A community health nurse is counseling a client who cares for a mentally ill parent. The client states, "I am feeling overwhelmed and exhausted." Which of the following referrals should the nurse make to provide this client with first level support?

Choice A Reason:
Research indicating that a screening is not warranted at this time and may be harmful aligns with a Grade D recommendation from the USPSTF. Grade D recommendations suggest that the service has no net benefit or that the harms outweigh the benefits, and therefore, it should be discouraged.

Choice B Reason:
A Grade C recommendation from the USPSTF means that the service should be selectively offered or provided to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. This means that while there is some benefit, it is not substantial enough to recommend the service for all individuals.

Choice C Reason:
The statement that there is not enough evidence to determine if a screening is helpful or not corresponds to a Grade I (Insufficient) recommendation. This grade indicates that the current evidence is insufficient to assess the balance of benefits and harms of the service. More research is needed to make a definitive recommendation.

Choice D Reason:
Research indicating that a screening exam is beneficial aligns with a Grade A or B recommendation. Grade A recommendations suggest high certainty that the net benefit is substantial, while Grade B recommendations suggest high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

Choice A: Make a Report to Child Protective Services (CPS)
This is the correct action for the nurse to take. Nurses are mandated reporters, meaning they are legally required to report any suspected cases of child abuse or neglect to the appropriate authorities. Child Protective Services (CPS) is the agency responsible for investigating reports of child abuse and ensuring the safety and well-being of children. Reporting to CPS ensures that the case is handled by professionals trained to investigate and intervene in such situations.

Choice B: Call the Police and Report the Suspected Abuse
While calling the police may seem like a logical step, it is not the primary action a nurse should take in this situation. The police may become involved later in the process, especially if there is an immediate threat to the child's safety. However, the initial report should be made to CPS, as they are the designated agency for handling child abuse cases.

Choice C: Call the Child's Guardian to Have the Child's Pediatrician Confirm the Suspected Abuse
This action is not appropriate because it could potentially place the child in further danger. If the guardian is the abuser, notifying them could lead to retaliation against the child or attempts to cover up the abuse. Additionally, it is not the role of the pediatrician to confirm abuse; this is the responsibility of CPS and law enforcement.

Choice D: Alert the School Principal of the Situation
While it is important to keep school officials informed, the nurse's primary responsibility is to report the suspected abuse to CPS. The school principal can be informed after the report has been made, but the immediate priority is to ensure the child's safety by contacting the appropriate authorities.