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:
The nurse should review the state laws to determine if and how this information should be shared with the National Notifiable Disease Surveillance System. This is the correct answer because HIV is a notifiable disease, meaning that cases must be reported to public health authorities to monitor and control the spread of the infection. Each state has specific laws and regulations regarding the reporting of notifiable diseases, and it is crucial for the nurse to be aware of these requirements to ensure compliance and public health safety.

Choice B Reason:
The nurse should recognize this diagnosis as an indication that the outreach program is not successful. This statement is incorrect. A positive diagnosis does not necessarily mean that the outreach program is unsuccessful. On the contrary, identifying and linking individuals to care is a key objective of such programs. The success of the program can be measured by its ability to reach high-risk individuals, provide testing, and ensure they receive appropriate care and support.

Choice C Reason:
Outside the healthcare team, the nurse should keep this diagnosis confidential. While confidentiality is critical in healthcare, the reporting of notifiable diseases like HIV is an exception due to public health concerns. The nurse must balance confidentiality with the legal obligation to report the diagnosis to public health authorities. This ensures that appropriate measures can be taken to prevent further transmission and provide necessary public health interventions.

Choice A Reason:
Increased exposure increases the risk of developing the disease. This statement describes a dose-response relationship, which is another important criterion for establishing causation. It indicates that as the level of exposure to a potential cause increases, the risk of developing the disease also increases. However, this does not specifically address the temporal sequence required to establish causation.

Choice B Reason:
The exposure must come before the disease develops. This is the correct definition of a temporal relationship in epidemiological studies. For causation to be established, it is essential that the exposure to the potential cause occurs before the onset of the disease. This temporal sequence is crucial because it helps to rule out reverse causation, where the disease might influence the exposure rather than the other way around.

Choice C Reason:
When the exposure is decreased or eliminated, the risk of disease declines or is eliminated. This statement describes the concept of reversibility, which is another criterion for causation. It suggests that reducing or removing the exposure should lead to a decrease in the incidence of the disease. While important, it does not specifically define the temporal relationship.

Choice D Reason:
A relationship is biologically plausible, and it makes sense. This statement refers to biological plausibility, which means that the observed association between exposure and disease is consistent with existing biological or medical knowledge. While biological plausibility supports causation, it does not define the temporal sequence necessary to establish a causal relationship.