The nurse is performing a cognitive assessment on a 16-year-old client. Which behaviors demonstrated will the nurse identify as middle formal operational, according to Piaget's theory? Select all that apply.

The correct answers are A, B, and C. In Piaget's theory of cognitive development, the middle formal operational stage (around 12-16 years) is characterized by abstract thinking, hypothetical reasoning, and concern for social issues. Choice A demonstrates the ability to prioritize social relationships over familial ones, reflecting abstract thinking. Choice B shows concern for a complex societal issue, which aligns with abstract and hypothetical reasoning. Choice C reflects the desire for autonomy and decision-making independence, typical of this stage. Choices D and E do not align with middle formal operational stage criteria. D indicates difficulty with complex reasoning, while E relates to personal behavior rather than abstract thinking or decision-making abilities.