A school nurse is examining the family history of a school-age child who has fractured their ulna for the second time. Which of the following findings place the child at risk for child abuse? (Select all that apply.)

Choice A rationale: Primary prevention: smoking cessation reduces risk before disease onset through behavior modification, nicotine dependence treatment, and health education. It does not involve screening or early detection characteristic of secondary prevention.

Choice B rationale: Tertiary prevention: referral aids rehabilitation, relapse prevention, and functional recovery after established disorder. Emphasizes reducing complications and improving life quality, not early detection or screening characteristic of secondary prevention measures.

Choice C rationale: Secondary prevention: prenatal care conducts screening and early detection of maternal–fetal complications, enabling interventions to limit progression and improve outcomes. This focuses on detection, not education typical of primary prevention.

Choice D rationale: Primary prevention: advocating anti-texting laws targets upstream determinants to prevent injuries before occurrence by reducing distracted driving risk. This is policy, not screening or early detection characteristic of secondary prevention.

Choice A rationale

Discussing the risks of being homeless with the client is an important part of understanding their situation, but it is not the nurse’s initial action when caring for a client who is homeless. The nurse’s initial action should be to establish trust and understand the client’s perspective.

Choice B rationale

This is the correct answer. Determining the client’s understanding of their living situation is the nurse’s initial action when caring for a client who is homeless. This helps the nurse to understand the client’s perspective and to tailor care to meet the client’s unique needs.

Choice C rationale

Assisting the client to develop goals for obtaining shelter is an important part of the care plan for a client who is homeless, but it is not the nurse’s initial action. The nurse’s initial action should be to establish trust and understand the client’s perspective.

Choice D rationale

Developing client teaching using a variety of strategies is an important part of nursing care, but it is not the nurse’s initial action when caring for a client who is homeless. The nurse’s initial action should be to establish trust and understand the client’s perspective.