60 minutes after
intervention until three consecutive values are within the target range (≥45 mg/dL or ≥2.5
mmol/L). Option A is excessive and not evidence-based. Option C is too infrequent during the
critical stabilization period. Option D is dangerous—reactive monitoring misses rebound
hypoglycemia, which is common after IV dextrose boluses due to insulin surge.*
---
* *Q5:** What is the definition of neonatal hypoglycemia per the S.T.A.B.L.E. Program 6th Edition
and current AAP guidelines?
. Glucose <60 mg/dL (<3.3 mmol/L) at any time in the first 72 hours
A
B. Glucose <45 mg/dL (<2.5 mmol/L) after the first 24 hours of life
C. Glucose <40 mg/dL (<2.2 mmol/L) in the first 4 hours, <45 mg/dL thereafter
D. Glucose <45 mg/dL (<2.5 mmol/L) at any point in the neonatal period
**[CORRECT]** D
* Rationale: The S.T.A.B.L.E. 6th Edition aligns with AAP guidelines defining neonatal
hypoglycemia as glucose <45 mg/dL (<2.5 mmol/L) at any point, with operational thresholds of
<40 mg/dL in the first 4 hours and <45 mg/dL thereafter. Option A is too high and would
overtreat normal transitional hypoglycemia. Option B misses the first 24-hour window. Option C
is close but the unified operational threshold is <45 mg/dL for clinical decision-making in
S.T.A.B.L.E.*
---
* *Q6:** Dextrose gel 40% (200 mg/g) is applied to the buccal mucosa of an asymptomatic,
38-week infant with glucose 35 mg/dL. What is the correct dose and next step?
. 0.5 mL/kg, then feed immediately and recheck glucose in 30 minutes
A
B. 1.0 mL/kg, then place NPO and observe for 2 hours
C. 0.3 mL/kg, then begin IV D10W infusion prophylactically
D. 1.5 mL/kg, then send to NICU for continuous monitoring
**[CORRECT]** A
* Rationale: Per S.T.A.B.L.E. 6th Edition and AAP guidelines, dextrose gel dose is 0.5 mL/kg
(200 mg/kg) applied to buccal mucosa, followed immediately by feeding (breast or formula), with
recheck in 30 minutes. Option B is incorrect because the infant should be fed, not made NPO.
Option C is overly aggressive for an asymptomatic infant who can be managed with oral
interventions. Option D is excessive—dextrose gel is designed to prevent NICU admission for
asymptomatic hypoglycemia.*
, ---
* *Q7:** An infant with hypoglycemia receives a D10W bolus. Thirty minutes later, the glucose is
85 mg/dL. What complication is the nurse most concerned about?
. Hyperglycemia-induced osmotic diuresis
A
B. Rebound hypoglycemia from pancreatic insulin surge
C. Dextrose-induced necrotizing enterocolitis (NEC)
D. Cerebral edema from rapid glucose correction
**[CORRECT]** B
* Rationale: S.T.A.B.L.E. 6th Edition emphasizes that IV dextrose boluses can trigger a reactive
insulin surge, causing rebound hypoglycemia 30–60 minutes post-bolus—this is why frequent
monitoring is critical. Option A (osmotic diuresis) occurs with sustained hyperglycemia >180
mg/dL, not a transient 85 mg/dL. Option C is incorrect because IV dextrose does not cause
NEC. Option D (cerebral edema) is associated with rapid correction of hypernatremia, not
hypoglycemia.*
---
* *Q8:** Which maternal condition places the infant at risk for BOTH hypoglycemia AND
hypocalcemia?
. Maternal Graves' disease
A
B. Maternal diabetes mellitus (any type)
C. Maternal phenylketonuria (PKU)
D. Maternal chorioamnionitis
**[CORRECT]** B
* Rationale: Maternal diabetes mellitus causes fetal hyperinsulinism (hypoglycemia risk) and is
associated with delayed parathyroid hormone response leading to hypocalcemia, especially in
IDM infants. Option A (Graves' disease) causes neonatal hyperthyroidism/hypothyroidism, not
primarily these metabolic issues. Option C (PKU) causes intellectual disability and microcephaly.
Option D (chorioamnionitis) causes sepsis risk but not specifically this dual metabolic profile.*
---
* *Q9:** A 4-hour old infant has glucose 28 mg/dL. The nurse starts a D10W infusion at 60
mL/kg/day. One hour later, glucose is 32 mg/dL. What is the most appropriate next action?
. Increase the infusion rate to 80 mL/kg/day and recheck in 1 hour
A
B. Give another 2 mL/kg D10W bolus and increase the infusion concentration to D12.5W
EDITION 2026 | Complete
Solutions | Neonatal Stabilization
Exam Guide | Pass Guaranteed -
A+ Graded
### **Sugar Module (Q1–10)**
* *Q1:** A 2-hour old term infant, born to a diabetic mother, has a point-of-care glucose of 38
mg/dL (2.1 mmol/L). The infant is asymptomatic. What is the most appropriate initial
intervention?
. Begin a continuous infusion of D10W at 60 mL/kg/day
A
B. Administer 2 mL/kg of D10W IV push over 1–2 minutes
C. Feed the infant formula or breast milk
D. Give 1 mL/kg of D25W IV push
**[CORRECT]** C
* Rationale: Per S.T.A.B.L.E. 6th Edition, for asymptomatic hypoglycemia (glucose 25–45
mg/dL), oral feeding (breast milk or formula) is first-line intervention. Option B is reserved for
symptomatic or severe hypoglycemia (<25 mg/dL). D25W (Option D) is too hyperosmolar for
neonates and can cause IV infiltration injury and rebound hypoglycemia. Test tip: Always assess
for symptoms first—"asymptomatic low glucose gets feeding, symptomatic gets IV."*
---
* *Q2:** Which of the following infants is at HIGHEST risk for developing neonatal hypoglycemia
in the first 6 hours of life?
. Term infant, appropriate for gestational age (AGA), born to a mother with well-controlled
A
gestational diabetes
B. 34-week preterm infant, small for gestational age (SGA), with birth weight 1,600 g
, . Term infant, large for gestational age (LGA), born to a mother with type 1 diabetes mellitus
C
D. 38-week infant with polycythemia (hematocrit 68%)
**[CORRECT]** B
* Rationale: Per S.T.A.B.L.E. 6th Edition, SGA and preterm infants have the highest risk due to
depleted glycogen stores, impaired gluconeogenesis, and increased metabolic demands. While
IDM-LGA infants (Option C) are high-risk, the combination of prematurity + SGA (Option B)
represents the most vulnerable population with minimal substrate reserves. Option A is lower
risk due to "well-controlled" diabetes. Option D (polycythemia) can cause hypoglycemia via
glucose consumption but is less common than prematurity/SGA.*
---
* *Q3:** A 3-hour old, 28-week gestation infant weighing 1,100 g has a glucose of 22 mg/dL (1.2
mmol/L) and is jittery with a weak cry. What is the correct management sequence?
. Feed 5 mL of breast milk via gavage tube, then recheck in 30 minutes
A
B. Administer 2 mL/kg of D10W IV push over 1–2 minutes, then start D10W continuous infusion
at 80 mL/kg/day
C. Give 2 mL/kg of D25W IV push, then begin D5W at 60 mL/kg/day
D. Apply dextrose gel 0.5 mL/kg to buccal mucosa and observe for 1 hour
**[CORRECT]** B
* Rationale: S.T.A.B.L.E. 6th Edition specifies that symptomatic hypoglycemia or glucose <25
mg/dL requires IV dextrose: 2 mL/kg D10W IV push (200 mg/kg) over 1–2 minutes, followed by
continuous D10W infusion. Option A is inappropriate for a preterm infant who is NPO and
symptomatic. Option C uses dangerous D25W (causes phlebitis, hyperosmolality) and
inadequate D5W concentration. Option D (dextrose gel) is for asymptomatic, term/near-term
infants per AAP guidelines—not for symptomatic preterm infants.*
---
* *Q4:** After treating hypoglycemia with IV dextrose, how frequently should point-of-care
glucose be monitored until stable?
. Every 5 minutes for the first hour
A
B. Every 30–60 minutes until three consecutive readings are within target range
C. Every 2 hours for 24 hours
D. Only when the infant becomes symptomatic again
**[CORRECT]** B
,* Rationale: S.T.A.B.L.E. 6th Edition recommends rechecking glucose every 30–60 minutes after
intervention until three consecutive values are within the target range (≥45 mg/dL or ≥2.5
mmol/L). Option A is excessive and not evidence-based. Option C is too infrequent during the
critical stabilization period. Option D is dangerous—reactive monitoring misses rebound
hypoglycemia, which is common after IV dextrose boluses due to insulin surge.*
---
* *Q5:** What is the definition of neonatal hypoglycemia per the S.T.A.B.L.E. Program 6th Edition
and current AAP guidelines?
. Glucose <60 mg/dL (<3.3 mmol/L) at any time in the first 72 hours
A
B. Glucose <45 mg/dL (<2.5 mmol/L) after the first 24 hours of life
C. Glucose <40 mg/dL (<2.2 mmol/L) in the first 4 hours, <45 mg/dL thereafter
D. Glucose <45 mg/dL (<2.5 mmol/L) at any point in the neonatal period
**[CORRECT]** D
* Rationale: The S.T.A.B.L.E. 6th Edition aligns with AAP guidelines defining neonatal
hypoglycemia as glucose <45 mg/dL (<2.5 mmol/L) at any point, with operational thresholds of
<40 mg/dL in the first 4 hours and <45 mg/dL thereafter. Option A is too high and would
overtreat normal transitional hypoglycemia. Option B misses the first 24-hour window. Option C
is close but the unified operational threshold is <45 mg/dL for clinical decision-making in
S.T.A.B.L.E.*
---
* *Q6:** Dextrose gel 40% (200 mg/g) is applied to the buccal mucosa of an asymptomatic,
38-week infant with glucose 35 mg/dL. What is the correct dose and next step?
. 0.5 mL/kg, then feed immediately and recheck glucose in 30 minutes
A
B. 1.0 mL/kg, then place NPO and observe for 2 hours
C. 0.3 mL/kg, then begin IV D10W infusion prophylactically
D. 1.5 mL/kg, then send to NICU for continuous monitoring
**[CORRECT]** A
* Rationale: Per S.T.A.B.L.E. 6th Edition and AAP guidelines, dextrose gel dose is 0.5 mL/kg
(200 mg/kg) applied to buccal mucosa, followed immediately by feeding (breast or formula), with
recheck in 30 minutes. Option B is incorrect because the infant should be fed, not made NPO.
Option C is overly aggressive for an asymptomatic infant who can be managed with oral
interventions. Option D is excessive—dextrose gel is designed to prevent NICU admission for
asymptomatic hypoglycemia.*
, ---
* *Q7:** An infant with hypoglycemia receives a D10W bolus. Thirty minutes later, the glucose is
85 mg/dL. What complication is the nurse most concerned about?
. Hyperglycemia-induced osmotic diuresis
A
B. Rebound hypoglycemia from pancreatic insulin surge
C. Dextrose-induced necrotizing enterocolitis (NEC)
D. Cerebral edema from rapid glucose correction
**[CORRECT]** B
* Rationale: S.T.A.B.L.E. 6th Edition emphasizes that IV dextrose boluses can trigger a reactive
insulin surge, causing rebound hypoglycemia 30–60 minutes post-bolus—this is why frequent
monitoring is critical. Option A (osmotic diuresis) occurs with sustained hyperglycemia >180
mg/dL, not a transient 85 mg/dL. Option C is incorrect because IV dextrose does not cause
NEC. Option D (cerebral edema) is associated with rapid correction of hypernatremia, not
hypoglycemia.*
---
* *Q8:** Which maternal condition places the infant at risk for BOTH hypoglycemia AND
hypocalcemia?
. Maternal Graves' disease
A
B. Maternal diabetes mellitus (any type)
C. Maternal phenylketonuria (PKU)
D. Maternal chorioamnionitis
**[CORRECT]** B
* Rationale: Maternal diabetes mellitus causes fetal hyperinsulinism (hypoglycemia risk) and is
associated with delayed parathyroid hormone response leading to hypocalcemia, especially in
IDM infants. Option A (Graves' disease) causes neonatal hyperthyroidism/hypothyroidism, not
primarily these metabolic issues. Option C (PKU) causes intellectual disability and microcephaly.
Option D (chorioamnionitis) causes sepsis risk but not specifically this dual metabolic profile.*
---
* *Q9:** A 4-hour old infant has glucose 28 mg/dL. The nurse starts a D10W infusion at 60
mL/kg/day. One hour later, glucose is 32 mg/dL. What is the most appropriate next action?
. Increase the infusion rate to 80 mL/kg/day and recheck in 1 hour
A
B. Give another 2 mL/kg D10W bolus and increase the infusion concentration to D12.5W
