A public health nurse is planning strategies to address substance use for clients in the community. Which of the following strategies are part of primary health promotion and prevention?

A. Vital signs. The client has a significantly elevated heart rate (110/min) and elevated blood pressure (178/82 mm Hg), both of which can be associated with autonomic responses in dumping syndrome. The dizziness and desire to lie down after eating are also classic symptoms. These signs reflect the body’s reaction to rapid gastric emptying and fluid shifts.
B. Prescribed diet. While a bland, soft diet is generally safe post-gastrectomy, it may not prevent dumping syndrome unless it includes specific modifications like low carbohydrate intake and small, frequent meals. However, this option alone does not directly indicate dumping syndrome.
C. Skin appearance. The client is noted to be diaphoretic and pale, which are common symptoms of dumping syndrome due to the vasomotor response and hypoglycemia that can follow rapid gastric emptying.
D. Blood glucose level. The client's fasting blood glucose dropped to 65 mg/dL, which is below the normal range. Hypoglycemia is a hallmark of late dumping syndrome, resulting from excessive insulin release after rapid carbohydrate absorption in the small intestine.
E. WBC count. The WBC count is within normal range (9,000/mm³) and does not indicate dumping syndrome or an infectious process. It is not relevant in this context.

A. Premature atrial complexes. These are early electrical impulses originating in the atria that cause premature heartbeats, but they do not consistently lengthen the P-R interval. The P-R interval usually remains within normal limits unless another condition is present.
B. First-degree atrioventricular (AV) block. A constant P-R interval longer than 0.20 seconds (normal range: 0.12–0.20 seconds) is characteristic of a first-degree AV block. A P-R interval of 0.35 seconds indicates a prolonged conduction delay through the AV node, consistent with this dysrhythmia.
C. Complete heart block. In complete (third-degree) heart block, there is no consistent relationship between P waves and QRS complexes, and the P-R interval is not constant. This is not consistent with a stable, prolonged P-R interval.
D. Atrial fibrillation. Atrial fibrillation is marked by irregularly irregular rhythm and absent, unidentifiable P waves, not a consistent P-R interval. The atria are quivering, not contracting in a coordinated way.