A client comes to the public health clinic requesting information about which immunizations to receive prior to visiting a developing nation. Which immunization should the nurse recommend as a priority for this client?

A) Smoking cessation:
Smoking cessation is a crucial preventive measure and is considered a primary prevention strategy to reduce the risk of developing smoking-related diseases. However, for a middle-aged client who already has health issues such as obesity or hypertension, secondary prevention focuses on early detection and management of conditions that have already developed or are at high risk of developing.

B) Compliance with antihypertensive and lipid-lowering agents:
While compliance with medication is essential for managing existing conditions such as hypertension or dyslipidemia, it is not a secondary prevention measure in itself. Secondary prevention is focused on screening and early detection of health issues before they progress further.

C) Blood pressure and lipid screening:
Blood pressure and lipid screening are appropriate secondary prevention measures for this client. Secondary prevention involves identifying and managing health conditions early to prevent progression or complications. Given the client’s smoking history, weight, and potential risk for cardiovascular issues, regular screening for blood pressure and lipid levels helps detect any developing issues early, allowing for timely intervention.

D) Increase physical activity and diet low in saturated fat:
Increasing physical activity and adopting a diet low in saturated fat are important lifestyle changes for overall health and primary prevention of chronic diseases. However, in the context of secondary prevention, where the focus is on monitoring and managing existing risk factors or health conditions, screening measures like blood pressure and lipid testing are more directly relevant.

A) Obtain a restraining order against the father:
Obtaining a restraining order is a legal action that can be taken to protect the child but is not typically within the scope of the nurse’s immediate responsibilities. This action would involve law enforcement and the legal system rather than being an immediate next step in the healthcare setting. The nurse's role is to report the suspected abuse and ensure that appropriate protective services are involved.

B) Encourage the mother to file a police report:
Encouraging the mother to file a police report is a potential step in addressing the situation, but it should not be the nurse's immediate next action. The nurse's primary responsibility is to ensure that the appropriate child protective services are notified and involved, as they are equipped to handle investigations and interventions in cases of suspected child abuse.

C) Ask the child if his father ever spanks him:
Asking the child about specific forms of discipline, such as spanking, could potentially place the child in a difficult or unsafe position, especially if abuse is suspected. It is not the nurse's role to investigate or interrogate the child directly. Instead, the focus should be on ensuring that the proper authorities are notified to handle the investigation.

D) Refer the family to protective service agencies:
Referring the family to protective service agencies is the most appropriate next step. These agencies are specialized in handling cases of suspected abuse and can provide the necessary intervention and support for the child’s safety and well-being. The nurse's role includes reporting suspected abuse to the appropriate authorities and ensuring that protective services are contacted to investigate and address the situation.