A client with suspected TB is undergoing a skin test. The nurse measures the induration at the injection site and finds it to be 10 mm. What does this result indicate?
Positive reaction, indicating active TB infection.
Negative reaction, indicating no TB infection.
Inconclusive result, requiring further testing.
Borderline reaction, suggesting a possible infection.
The Correct Answer is A
Choice A rationale:
A skin test result with an induration of 10 mm is considered positive in certain populations, indicating an active TB infection. These populations include people with known close contact with TB-infected individuals, HIV-positive individuals, recent immigrants from high-prevalence countries, and those with chest X-ray findings consistent with previous TB. The positive result means that the person has been exposed to the TB bacteria and has developed a delayed hypersensitivity reaction to the purified protein derivative (PPD) injected during the skin test.
Choice B rationale:
A negative reaction, indicating no TB infection, would typically be a skin induration of less than 5 mm. In this case, with an induration of 10 mm, a negative reaction can be ruled out.
Choice C rationale:
An induration of 10 mm is not considered an inconclusive result. Inconclusive results are usually associated with very small indurations or circumstances where there is uncertainty about the interpretation of the test.
Choice D rationale:
A borderline reaction is not typically associated with TB testing. Borderline reactions are less specific and are not commonly used to interpret the results of TB skin tests.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
This statement indicates the client understands the nurse's teaching about shingles. The client should avoid contact with pregnant women, immunocompromised individuals, newborns, and those who have not had chickenpox or been vaccinated against it. Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. Direct contact with shingles lesions can transmit the virus to susceptible individuals, leading to chickenpox in those who have not had it before.
Choice B rationale:
Direct contact with family members, especially if they are part of the vulnerable populations mentioned, should be avoided until the shingles lesions are crusted over. This is to prevent transmission of the virus to susceptible individuals.
Choice C rationale:
Respiratory hygiene is still important for individuals with shingles, even though the virus is primarily spread through contact with the lesions. Respiratory droplets can potentially transmit the virus to others, so it's essential to follow good hygiene practices.
Choice D rationale:
Sharing personal items should be avoided during shingles, as it can increase the risk of transmission to others who have not had chickenpox or been vaccinated.
Correct Answer is D
Explanation
Choice A rationale:
The Interferon-gamma release assay (IGRA) is another test used to detect TB infection. It measures the release of interferon-gamma by T-cells in response to TB antigens. However, in this question, the specific test described involves injecting tuberculin into the forearm, which is the characteristic of the TST, not the IGRA.
Choice B rationale:
Chest x-ray is not a test used to detect TB infection directly. It is useful for identifying active pulmonary TB, but it does not detect latent TB infection, which is what the tuberculin skin test is designed for.
Choice C rationale:
Sputum smear microscopy is a test used to diagnose active TB by examining sputum samples for acid-fast bacilli. It is not used for detecting latent TB infection, as the tuberculin skin test does.
Choice D rationale:
The tuberculin skin test (TST), also known as the Mantoux test, involves injecting a small amount of tuberculin into the forearm and then measuring the induration (localized swelling and redness) at the injection site after 48 to 72 hours. A positive TST result indicates exposure to TB but does not distinguish between latent TB infection and active TB disease.
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