A nurse is assessing a newborn who was exposed to heroin during pregnancy. Which of the following findings should indicate to the nurse that the newborn is experiencing neonatal abstinence syndrome? (Select all that apply)

Choice A rationale Body tremors are a key indicator of central nervous system (CNS) hyperirritability, which is a major component of neonatal abstinence syndrome (NAS) following in utero exposure to opioids like heroin. The newborn's immature CNS struggles to adapt after the abrupt cessation of the drug, leading to uncoordinated, jerky movements, exaggerated reflexes, and generalized irritability. Choice B rationale Tachypneic respirations (respiratory rate greater than 60 breaths/min) are a common sign of NAS. This occurs due to the dysregulation of the autonomic nervous system and increased metabolic rate associated with the hyperirritable state. Other respiratory signs include flaring, retractions, and frequent yawning or sneezing, reflecting CNS overstimulation. Choice C rationale The hyperirritability of the CNS in NAS typically leads to increased and exaggerated reflexes (hyperreflexia), such as a hyperactive Moro reflex, not decreased reflexes. Decreased reflexes would suggest CNS depression, which is characteristic of acute opioid intoxication, not the withdrawal state of NAS. Choice D rationale Newborns experiencing NAS are characterized by CNS hyperstimulation, leading to excessive wakefulness, irritability, and an inability to be consoled, often referred to as hyperactivity or agitation. Extreme lethargy and hypoactivity are signs of CNS depression or severe illness, which is contrary to the expected presentation of NAS. Choice E rationale The hyper-responsiveness of the newborn's CNS in NAS causes a characteristic high-pitched, non-stop, inconsolable crying. This shrill, distressed cry is due to the sustained state of irritability and neurological overstimulation, representing a significant manifestation of withdrawal symptoms that is distressing to both the newborn and the caregivers.