A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following findings should the nurse expect? (Select all that apply.)

Choice A rationale Acrocyanosis, characterized by bluish discoloration of the hands and feet, is a common and usually benign finding in newborns, especially shortly after birth due to immature peripheral circulation. It does not typically indicate neonatal abstinence syndrome, which is a neurological and systemic hyperexcitability response to opioid withdrawal. Choice B rationale Hypotonia, or decreased muscle tone, is generally a sign of central nervous system depression or neuromuscular disorder. In contrast, newborns with neonatal abstinence syndrome typically exhibit hypertonia, characterized by increased muscle tone, tremors, and hyperreflexia, due to the overstimulation of the central nervous system following cessation of maternal opioid exposure. Choice C rationale An exaggerated Moro reflex, characterized by an overly robust and prolonged startle response, is a common manifestation of central nervous system irritability seen in newborns experiencing neonatal abstinence syndrome. This hyperreflexia is a direct result of the withdrawal symptoms, indicating an overactive nervous system in response to the absence of the previously supplied opioid. Choice D rationale Tachypnea, or rapid breathing, is a frequent finding in newborns with neonatal abstinence syndrome. This symptom is often attributed to central nervous system irritability and increased metabolic demand associated with withdrawal, leading to respiratory distress. The respiratory rate often exceeds the normal range of 30-60 breaths per minute. Choice E rationale A shrill-pitched cry, often described as inconsolable or high-pitched, is a classic and distinctive symptom of neonatal abstinence syndrome. This abnormal cry pattern is indicative of central nervous system irritation and dysregulation, reflecting the newborn's discomfort and hyperirritability stemming from opioid withdrawal. This cry often differs from a typical hunger or discomfort cry.