A nurse is reinforcing teaching about the role of the immune system to a client who has psoriasis. Which of the following explains the immune system dysfunction associated with psoriasis?

A. Autonomy vs. Shame and Doubt. This stage (ages 1–3 years) is when toddlers begin to assert independence by making simple choices and attempting self-care. However, they lack the cognitive ability and motor skills to manage a suprapubic catheter independently.

B. Trust vs. Mistrust. This stage (birth to 1 year) focuses on developing trust in caregivers. Infants are entirely dependent on others for care and are not developmentally capable of learning catheter care.

C. Initiative vs. Guilt. This stage (ages 3–6 years) involves children exploring their environment and developing a sense of initiative. While they may be curious, they are not developmentally ready to take responsibility for complex self-care tasks like catheter maintenance.

D. Industry vs. Inferiority. This stage (ages 6–12 years) is when children develop a sense of competence and responsibility. They are eager to learn new skills, follow instructions, and take part in their own care, making this the appropriate stage for teaching suprapubic catheter care.

A. Atrial fibrillation on the cardiac monitor. Rheumatic fever can cause carditis, but atrial fibrillation is not a typical finding. Instead, valvular damage, tachycardia, or murmurs are more commonly observed.

B. Elevated BUN and creatinine on morning laboratory results. Rheumatic fever primarily affects the heart, joints, skin, and brain, not the kidneys. Elevated BUN and creatinine are more indicative of post-streptococcal glomerulonephritis, a separate complication of streptococcal infection.

C. Involuntary movements of extremities. Sydenham’s chorea, characterized by involuntary, jerky movements, is a classic neurologic manifestation of rheumatic fever. It results from inflammation affecting the basal ganglia of the brain.

D. Alopecia. Rheumatic fever does not cause alopecia. Hair loss is more commonly associated with autoimmune diseases such as lupus, not post-streptococcal complications.

E. Report of chest pain. Chest pain can indicate carditis, a major criterion for rheumatic fever. Inflammation of the heart's endocardium, myocardium, or pericardium may lead to pain, murmurs, or heart failure symptoms.

F. Oliguria. Decreased urine output is more commonly seen in post-streptococcal glomerulonephritis rather than rheumatic fever, as rheumatic fever primarily affects the heart, joints, and nervous system.