Practice Question
A nurse is caring for a newborn who is 5 days old.
Answer Choices:
Correct Answer:
Weigh the newborn daily.
Rationale:
Weigh the newborn daily
🔷Infants with NAS have high energy expenditure (due to tachypnea, tremors, and constant crying) and inefficient feeds, placing them at high risk for excessive weight loss; daily weights provide an early, objective signal of nutritional adequacy.
🔷Trending weight alongside intake/output and feeding tolerance helps the team titrate caloric density, feeding frequency, and supplemental strategies (e.g., paced feeds, gavage if needed) to maintain euglycemia and growth.
🔷Because autonomic dysregulation increases insensible fluid losses, tight weight surveillance supports timely fluid and electrolyte adjustments to prevent dehydration.
🔷Weight trajectory also correlates with clinical NAS scores (e.g., Finnegan/Eat-Sleep-Console approaches), guiding decisions on non-pharmacologic vs. pharmacologic treatment intensity.
🔷Early detection of suboptimal gain allows rapid intervention (lactation support, formula fortification, or feeding therapy), protecting neurodevelopmental outcomes and length of stay.
Swaddle the newborn with flexed extremities
🔷Firm, flexed swaddling provides deep pressure and proprioceptive input that dampens hyperarousal and startle (exaggerated Moro)—hallmark features of opioid withdrawal—thereby reducing energy expenditure.
🔷The flexed, midline posture mimics in-utero positioning, which lowers cortisol, stabilizes autonomic function (heart rate, respirations), and improves state regulation (longer, more restorative sleep).
🔷Effective swaddling decreases tremors and frantic movements, improving feeding organization (coordination of suck–swallow–breathe) and reducing aerophagia and emesis.
🔷By limiting sensory overflow, swaddling shortens crying bouts and enhances consolability, which is central to the Eat-Sleep-Console care model for NAS.
🔷Combined with non-nutritive sucking and skin-to-skin, swaddling is a first-line, evidence-based non-pharmacologic therapy that can reduce the need for opioid weans and shorten hospitalization.
Maintain a low-stimulation environment
🔷NAS infants exhibit sensory hypersensitivity; controlling light, noise, and handling frequency minimizes autonomic surges that drive tachypnea, tachycardia, and high-pitched crying.
🔷A quiet, dim room with clustered care preserves uninterrupted sleep cycles, improving feeding readiness and weight gain while lowering withdrawal scores.
🔷Reducing environmental stimuli lowers oxygen consumption and caloric burn, helping stabilize vital signs (e.g., respiratory rate) and facilitating thermoregulation.
🔷Gentle containment holds, slow transitions, and limited caregiver turnover further prevent over-stimulation, supporting neurobehavioral organization.
🔷This foundation of trauma-informed, developmentally supportive care frequently decreases pharmacologic requirements and enhances parent–infant bonding through calmer, more successful interactions.
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This question is from RN Maternal Newborn 2023 OCT 28 which contains 66 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Maternal & Newborn Care
- Answer Choices: 7