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

Choice A reason: Acrocyanosis, a benign bluish discoloration of extremities, is common in healthy newborns due to immature peripheral circulation, not specific to neonatal abstinence syndrome (NAS). NAS involves central nervous system irritability from opioid withdrawal, causing symptoms like tachypnea or tremors, not peripheral vasoconstriction unrelated to withdrawal physiology. Choice B reason: Hypotonia is not typical in neonatal abstinence syndrome, which causes hypertonia due to central nervous system irritability from opioid withdrawal. Hypotonia suggests other conditions, like neuromuscular disorders, not the hyperactive neurological state of NAS, where increased muscle tone and reflexes dominate due to autonomic dysregulation. Choice C reason: Tachypnea is expected in neonatal abstinence syndrome, as opioid withdrawal causes autonomic hyperactivity, increasing respiratory drive. The newborn’s immature nervous system responds to withdrawal stress with rapid breathing, reflecting heightened metabolic demand and sympathetic activation, a hallmark of NAS requiring careful monitoring to prevent respiratory distress. Choice D reason: A shrill pitched cry is a classic finding in neonatal abstinence syndrome, indicating central nervous system irritability from opioid withdrawal. The high-pitched cry reflects neurological overstimulation, as the infant’s brain struggles to regulate without opioid exposure, distinguishing NAS from normal newborn behavior and requiring supportive care. Choice E reason: An exaggerated Moro reflex is expected in neonatal abstinence syndrome, as withdrawal heightens neurological excitability. The reflex, triggered by sudden movement, is amplified due to central nervous system irritability, reflecting the infant’s hypersensitive autonomic response to opioid withdrawal, necessitating calming interventions to reduce overstimulation.