A community health nurse is discussing advance directives with a client. The nurse should identify that which of the following statements made by the client indicates an understanding of the purpose of advance directives?

Choice A reason: The child has recent onset of urinary incontinence is a possible sign of maltreatment, as it may indicate sexual abuse, emotional trauma, or neglect. The school nurse should report this finding to the child protective services and follow up with the child and the family¹².

Choice B reason: The child receives free lunches at school is not a sign of maltreatment, but rather a socioeconomic indicator. The school nurse should not assume that the child is maltreated based on this factor alone, but rather assess the child for other signs and symptoms of abuse or neglect³.

Choice C reason: The child has bruises on both knees is not a sign of maltreatment, but rather a common injury among children who are active and playful. The school nurse should not report this finding unless there are other suspicious circumstances, such as inconsistent explanations, unusual locations, or patterns of bruises⁴.

Choice D reason: The child reports having a toothache is not a sign of maltreatment, but rather a health issue that may require dental care. The school nurse should not report this finding unless there are other signs of neglect, such as poor oral hygiene, lack of access to health care, or failure to follow up on referrals⁵.

Choice A reason: This is incorrect. Clostridium difficile is a bacterium that causes an infection of the colon, which can result in diarrhea, abdominal pain, and fever¹. Clostridium difficile is transmitted by contact with fecal matter or contaminated surfaces². Therefore, it requires contact precautions, not airborne precautions³.

Choice B reason: This is incorrect. Influenza is a viral infection that affects the respiratory tract, causing symptoms such as fever, cough, sore throat, and muscle aches⁴. Influenza is transmitted by respiratory droplets that are generated by coughing, sneezing, or talking⁵. Therefore, it requires droplet precautions, not airborne precautions³.

Choice C reason: This is correct. Disseminated herpes zoster is a widespread form of shingles that affects multiple areas of the skin and can involve the internal organs⁶. Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox⁷. Disseminated herpes zoster is transmitted by airborne particles that contain the virus, or by direct contact with the lesions⁶. Therefore, it requires airborne precautions, as well as contact precautions³.

Choice D reason: This is incorrect. Respiratory syncytial virus (RSV) is a common respiratory virus that causes mild to severe infections of the lungs and airways, especially in infants and young children⁸. RSV is transmitted by respiratory droplets, or by contact with contaminated surfaces or secretions⁹. Therefore, it requires contact precautions, and sometimes droplet precautions, but not airborne precautions³.