Scenario:

A nurse is caring for a 32-year-old female client who was recently diagnosed with endometriosis. The client is in the clinic for a follow-up visit after beginning nafarelin treatment.

Setting: Clinic

Exhibits

Which of the following manifestations reported by the client should the nurse identify as a therapeutic effect of the nafarelin? (Select all that apply.)

Choice A rationale

A water heater temperature of 54.4°C (130°F) is a safety risk because it can cause burns. Older adults have thinner skin and are more susceptible to burns.

Choice B rationale

Electric cords behind furniture can be a safety risk because they can cause tripping or fire if the cords are damaged.

Choice C rationale

Throw rugs are a safety risk because they can slide underfoot and cause falls, especially in older adults who may have balance issues.

Choice D rationale

Raised toilet seats are not a safety risk. In fact, they are often recommended for older adults to prevent falls in the bathroom.

Choice E rationale

A bathtub with rails is not a safety risk. Rails can provide support and prevent falls when the older adult is entering or exiting the bathtub.

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.