A 3-day-old infant is being monitored for neonatal abstinence syndrome (NAS). Review the trend of assessments and interventions. For each question, select the best response.

Quick answer
The trend shows progressive feeding decline, rising Finnegan scores, increasing loose stools, weight loss, and temperature elevation, indicating worsening NAS with risk of dehydration and poor growth. The priority is to support feeding and hydration, maintain low-stimulation care, and escalate to the provider for possible pharmacologic intervention.

Why this is correct
NAS can cause poor feeding, excessive sucking, irritability, loose stools, and temperature instability. A downward feeding trend with rising Finnegan scores and weight loss suggests the infant is not meeting nutritional needs and may require medication. Early intervention prevents dehydration and poor weight gain.

Clinical picture
In NAS, Finnegan scores ≥8 on two consecutive assessments or ≥12 on one assessment may indicate need for pharmacologic treatment. Feeding difficulties are common and require supportive measures such as small frequent feeds, high-calorie formula if needed, and careful monitoring of intake and output.

Memory hook
NAS management: assess with Finnegan scoring, provide low-stimulation environment, support feeding, monitor weight and hydration, and escalate for pharmacologic treatment when scores indicate.

NCLEX decision rule
If an infant with NAS shows declining feeding, increasing Finnegan scores, and weight loss, the nurse should prioritize feeding support, hydration, and provider notification for possible medication.

Why the alternatives are wrong
Waiting to see if symptoms resolve spontaneously is unsafe given the clear worsening trend. Checking blood glucose is not the priority because the symptoms are more consistent with NAS than hypoglycemia. Delaying feeding assessment or placing the infant in a bright, noisy room would worsen withdrawal symptoms.