A nurse is assessing a newborn who is 48 hr old and has a maternal history of methadone use during pregnancy.Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome?

Choice A rationaleHyporeactivity is not typically associated with neonatal abstinence syndrome. Common indicators include heightened sensory sensitivity and autonomic dysregulation, leading to hyperactivity rather than hyporeactivity.Choice B rationaleExcessive high-pitched crying results from central nervous system hyperirritability caused by withdrawal. Neonatal abstinence syndrome involves exaggerated responses to stimuli, reflecting the neonate’s difficulty in self-regulation.Choice C rationaleAcrocyanosis, or bluish discoloration of the extremities, is a normal finding in newborns and not a specific indicator of neonatal abstinence syndrome. It resolves as circulation improves post-birth.Choice D rationaleA respiratory rate of 50/min is within the normal range for neonates (30–60/min). Neonatal abstinence syndrome often presents with tachypnea, highlighting autonomic nervous system dysregulation.