A client receives a tuberculin (PPD) skin test on Thursday at 1200. The nurse documents on the medication record that the results need to be read:

Sunday morning

Saturday morning

Friday morning

Monday morning

Answer and Explanation

The Correct Answer is A

The tuberculin skin test (TST), also known as the Mantoux test, is used to determine if a person has been infected with the tuberculosis (TB) bacteria. The test involves injecting a small amount of purified protein derivative (PPD) into the skin of the forearm. The injection site is then examined 48 to 72 hours later for a reaction, which is measured in millimeters of induration (swelling).

Choice A reason:

Sunday morning is the correct time to read the test results. Since the test was administered on Thursday at 1200, the 48 to 72-hour window for reading the results would fall between Saturday at 1200 and Monday at 1200. Reading the results on Sunday morning falls within this time frame, making it the appropriate choice.

Choice B reason:

Saturday morning is not the correct time to read the test results. Reading the test results on Saturday morning would be less than 48 hours after the test was administered, which is too early to accurately assess the reaction. The test needs to be read between 48 and 72 hours after administration to ensure accurate results.

Choice C reason:

Friday morning is also not the correct time to read the test results. Reading the test results on Friday morning would be only 24 hours after the test was administered, which is far too early. The immune response to the PPD injection takes time to develop, and reading the test too early can result in a false-negative result.

Choice D reason:

Monday morning is within the acceptable time frame to read the test results, but it is at the very end of the 72-hour window. While it is still technically correct, it is generally recommended to read the test closer to the 48-hour mark to ensure the most accurate results. Therefore, Sunday morning is a better choice.

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Correct Answer is A

Explanation

Choice A reason: The influenza vaccine and the pneumococcal pneumonia vaccine protect against different pathogens. The influenza vaccine protects against the flu virus, while the pneumococcal vaccine protects against Streptococcus pneumoniae, a common cause of bacterial pneumonia. It is important for individuals, especially those with chronic respiratory diseases, to receive both vaccines to reduce the risk of severe respiratory infections.

Choice B reason: Stating that the client is fully protected against both influenza and pneumonia with just the flu vaccine is incorrect. The flu vaccine does not provide protection against bacterial pneumonia caused by Streptococcus pneumoniae. Therefore, it is essential to receive the pneumococcal vaccine as well.

Choice C reason: While influenza can lead to secondary bacterial pneumonia, it is not accurate to say that influenza will cause pneumonia in many cases. The primary purpose of the influenza vaccine is to prevent the flu, not pneumonia. The pneumococcal vaccine specifically targets the bacteria that cause pneumonia.

Choice D reason: Suggesting that the client should get the pneumonia vaccine to prevent carrying the disease to others is not the most appropriate response. The primary reason for receiving the pneumococcal vaccine is to protect the individual from developing bacterial pneumonia, not just to prevent transmission.

A. Tachycardia. B. Decreased respirations. C. Malignant hyperthermia. D. Hypokalemia.

Correct Answer is C

Explanation

Choice A reason: Tachycardia, or an increased heart rate, can occur as a side effect of some anesthetic agents, particularly those that stimulate the sympathetic nervous system. However, it is not the most common or severe adverse effect associated with anesthesia.

Choice B reason: Decreased respirations, or respiratory depression, is a known side effect of many anesthetic agents, especially opioids and sedatives used during anesthesia. While significant, it is typically managed with careful monitoring and supportive measures.

Choice C reason: Malignant hyperthermia is a rare but life-threatening reaction to certain anesthetic agents, such as succinylcholine and volatile anesthetics. It is characterized by a rapid increase in body temperature and severe muscle contractions. Immediate treatment with dantrolene and supportive measures are crucial to manage this condition.

Choice D reason: Hypokalemia, or low potassium levels, is not commonly associated with anesthetic agents. It is more often related to other medical conditions or treatments, such as diuretic use or gastrointestinal losses.

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A client receives a tuberculin (PPD) skin test on Thursday at 1200. The nurse documents on the medication record that the results need to be read:

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Naxlex Comprehensive Predictor Exams

An older adult client with chronic respiratory disease tells the nurse it is unnecessary to receive the pneumococcal pneumonia vaccine because the influenza vaccine was just received two months ago. Which response by the nurse is most appropriate?

Correct Answer is A

Explanation

The nurse is aware that a common adverse effect of anesthetic agents experienced by the client is:

Correct Answer is C

Explanation

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