A nurse is providing discharge teaching to a client who has several new prescriptions.
For which of the following findings should the nurse consult a social worker?

Choice A rationale

While financial concerns are stressful, they represent a concrete problem to be solved and don't necessarily reflect a loss of personal agency or autonomy. This statement indicates worry about a specific external resource rather than a global feeling of powerlessness. The client retains control over how they manage their finances, even if the situation is challenging.

Choice B rationale

Expressing gratitude, or a perceived lack thereof, points toward an emotional or spiritual struggle. The client feels they are not meeting an internal standard, but this is a self-evaluation, not a statement of being controlled by external forces. They still have the ability to choose how they feel and how they express their emotions.

Choice C rationale

This statement reflects a spiritual or existential crisis, questioning the fairness of their situation. It is a search for meaning and a struggle with the concept of justice. The client is reflecting on past actions and their current circumstances, but this does not directly indicate a loss of control over their present life.

Choice D rationale

This statement directly addresses a lack of personal autonomy and agency. A feeling of "not having much say" is a direct expression of being controlled by external forces, which is a hallmark of the psychological experience of loss of control. This feeling is particularly common in terminal illness where the disease process dictates many outcomes.

Choice A rationale: Regulation of industrial pollution represents a primary prevention measure because it prevents harmful exposures before disease occurs. Airborne particulates, heavy metals like lead, and contaminated water from industrial discharge contribute to chronic respiratory disease, neurological impairment, and carcinogenesis. By addressing environmental hazards at their source, the nurse prevents the initial onset of illness across the population rather than intervening after disease develops, thus meeting the scientific definition of primary prevention at the community level.

Choice B rationale: Screening for health concerns such as elevated blood pressure, lead levels, or signs of abuse is classified as secondary prevention. This is because screening identifies disease at an early stage but does not prevent its occurrence. Normal blood pressure ranges are 90–120 mmHg systolic and 60–80 mmHg diastolic; detecting hypertension outside these limits is secondary rather than primary. Therefore, while scientifically beneficial, screening is not a primary prevention intervention.

Choice C rationale: Providing treatment for chronic conditions such as diabetes or hypertension falls under tertiary prevention. This strategy reduces complications, optimizes function, and delays progression of established illness but does not prevent disease onset. For example, diabetes management with insulin or hypertension management with antihypertensives reduces morbidity, yet the pathology already exists. As a result, this approach scientifically cannot be classified as primary prevention but instead as a tertiary, restorative intervention.

Choice D rationale: Implementing a school-based program on healthy relationships constitutes a primary prevention intervention because it aims to prevent intimate partner violence and unhealthy social patterns before they develop. Educational strategies modify risk factors by promoting protective behaviors in youth populations. Primary prevention focuses on avoiding the occurrence of violence, not detecting or treating it after occurrence. Therefore, this intervention is correctly categorized as primary prevention at the population level.

Choice E rationale: Providing information to leaders about creating a community garden represents a primary prevention activity because it addresses modifiable upstream determinants of chronic disease. Access to fruits and vegetables lowers the risk of hypertension, obesity, and type 2 diabetes. Normal fasting glucose should remain between 70–100 mg/dL, and diets high in processed foods elevate this risk. Community gardens improve nutrition access before illness develops, aligning with primary prevention science.

Choice F rationale: Assisting survivors in finding counseling represents tertiary prevention. At this stage, violence has already occurred, and counseling addresses the consequences to restore mental and emotional health. Tertiary prevention focuses on reducing long-term impacts rather than preventing the initial occurrence. Thus, while scientifically important for recovery and resilience, counseling does not fulfill the definition of primary prevention and is therefore not applicable as the correct answer here.

Choice G rationale: Requesting yearly water testing results is a secondary prevention measure. Surveillance identifies contaminants such as lead levels above the normal reference of less than 5 µg/dL in children but does not prevent the contamination from occurring. Monitoring allows early detection of exposure but still requires corrective action after the hazard is present. Therefore, this scientifically aligns with secondary prevention rather than primary prevention.