A nurse is assisting with teaching a class about Piaget's stages of cognitive development. The nurse should reinforce that abstract thinking develops during which of the following stages?

Choice A reason : Administering an opioid narcotic can be an effective measure for managing dyspnea in end-of-life care. Opioids, such as morphine, can reduce the sensation of breathlessness and improve comfort without significantly affecting oxygen saturation levels. The use of opioids is a well-established practice in palliative care for the relief of dyspnea, particularly when other causes of dyspnea have been addressed and managed appropriately.

Choice B reason : Increasing the heat in the client's room is not a recommended action for managing dyspnea and may actually worsen the client's comfort. Patients experiencing dyspnea often feel better in a cooler environment, as warm temperatures can make breathing feel more labored⁴.

Choice C reason : Placing the head of the client's bed flat is not advisable for managing dyspnea. Elevating the head of the bed can help ease breathing by reducing pressure on the diaphragm and allowing for better lung expansion. A semi-upright position, such as Fowler's or semi-Fowler's position, is typically recommended for patients experiencing dyspnea.

Choice D reason : Nasotracheal suctioning is a procedure used to clear secretions from the airway. While it may be necessary in some cases, it is not a standard action for managing dyspnea in end-of-life care unless there is a specific indication, such as excessive secretions that the patient cannot clear on their own. It can be uncomfortable and distressing for the patient and should be used judiciously⁵.

Choice A reason : Trust vs. Mistrust.The stage of Trust vs. Mistrust is the first stage of Erikson's theory of psychosocial development, occurring from birth to approximately 18 months of age. In this stage, the infant is uncertain about the world and looks towards their primary caregiver for stability and consistency of care. If the caregiver is reliable, consistent, and nurturing, the child will develop a sense of trust, believing that the world is safe and that people are dependable and affectionate. This sense of trust allows the child to feel secure even when threatened and extends into their other relationships, maintaining their sense of security amidst potential threats.

Choice B reason : Autonomy vs. Shame and Doubt.The stage of Autonomy vs. Shame and Doubt is the second stage of Erikson's theory, spanning the toddler years from 18 months to three years. In this stage, toddlers begin to assert their independence by making choices and taking control over their actions. Success in this stage leads to feelings of autonomy, while failure results in feelings of shame and doubt. However, this stage is not applicable to the scenario described, as it involves an infant, not a toddler.

Choice C reason : Identity vs. Role Confusion.Identity vs. Role Confusion is the fifth stage, occurring during the teen years from 12 to 18. This stage is characterized by the exploration of personal identity and the development of a sense of self. The scenario provided does not pertain to an adolescent, so this stage is not relevant to the infant's experience.

Choice D reason : Integrity vs. Despair.The stage of Integrity vs. Despair is the eighth and final stage of Erikson's theory, occurring in older adulthood from 65 to death. This stage involves reflecting on one's life and either concluding it with a sense of integrity and fulfillment or with a sense of despair over a life misspent. This stage is not applicable to the infant described in the scenario.