The nurse is caring for a child with chronic kidney disease who is experiencing renal osteodystrophy. Which outcome should the nurse explain to the parents about the sequela for their child with renal osteodystrophy?

Choice A reason: Playing "peek-a-boo" is a normal behavior for a 6-month-old infant. It shows that the infant has developed object permanence, which is the understanding that objects and people still exist even when they are out of sight. This is a sign of cognitive development and social interaction.

Choice B reason: Turning head to locate sound is a normal behavior for a 6-month-old infant. It shows that the infant has developed auditory localization, which is the ability to identify the direction and distance of a sound source. This is a sign of sensory development and curiosity.

Choice C reason: Having doubled birth weight is a normal milestone for a 6-month-old infant. It shows that the infant has adequate growth and nutrition. The average birth weight for a full-term infant is about 3.4 kg (7.5 lb), and the average weight for a 6-month-old infant is about 6.8 kg (15 lb).

Choice D reason: Demonstrating startle reflex is an abnormal behavior for a 6-month-old infant. The startle reflex, also known as the Moro reflex, is an involuntary response to a sudden loud noise or movement. The infant will extend the arms and legs, arch the back, and then curl the arms and legs inward. This reflex is present at birth and usually disappears by 4 months of age. If the reflex persists beyond 6 months of age, it may indicate a neurological problem or developmental delay. The nurse should request further evaluation by the health care provider.

Choice A reason: Autonomy is not the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Autonomy is the stage that occurs from 18 months to 3 years of age, when the child develops a sense of independence and self-control. The conflict in this stage is between autonomy and shame and doubt. The nurse may address this stage when teaching the client's parents about how to support their child's autonomy and avoid overprotection or criticism.

Choice B reason: Identity is not the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Identity is the stage that occurs from 12 to 18 years of age, when the adolescent develops a sense of self and personal identity. The conflict in this stage is between identity and role confusion. The nurse may address this stage when teaching the client about how to cope with the psychosocial challenges of having a chronic condition and how to maintain a positive self-image and self-esteem.

Choice C reason: Industry is the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Industry is the stage that occurs from 6 to 11 years of age, when the child develops a sense of competence and achievement. The conflict in this stage is between industry and inferiority. The nurse may address this stage when teaching the client about how to manage their diabetes and how to acquire the skills and knowledge needed for self-care and health promotion.

Choice D reason: Initiative is not the stage of Erikson's theory of psychosocial development that the nurse is addressing when teaching this client about insulin injections. Initiative is the stage that occurs from 3 to 6 years of age, when the child develops a sense of initiative and creativity. The conflict in this stage is between initiative and guilt. The nurse may address this stage when teaching the client about how to express their feelings and opinions about their diabetes and how to participate in decision-making and problem-solving.