Community / public health nursing · practice question

The school nurse during a vaccination clinic is being evaluated for risk related to tertiary prevention. Assessment data include a neighborhood screening event identifies multiple clients with blood pressure above 180/100 mm Hg. Which action should the nurse take first?

Multiple choiceEasynclex-rn-bsnnclex-validatednclex-2026community-public-health

Administer the next scheduled intervention before reassessing the client.Assess airway, breathing, and circulation; address immediate safety risk; then notify the provider per protocol.Complete all remaining scheduled tasks before reassessing the client.Offer a warm blanket and reschedule assessment until after lunch.

Answer and explanation

Correct answer

B. Assess airway, breathing, and circulation; address immediate safety risk; then notify the provider per protocol.

Why

NCLEX priority questions require stabilizing the client first using ABCs and focused assessment before comfort measures, documentation only, or delayed escalation.

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The school nurse during a vaccination clinic is being evaluated for risk related to tertiary prevention. Assessment data include a neighborhood screening event identifies multiple clients with blood pressure above 180/100 mm Hg. Which action should the nurse take first?

Correct answer

Why

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