A nurse is working to reduce individual and family violence in the local community. Which of the following actions by the nurse is an example of tertiary prevention?

A. Shut the doors and windows of the room: Closing doors and windows helps to contain the fire and reduce the spread of smoke. However, this should be done only after ensuring the immediate safety of the client, as human life always takes precedence over property or containment.

B. Activate the alarm: Activating the fire alarm alerts others to the danger and initiates the facility’s fire response plan. While essential, it is not the first action if a client’s life is at immediate risk due to proximity to the fire.

C. Move the client to another location: Client safety is the highest priority in any emergency. The nurse should immediately remove the client from the danger area before addressing containment or notification steps. This action aligns with the “Rescue” step of the RACE (Rescue, Alarm, Contain, Extinguish) protocol.

D. Attempt to extinguish the fire: Using a fire extinguisher is appropriate only if the nurse has been trained and the fire is small and manageable. However, it is not the priority when a client is present and at risk, as attempting to extinguish the fire could delay evacuation and jeopardize safety.

Rationale for Correct Choices:

• Teach healthcare workers how to distinguish the disease from chickenpox: Smallpox and chickenpox may initially present with similar rash-like symptoms. Rapid and accurate recognition by healthcare workers is critical to implement isolation protocols and prevent further transmission in a bioterrorism event.
• Vaccinate laboratory workers against the disease: Laboratory workers who may handle specimens suspected of containing smallpox virus are at high occupational risk. Pre-exposure vaccination is appropriate for these individuals to protect them during diagnostic and investigative procedures.

Rationale for Incorrect Choices:

• Obtain standing orders to treat infected individuals with ciprofloxacin: Ciprofloxacin is not effective against smallpox, which is caused by a virus. Using an antibiotic would not provide benefit unless there were bacterial complications. The preferred antiviral agent for smallpox is tecovirimat (TPOXX).
• Perform routine screening to identify infected animals: Smallpox does not occur in animals; it has no animal reservoir. Screening animals would not contribute to disease surveillance or prevention and is not a necessary step in smallpox preparedness.
• Implement routine vaccination for the disease for the general public population: Routine smallpox vaccination was stopped decades ago after global eradication. In a bioterrorism scenario, targeted vaccination (ring vaccination) would be used rather than mass immunization.