A nurse is conducting discharge teaching for a patient who has seizures and a new prescription for phenytoin. Which statements by the patient indicate a need for further teaching?

The correct answer is Choice D

Choice A rationale: Moral reasoning, including distinguishing right from wrong, requires abstract cognitive processing and internalization of social norms, typically emerging during the concrete operational stage around age 7. Toddlers are in Piaget’s sensorimotor to early preoperational phase, where egocentrism dominates and behavior is guided by immediate consequences rather than ethical principles. They lack the neurological maturity and social-cognitive integration required for moral discourse, making this milestone developmentally inappropriate for the toddler age group.

Choice B rationale: Performing simple chores involves task comprehension, motor coordination, and social cooperation, which are more consistently observed in preschool-aged children (4–5 years). Toddlers may imitate adult actions but lack sustained attention, impulse control, and fine motor precision needed for chore completion. Their psychosocial development is centered on autonomy and exploration, not structured responsibility. Expecting chore cooperation at this stage exceeds normative developmental expectations and may lead to frustration or behavioral resistance.

Choice C rationale: Printing letters and numbers requires advanced fine motor control, visual-motor integration, and symbolic cognition, typically achieved between ages 5 and 6. Toddlers are still developing basic hand-eye coordination and may engage in scribbling, but they lack the neuromuscular refinement and cognitive mapping needed for structured writing. Neurodevelopmental milestones do not support this skill in the toddler phase, making it scientifically inaccurate to expect printing behavior before preschool age.

Choice D rationale: By age 3, toddlers begin to tolerate brief separations from primary caregivers due to improved object permanence, emotional regulation, and social awareness. This aligns with Erikson’s autonomy vs. shame and doubt stage, where toddlers explore independence while maintaining secure attachment. Separation anxiety peaks around 9–18 months and typically declines by age 3. The ability to separate easily for short periods reflects healthy psychosocial development and is a scientifically appropriate expectation for toddlers.

Choice A rationale

While swelling in the legs can be a side effect of some medications, it is not a measure of the effectiveness of sertraline. Sertraline is an antidepressant, and its effectiveness would be measured by improvements in mood and behavior.

Choice B rationale

An improvement in mood is a key indicator that the sertraline is effective. Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and other mood disorders. It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Choice C rationale

While it’s important to monitor blood pressure in patients taking any medication, a blood pressure within the expected range is not specifically an indication of the effectiveness of sertraline.

Choice D rationale

Weight loss is not a primary indicator of the effectiveness of sertraline. While some patients may experience weight changes while taking this medication, it is not a measure of its effectiveness in treating depression or other mood disorders.