A nurse is assisting with teaching a client about the sleep-wake cycle. The nurse should include that which of the following factors can interfere with the sleep-wake cycle?

Choice A reason : Asthma is a chronic condition characterized by respiratory symptoms such as wheezing, shortness of breath, and coughing due to airway inflammation and constriction. While genetic and environmental factors contribute to the development of asthma, there is no direct correlation between advanced maternal age and an increased risk of asthma in offspring. Asthma's etiology is multifactorial and more closely related to family history, exposure to allergens, and respiratory infections during early childhood.

Choice B reason : Spina bifida is a neural tube defect that occurs when the spine and spinal cord don't form properly. It's associated with factors such as folic acid deficiency during early pregnancy, certain medications, diabetes, and obesity. Although advanced maternal age may slightly increase the risk of chromosomal abnormalities, it is not considered a significant risk factor for spina bifida. Adequate intake of folic acid before conception and during early pregnancy is the most effective prevention strategy.

Choice C reason : Down syndrome is a genetic disorder caused by the presence of an extra copy of chromosome 21 (trisomy 21). The risk of conceiving a child with Down syndrome increases with maternal age, particularly after age 35. This is due to the higher likelihood of nondisjunction events during cell division in older eggs, leading to an abnormal number of chromosomes. Advanced maternal age is a well-established risk factor for Down syndrome, and prenatal screening is recommended to assess the risk.

Choice D reason : Facial malformations, such as cleft lip or palate, are congenital anomalies that can affect the appearance and function of a child's face. These conditions are influenced by genetic and environmental factors, including certain medications, nutritional deficiencies, and exposure to harmful substances during pregnancy. While advanced maternal age may contribute to an increased risk of chromosomal abnormalities, it is not specifically linked to an increased risk of isolated facial malformations.

Choice A reason : Prolonged grief, also known as complicated grief, is characterized by an intense longing and preoccupation with thoughts or memories of a loved one, which persists long after the loss has occurred. It can significantly impair important areas of functioning and is defined by the DSM-5-TR as grief that stays with you long-term. The client's inability to accept the loss after three years suggests that they may be experiencing prolonged grief, which may require the guidance of a mental health professional for resolution.

Choice B reason : Uncomplicated grief, also known as normal grief, involves a range of feelings, including sadness, anger, and longing, that gradually start to improve over time. The person experiencing uncomplicated grief will begin to accept the loss and resume normal activities. Since the client is still unable to accept the loss after three years, this would not be classified as uncomplicated grief.

Choice C reason : Disenfranchised grief occurs when an individual's grief is not acknowledged or validated by society, often because the relationship to the deceased is not recognized, such as in the case of a pet or a distant relative. This type of grief is not typically associated with the duration of the grief but rather with the social context in which the grieving occurs.

Choice D reason : Anticipatory grief occurs before the actual loss, often in situations where a loved one is terminally ill. It involves grieving the impending loss and can include some of the same emotions as post-loss grief. Since the client's partner has already died, this would not be considered anticipatory grief.