A nurse is assessing a newborn who is 48 hours old and is experiencing opioid withdrawals.Which of the following findings should the nurse expect?
Explanation & Rationale
Choice A rationaleHypotonicity is not a common symptom of opioid withdrawal. Instead, hypertonicity, characterized by increased muscle tone, is observed due to overstimulation of the central nervous system from opioid abstinence.Choice B rationaleModerate tremors of the extremities are a hallmark of neonatal abstinence syndrome. These tremors result from heightened central nervous system activity as the newborn's body adjusts to the absence of opioids.Choice C rationaleAxillary temperature of 36.1°C (96.9°F) indicates hypothermia, which is not characteristic of opioid withdrawal. Instead, hyperthermia or an elevated temperature is more commonly associated with withdrawal symptoms.Choice D rationaleExcessive sleeping is not typical in neonatal opioid withdrawal. Irritability and difficulty sleeping due to hyperarousal and discomfort are far more indicative of withdrawal in a newborn.