A newborn is diagnosed with having neonatal abstinence syndrome (NAS). What is the priority nursing care?

Choice A rationale Increasing breastmilk intake is generally beneficial for newborns but is not the priority care for an infant experiencing the hyperirritability and gastrointestinal distress associated with neonatal abstinence syndrome (NAS). The priority is managing the severe symptoms of withdrawal, which include excessive central nervous system stimulation and autonomic instability. Hydration and nutrition, including breastmilk, are important but secondary to stabilization. Choice B rationale Reducing environmental stimuli, such as dimming the lights, minimizing noise, and swaddling, is the priority nursing care for an infant with NAS. These interventions help to decrease the overstimulation of the central nervous system, which is characterized by excessive crying, tremors, hypertonia, and seizures in severe cases. Creating a calm environment promotes relaxation and conserves the infant's energy. Choice C rationale Assessing for age-appropriate developmental level is an important component of overall pediatric care, but it is not the immediate priority for a newborn experiencing the acute physical signs of drug withdrawal characteristic of NAS. The immediate focus must be on managing the life-threatening physiological symptoms and providing comfort through supportive, low-stimulation care, and pharmacological treatment if symptoms are severe. Choice D rationale Administering an opioid antagonist, such as naloxone, is contraindicated in an infant with NAS because it can precipitate immediate, severe, and potentially fatal withdrawal symptoms. Treatment for NAS generally involves supportive care and sometimes gradually weaning the infant off opioids using replacement therapy (e.g., morphine, methadone) if non-pharmacologic measures are insufficient to manage symptoms.