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.)
High-pitched crying
Tachypneic respirations
Body tremors
Extreme lethargy
Decreased reflexes
Correct Answer : A,B,C
A. High-pitched, excessive crying is a common sign of neonatal abstinence syndrome (NAS).
B. Tachypnea (rapid breathing) is a typical respiratory symptom of NAS.
C. Body tremors and jitteriness are classic signs of withdrawal in newborns.
D. Newborns with NAS typically exhibit hyperactivity, not extreme lethargy.
E. Reflexes are usually increased (hyperactive), not decreased, in NAS.
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Related Questions
Correct Answer is C
Explanation
A. Hypotension, not hypertension, is expected in hemorrhagic shock due to blood loss.
B. Tachypnea, not bradypnea, usually occurs as the body tries to compensate for hypoxia.
C. Tachycardia is an early compensatory response to blood loss to maintain cardiac output.
D. Oliguria (decreased urine output), not polyuria, is expected due to poor perfusion of kidneys in shock.
Correct Answer is C
Explanation
A. HSV-2 can cause neonatal herpes, which may result in serious complications or fetal demise if transmitted at delivery.
B. Tight-fitting undergarments can increase moisture and irritation; clients should wear loose cotton underwear to promote healing.
C. The risk of neonatal transmission is highest when active lesions or viral shedding are present at the time of vaginal delivery.
D. Antiviral medications (e.g., acyclovir) suppress viral replication and reduce outbreaks and shedding but do not eradicate the virus.
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