A community health nurse is reviewing the levels of disease prevention. Which of the following activities is an example of tertiary prevention?

Choice A reason: There are no current occurrences of smallpox. Smallpox was declared eradicated in 1980 by the World Health Organization (WHO) after a successful global vaccination campaign. Therefore, the statement that there are rare, occasional occurrences of smallpox is incorrect.

Choice B reason: Smallpox lesions do not appear in various stages of healing at the same time. Unlike chickenpox, where lesions can be in different stages of healing simultaneously, smallpox lesions typically develop and progress through stages uniformly. This means that all lesions are generally at the same stage of development at any given time.

Choice C reason: The vesicles of smallpox are indeed more abundant on the face and extremities compared to the trunk. This distribution pattern is a distinguishing feature of smallpox, as opposed to chickenpox, which tends to have a more central distribution with more lesions on the trunk.

Choice D reason: Vaccination against smallpox provides lifelong immunity. The smallpox vaccine, which uses a live virus related to smallpox called vaccinia, has been shown to provide long-lasting immunity. Studies have indicated that immunity can last for decades, and even those vaccinated many years ago retain some level of protection.

Choice A reason:

Calling the lab to verify the client’s results is a reasonable step if there is any doubt about the accuracy of the lab results. However, in this scenario, the potassium level of 5.2 mEq/L is already documented, and the nurse should act on this information. Verifying the results would delay necessary actions and could potentially harm the patient if the high potassium level is not addressed promptly.

Choice B reason:

Omitting the KCL dose and documenting it as not given is a prudent action because administering potassium chloride to a patient with an elevated potassium level (5.2 mEq/L) could exacerbate hyperkalemia, which can lead to serious cardiac issues. However, this action alone is not sufficient. The nurse must also inform the prescribing physician to reassess the patient’s treatment plan.

Choice C reason:

Giving the ordered KCL as prescribed would be inappropriate in this situation. The patient’s potassium level is already elevated, and administering additional potassium could lead to hyperkalemia, which can cause dangerous cardiac arrhythmias or even cardiac arrest. Therefore, this option should be avoided.

Choice D reason:

Calling the prescribing physician and informing her of the client’s serum potassium level results is the most appropriate action. The physician needs to be aware of the elevated potassium level to make an informed decision about the patient’s treatment plan. The physician may decide to withhold the potassium chloride, order additional tests, or take other actions to manage the patient’s potassium levels safely.