A home health nurse is scheduled for a first time visit to a client. Which of the following should the nurse perform first?

Choice A reason: One dose of the immunization does not give children lifelong protection from hepatitis B. The immunization requires a series of three or four doses, depending on the vaccine type, to provide long-term immunity. The first dose is usually given at birth, followed by the second dose at 1 to 2 months of age, and the third dose at 6 to 18 months of age. Some children may need a fourth dose at 4 to 6 years of age.

Choice B reason: Hepatitis B does not spread easily among children through casual contact. Hepatitis B is a blood-borne infection that is transmitted through exposure to infected blood or body fluids, such as through sexual contact, sharing needles, or from mother to child during birth. Casual contact, such as hugging, kissing, or sharing food, does not pose a risk of transmission.

Choice C reason: Many people who acquire acute hepatitis B develop chronic hepatitis. Chronic hepatitis is a condition where the infection persists for more than six months and causes inflammation and scarring of the liver. Chronic hepatitis can lead to serious complications, such as cirrhosis, liver failure, or liver cancer. About 90% of infants, 25% to 50% of children aged 1 to 5 years, and 5% to 10% of adults who get infected with hepatitis B will develop chronic hepatitis.

Choice D reason: People who have had a hepatitis B infection do not need the immunization. The immunization is only effective in preventing the infection, not treating it. People who have had a hepatitis B infection will develop natural immunity, which means they will not get infected again. However, they should still be monitored for any signs of liver damage or complications.

Choice A reason: Determining the client's understanding of her living situation is the first action that the nurse should take. This is based on the principle of client-centered care, which states that the nurse should respect the client's values, preferences, and needs, and involve the client in the decision-making process. The nurse should assess the client's perception of her homelessness, the factors that contributed to it, and the resources that are available to her.

Choice B reason: Assisting the client to develop goals for obtaining shelter is not the first action that the nurse should take. This is an important intervention, but it should be done after the nurse has assessed the client's understanding of her living situation and explored the client's readiness and motivation to change.

Choice C reason: Discussing the risks of being homeless with the client is not the first action that the nurse should take. This is an important intervention, but it should be done after the nurse has assessed the client's understanding of her living situation and established a trusting relationship with the client. The nurse should avoid being judgmental or paternalistic, and instead use a harm reduction approach that focuses on minimizing the negative consequences of homelessness.

Choice D reason: Developing client teaching using a variety of strategies is not the first action that the nurse should take. This is an important intervention, but it should be done after the nurse has assessed the client's understanding of her living situation and identified the client's learning needs and preferences. The nurse should use strategies that are appropriate for the client's literacy level, language, culture, and cognitive ability.