# 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.

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> language: en  
> subject: Health Promotion/Disease Prevention  
> category: HPM

## Question

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.

| Time | Data |
| --- | --- |
| 0800 | feeding: 45 mL; finnegan: 8; weight: 2950 g; stool: 2 loose; temperature: 37.1°C; intervention: Encouraged frequent small feeds |
| 1200 | feeding: 35 mL; finnegan: 10; weight: –; stool: 3 loose; temperature: 37.3°C; intervention: Swaddled, dim lights, cluster care |
| 1600 | feeding: 25 mL; finnegan: 12; weight: –; stool: 4 watery; temperature: 37.6°C; intervention: Provider notified; labs pending |
| 2000 | feeding: 15 mL; finnegan: 14; weight: 2890 g; stool: 5 watery; temperature: 37.9°C; intervention: Awaiting provider response |

Q1. Based on the trend, which finding is most concerning and requires immediate attention?

Temperature increased from 37.1°C to 37.9°C
Feeding volume decreased from 45 mL to 15 mL over 12 hours
Finnegan score increased from 8 to 14
Weight decreased from 2950 g to 2890 g

Q2. At 2000, the provider has not yet responded. What is the nurse's priority action?

Repeat the Finnegan score in 1 hour
Attempt a small oral feeding and document tolerance
Initiate intravenous fluids as ordered
Escalate to the charge nurse or rapid response team

Q3. Which intervention is most appropriate for the nurse to implement while awaiting provider response?

Swaddle the infant and reduce environmental stimuli
Offer a high-calorie formula every 4 hours
Administer oral morphine as per standing order
Place the infant in a bright, noisy room to stimulate feeding

## Explanation

The infant's feeding volume is declining while Finnegan scores, stool output, and temperature are rising, indicating worsening withdrawal and risk for dehydration. The nurse must prioritize hydration and nutrition support, continue low-stimulation care, and escalate to the provider for possible pharmacologic treatment.

## In-depth explanation

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.

Sources
1NCSBN 2026 NCLEX-RN Test Plan
2AAP Neonatal Opioid Withdrawal Syndrome

## Clinical scenario

A 3-day-old infant born at 38 weeks gestation to a mother on methadone maintenance is being monitored for neonatal abstinence syndrome (NAS). The infant is rooming-in with the mother. The nurse reviews the following trend data.

## Key concepts

- **Neonatal Abstinence Syndrome (NAS)** — A withdrawal syndrome in newborns exposed to opioids in utero, characterized by central nervous system irritability, gastrointestinal dysfunction, and autonomic instability.
- **Finnegan Neonatal Abstinence Scoring System** — A standardized tool used to assess the severity of NAS based on signs such as tremors, excessive crying, sleep disturbance, feeding difficulties, and loose stools.
- **Low-stimulation environment** — A care approach for infants with NAS that reduces sensory input through dim lighting, quiet surroundings, swaddling, and clustering care to minimize agitation and support neurobehavioral regulation.

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