A nurse is assessing a newborn. Which of the following findings indicates a need to check the newborn's blood glucose level for hypoglycemia?

Choice A rationale: A shrill, high-pitched cry is more commonly associated with increased intracranial pressure or neonatal abstinence syndrome (withdrawal) rather than hypoglycemia. While a hypoglycemic infant may be irritable, their cry is typically described as weak or absent due to low energy reserves. Choice B rationale: Weak peripheral pulses are a sign of poor perfusion or cardiovascular compromise, such as coarctation of the aorta or neonatal shock. Hypoglycemia primarily affects neurological and muscular function rather than directly causing a decrease in pulse strength. Choice C rationale: Yellowish skin, or jaundice, is caused by elevated bilirubin levels (hyperbilirubinemia). While severe jaundice can lead to neurological issues, it is a separate metabolic concern from blood glucose instability. Choice D rationale: Hypotonia, or "floppiness," is a classic clinical manifestation of neonatal hypoglycemia. When the brain and muscles are deprived of adequate glucose, the newborn lacks the energy to maintain normal muscle tone. Other key signs include jitteriness, lethargy, poor feeding, and a subnormal temperature.