Neonatal Nurse Practitioner NCC Practice Exam

The main idea here is recognizing the hallmark signs of neonatal abstinence syndrome (NAS). NAS results from withdrawal after in-utero exposure to substances such as opioids, and the infant typically shows central nervous system hyperarousal with feeding and autonomic disturbances. The most characteristic presentation is jitteriness and irritability, with feeding difficulties and yawning, often accompanied by a high-pitched cry. These signs reflect the baby’s nervous system in withdrawal and the stress of finding relief from discomfort.

Context helps: NAS signs appear as the newborn’s brain and body react to the absence of the substance they were exposed to in utero. While some autonomic symptoms can occur, the cluster described—jitteriness, irritability, feeding problems, yawning, and a high-pitched cry—is classic for NAS.

Why the other options don’t fit NAS as the major sign: bradycardia with hypotension isn’t typical of NAS and would suggest other serious conditions like sepsis or congenital heart issues. Severe jaundice by itself points to hyperbilirubinemia or liver immaturity rather than withdrawal. Macrosomia is a feature associated with maternal diabetes or other growth factors, not withdrawal.

So, the best answer describes jitteriness with irritability, feeding difficulties with yawning, and a high-pitched cry.