During a home health visit, a school-age child who has muscular dystrophy confides in the nurse that he was struck by his parents. Which of the following actions should the nurse take first?

Choice A reason: Arranging for Meals on Wheels assistance is not the priority action, as it does not address the underlying issue of the client's partner's refusal to help with feeding. Meals on Wheels may also not be suitable for the client's dietary needs and preferences.

Choice B reason: Determining the client's ability to self-feed is the priority action, as it will help the nurse assess the client's nutritional status and needs, as well as the level of support required from the partner or other caregivers. The nurse can also educate the partner on the importance of adequate nutrition and hydration for the client, and provide strategies to facilitate feeding.

Choice C reason: Directing the home health aide to assist with meals is not the priority action, as it may not be feasible or acceptable to the client or the partner. The home health aide may also not have the skills or training to assist with feeding a client with Alzheimer's disease.

Choice D reason: Referring the client's partner to an Alzheimer's support group is not the priority action, as it does not address the immediate problem of the client's lack of eating. However, it may be a helpful intervention in the long term, as it can provide the partner with emotional support, education, and resources to cope with the challenges of caring for a client with Alzheimer's disease.

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.