The nurse is conducting a prenatal assessment on a client in the first trimester.
Which pre-existing factors should the nurse identify as increasing the client's risk for developing postpartum mood disorders? Select all that apply.

Choice A rationale

Industry is the positive outcome of Erikson’s fourth stage of development, Industry vs. Inferiority, which typically occurs during the school-age years (ages 6 to 11). This stage focuses on the child's ability to learn new skills and complete tasks. It is not the result of infant care. In the infant stage, the focus is strictly on the acquisition of security and the reliability of the environment, not on the competence or productivity associated with later childhood.

Choice B rationale

Erikson’s first stage of psychosocial development is Trust vs. Mistrust. This stage occurs from birth to approximately 18 months. When a caregiver provides consistent, predictable, and affectionate care, the infant develops a sense of trust. However, if the care is inconsistent, cold, or fails to meet the infant's basic needs for food and comfort, the infant learns to view the world as unreliable and dangerous, resulting in the developmental outcome of mistrust.

Choice C rationale

Guilt is the negative outcome of Erikson’s third stage, Initiative vs. Guilt, which occurs during the preschool years (ages 3 to 5). During this time, children begin to assert power and control over their environment through play and social interaction. If their efforts are criticized or controlled too strictly, they may develop a sense of guilt. This is a much more complex cognitive and social stage than the foundational trust-building required during infancy.

Choice D rationale

Role confusion is the negative outcome of the fifth stage of Erikson’s theory, Identity vs. Role Confusion, which occurs during adolescence. At this stage, individuals struggle to develop a personal identity and a sense of self. It is unrelated to the infant’s struggle to find security. The psychosocial needs of an infant are focused on physical and emotional safety, whereas role confusion involves the complex integration of social roles and personal values in young adulthood. .

Choice A rationale

A four-year-old child losing several teeth is an abnormal clinical finding that necessitates a thorough investigation into their nutritional status. While the shedding of primary teeth is a biological certainty, it typically commences around age six. Premature tooth loss can be a clinical manifestation of severe malnutrition, specifically deficiencies in calcium, phosphorus, or vitamin D, or potentially underlying systemic diseases or localized periodontal infections that require immediate medical and dental evaluation for the patient.

Choice B rationale

Stating that it is normal for a four-year-old to lose deciduous teeth is scientifically inaccurate and provides false reassurance to the parents. The physiological process of resorption of the roots of primary teeth, driven by the eruption of permanent successors, generally begins between the ages of five and seven. Losing multiple teeth at age four is premature and suggests a pathological process, such as dental caries, trauma, or metabolic bone disturbances, rather than a normal developmental milestone.

Choice C rationale

Recommending increased flossing assumes that the tooth loss is strictly due to poor oral hygiene and periodontal disease. While hygiene is important, flossing alone will not prevent teeth from falling out if the underlying cause is systemic, such as a primary immune deficiency or a metabolic disorder. Furthermore, this response ignores the diagnostic priority of determining why the teeth are being lost prematurely, potentially delaying necessary medical intervention for the child's underlying health condition.

Choice D rationale

Suggesting that the child should drink milk often is a limited intervention that addresses calcium intake but fails to investigate the etiology of the premature tooth loss. While calcium is essential for dental hydroxyapatite stability, simply increasing milk consumption does not account for other factors like protein-energy malnutrition or endocrine disorders. The nurse must first ensure a comprehensive physical and nutritional assessment is performed rather than offering a simplistic dietary suggestion that may not solve the problem.