Which of these clients would the triage nurse request the healthcare provider to examine immediately?

Correct Answer: A

Rationale: The correct answer is A. Audible wheezing and grunting in an infant indicate respiratory distress, which is a critical condition requiring immediate assessment and intervention by the healthcare provider. Choices B, C, and D do not present with immediate life-threatening conditions that require urgent evaluation. Soot on the face and shirt, second-degree burns on the hand, and singed hair, while concerning, do not pose an immediate threat to life compared to respiratory distress in an infant.

Correct Answer: A

Rationale: The correct answer is A: Primary prevention. Administering a booster dose of DTaP vaccine to an infant is an example of primary prevention. Primary prevention aims to prevent disease or injury before it occurs by preventing exposure to risk factors. Tertiary prevention focuses on reducing the impact of a disease or injury that has already occurred, while secondary prevention involves early detection and treatment to prevent the progression of disease. Choice B, tertiary prevention, is incorrect as it deals with managing the consequences of a disease rather than preventing it. Choice C, secondary prevention, is also incorrect as it focuses on early detection and treatment rather than vaccination to prevent the disease. Choice D, primary nursing, is unrelated to the level of prevention being implemented in this scenario.

Correct Answer: A

Rationale: The correct answer is A. A community adopting a no smoking policy is a positive outcome for the Leading Health Indicators of Healthy People 2020 as it promotes a healthier environment by reducing exposure to secondhand smoke and decreasing smoking-related illnesses. Choices B, C, and D do not directly align with the goals of the Leading Health Indicators. While public transportation and reduced dropout rates are beneficial for community well-being, they are not specific examples of Leading Health Indicators. Decreasing divorce rates, while potentially beneficial for family stability, is not a focus area of the Leading Health Indicators.

Correct Answer: D

Rationale: The appropriate nursing action in response to significantly high blood pressure readings like 172/104 mm Hg and 164/98 mm Hg is to confirm the readings by taking the blood pressure in the other arm. This can help rule out any error or issue specific to that arm. The nurse should then schedule a healthcare practitioner's appointment for as soon as possible to further assess the client's condition and determine the appropriate intervention. Choice A is incorrect because solely referring the client to a nutritionist for a low-sodium diet without further assessment or confirmation of the blood pressure readings is premature. Choice B is incorrect as the client is already seated, and calling paramedics for immediate transport to the hospital is not warranted based solely on the blood pressure readings provided. Choice C is incorrect as stress may not be the sole reason for the high blood pressure readings, and further assessment is required before referring the client to counseling services.

Correct Answer: C

Rationale: The correct answer is the 60-year-old homeless person who is an alcoholic and smokes. This individual has the highest risk of developing community-acquired pneumonia due to factors such as homelessness, alcoholism, and smoking, which weaken the immune system and make them more susceptible to respiratory infections. Choice A is incorrect as working with underprivileged children, while potentially exposing the individual to various illnesses, does not directly increase the risk of pneumonia. Choice B is less likely as exercise-induced wheezing may suggest asthma but does not directly correlate with pneumonia risk. Choice D, an aerobics instructor who eats only vegetables and skips meals, does not have the same level of risk factors for pneumonia as the homeless person in choice C.