A client with emphysema is reporting difficulty breathing and exhibiting audible wheezing. The nurse administers albuterol as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate intervention by the nurse?

Choice A reason: Hemoccult tests detect blood in sputum, indicating hemoptysis, a TB symptom, but do not confirm Mycobacterium tuberculosis infection. Sputum culture is required for definitive diagnosis, as hemoccult only identifies bleeding, which is nonspecific and can occur in other respiratory conditions.

Choice B reason: Chest x-ray or CT scans show pulmonary abnormalities like cavitary lesions in TB but are not confirmatory. Radiographic findings suggest TB but require microbiological confirmation via sputum culture, as similar patterns occur in other lung diseases, making imaging supportive but not diagnostic.

Choice C reason: Sputum culture positive for Mycobacterium tuberculosis is the gold standard for TB diagnosis. It directly identifies the pathogen, confirming active infection. Other tests like skin tests or imaging are suggestive but not definitive, as they cannot distinguish active TB from latent or other conditions.

Choice D reason: A positive PPD skin test indicates TB exposure or latent infection but does not confirm active disease. False positives occur with prior BCG vaccination or nontuberculous mycobacteria. Sputum culture is needed to verify active TB, making the skin test less definitive.

Choice A reason: Increasing iron-rich foods (e.g., red meat, spinach) corrects anemia by boosting hemoglobin synthesis, as iron is essential for red blood cell production. This addresses the underlying deficiency, improving oxygen transport, making it the priority dietary recommendation for anemia management.

Choice B reason: Limiting vitamin C is incorrect, as it enhances iron absorption, aiding anemia correction. Iron-rich foods are the priority, as they directly supply the deficient nutrient, improving hemoglobin levels, making vitamin C restriction counterproductive to effective anemia treatment.

Choice C reason: Restricting green leafy vegetables, which are iron-rich, worsens anemia. These foods (e.g., spinach) provide dietary iron, essential for hemoglobin synthesis. Increasing iron intake is the priority, as it corrects the deficiency, making vegetable restriction inappropriate for anemia.

Choice D reason: Avoiding whole grains is irrelevant, as they provide nutrients supporting overall health. Iron-rich foods directly address anemia by supplying iron for red blood cell production, making them the priority dietary recommendation over grain restrictions, which do not impact anemia correction.