The nurse is preparing for an initial home care visit for a client with diabetes. Which action by the nurse is appropriate? SELECT ALL THAT APPLY

Choice A reason: Discipline in the school setting for improper handwashing is not an appropriate action by the nurse, as it may not prevent the spread of influenza or promote healthy behaviors. Influenza is a viral infection that affects the respiratory system and can be transmitted by direct or indirect contact with respiratory droplets from an infected person. Handwashing is one of the most effective ways to prevent the transmission of influenza and other infectious diseases, but it requires proper technique, frequency, and duration. The nurse should not punish or blame the students for their handwashing habits but rather educate and encourage them to wash their hands with soap and water for at least 20 seconds, especially before and after eating, after using the bathroom, after coughing or sneezing, and after touching potentially contaminated surfaces.

Choice B reason: Education regarding respiratory and hand hygiene is an appropriate action by the nurse, as it helps to prevent the spread of influenza and promote healthy behaviors. The nurse should provide accurate and relevant information to the students, staff, and parents about the causes, symptoms, prevention, and treatment of influenza. The nurse should also teach and demonstrate proper respiratory and hand hygiene practices, such as covering the mouth and nose with a tissue or elbow when coughing or sneezing, disposing of used tissues in a trash can, washing hands frequently with soap and water or using alcohol-based hand sanitizer, avoiding touching the eyes, nose, and mouth, and staying away from sick people.

Choice C reason: Running a mandatory flu clinic is not an appropriate action by the nurse, as it may not be feasible, ethical, or effective in preventing influenza. Influenza vaccination is one of the best ways to prevent influenza and its complications, but it requires informed consent, adequate supply, trained personnel, and appropriate timing. The nurse cannot force or coerce anyone to receive the flu vaccine without their permission or against their wishes. The nurse should respect the autonomy and preferences of the students, staff, and parents, and provide them with evidence-based information about the benefits and risks of influenza vaccination. The nurse should also collaborate with the health department and other community partners to organize voluntary flu clinics that are accessible, affordable, and convenient for those who want to receive the vaccine.

Choice D reason: Closing the school for 6 weeks is not an appropriate action by the nurse, as it may not be necessary, practical, or beneficial in preventing influenza. Influenza outbreaks can vary in severity, duration, and impact depending on several factors, such as the strain of the virus, the level of immunity in the population, the availability of vaccines and antiviral medications, and the implementation of preventive measures. The nurse should monitor the situation closely and follow the guidance of the health authorities regarding school closure decisions. The nurse should also consider the potential consequences of school closure on the student's education, socialization, nutrition, safety, and mental health. The nurse should weigh the benefits and harms of school closure against other alternatives, such as increasing ventilation, cleaning and disinfecting surfaces, screening for symptoms, isolating sick students or staff members, reducing class size or mixing groups.

Choice A reason: Administering an antipyretic is not the next action that the nurse should initiate. An antipyretic is a medication that lowers fever, which is a common symptom of meningococcal meningitis. However, fever is not a life-threatening condition, and it may have some beneficial effects on fighting infection. The nurse should first prioritize other actions that are more urgent or critical for the client's safety and outcome.

Choice B reason: Decreasing environmental stimuli is not the next action that the nurse should initiate. Decreasing environmental stimuli is a nursing intervention that can help reduce agitation, confusion, or seizures in clients with meningococcal meningitis. However, it is not an immediate or essential action, and it may not be effective if the client's condition worsens or progresses to coma.

Choice C reason: Assessing the cranial nerves is the next action that the nurse should initiate. Cranial nerve assessment is a neurological examination that evaluates the function of 12 pairs of nerves that originate from the brainstem and control various sensory and motor functions, such as vision, hearing, smell, taste, facial expression, eye movement, swallowing, speech, and balance. Meningococcal meningitis is an inflammation of the meninges, which are the membranes that cover and protect the brain and spinal cord. Meningeal inflammation can compress or damage the cranial nerves, causing various signs and symptoms, such as headache, photophobia, diplopia, facial palsy, dysphagia, dysarthria, or nystagmus. Assessing the cranial nerves can help detect any neurological deficits or complications early, and guide appropriate interventions or referrals.

Choice D reason: Completing a vascular assessment is not the next action that the nurse should initiate. A vascular assessment is a physical examination that evaluates the blood flow and circulation in different parts of the body, such as the arms, legs, abdomen, or neck. It may include checking pulses, blood pressure, capillary refill, skin color, temperature, or edema. A vascular assessment may be relevant for some clients with meningococcal meningitis who develop septic shock or disseminated intravascular coagulation (DIC), which are serious conditions that affect blood vessels and clotting factors. However, these are not common or early manifestations of meningococcal meningitis, and they require more advanced or specialized assessments and treatments.