A nurse is teaching about preventing sudden unexpected infant death (SUID) to a parent of a 1-month-old infant. Which of the following ling indicates that the parent understands how to place the infant in the crib at bedtime?

Rationale for correct choices

• Thoughts of self‑harm: The client recently experienced multiple major stressors, loss of a job and the end of a long-term relationship, while displaying flat affect, tearfulness, withdrawal, and refusal to eat. These changes, combined with the statement, “My life is a mess,” indicate worsening depression and internal distress. These findings elevate the risk for self‑harm and require immediate monitoring.

• Hopelessness: The client’s statements reflect feelings of worthlessness and an inability to see a path forward, which are hallmark signs of hopelessness. Their withdrawal, refusal to eat, and persistent tearfulness reinforce that they are overwhelmed and unable to cope with current stressors. Hopelessness is closely linked with suicidal ideation, explaining the elevated self‑harm risk.

Rationale for incorrect choices

• Anorexia nervosa: Although the client is refusing meals, this refusal occurs in the context of emotional distress rather than weight‑loss motivation or body‑image disturbance. The client’s BMI is low but not critically low, and there is no fear of gaining weight or distorted self‑perception. Appetite changes are common in depression and better explained by mood not eating disorders.

• Acute dystonic reaction: Acute dystonia is associated with antipsychotic medications, not sertraline, which the client is currently taking. No signs such as muscle spasms, stiff neck, or oculogyric crisis are present. The client’s symptoms are emotional and cognitive, not neuromuscular.

• Refusal to eat: While refusal to eat is concerning, it alone does not most strongly indicate risk for self‑harm. Poor appetite is common in depression and may reflect low motivation or energy. It lacks the direct emotional connotation that hopelessness carries in predicting self‑harm.

• Family history: A family history of major depressive disorder increases long‑term vulnerability but does not explain the client’s immediate risk situation. The client’s current behaviors and statements provide more immediate clinical evidence than hereditary factors. Family history does not sufficiently reflect the acute emotional state contributing to self‑harm risk.

Rationale for correct choices

• Pulmonary embolism: The client exhibits sudden onset of dyspnea, chest discomfort, tachypnea, hypoxemia (oxygen saturation 92% on 2 L O₂), and appears in respiratory distress, all of which are classic signs of a pulmonary embolism. Postoperative orthopedic patients, especially after hip arthroplasty, are at high risk due to immobility, venous stasis, and hypercoagulability.

• Recent surgery: The client’s recent total hip arthroplasty increases the risk of thromboembolic events. Surgical procedures, particularly major orthopedic surgeries, create a hypercoagulable state and contribute to venous stasis, which can precipitate a pulmonary embolism.

Rationale for incorrect choices

• Pneumothorax: Pneumothorax typically presents with unilateral chest pain, sudden shortness of breath, and decreased or absent breath sounds on one side. The client’s crackles are bilateral and S3/S4 heart sounds are present, which are not consistent with pneumothorax.

• Pneumonia: Although the client has fever and crackles, the sudden onset of symptoms and acute respiratory distress are more consistent with pulmonary embolism rather than pneumonia, which usually develops gradually. Additionally, the timing shortly after surgery favors a thromboembolic event over an infectious process.

• Tobacco use: The client reports no history of tobacco use, making this an irrelevant risk factor for the current acute episode.

• Activity level: While immobility can contribute to thrombus formation, the client ambulated with assistance earlier, and the more significant risk factor remains recent surgery, which directly predisposes to pulmonary embolism.