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 A
Explanation
Choice A rationale:
The nurse should advise the patient with chickenpox to avoid contact with pregnant women, immunocompromised individuals, newborns, and people who have not had chickenpox or been vaccinated. Chickenpox is highly contagious and can be severe or even life-threatening for vulnerable populations. This precaution helps protect those who are at a higher risk of complications from the infection.
Choice B rationale:
Sharing personal items such as towels and utensils should be avoided during chickenpox. Chickenpox spreads through respiratory droplets and direct contact with fluid from the blisters. Sharing personal items can increase the risk of transmission to others.
Choice C rationale:
It is not appropriate for the nurse to recommend scratching the chickenpox lesions. Scratching can lead to secondary bacterial infections and scarring. The patient should be encouraged to use methods like calamine lotion or antihistamines to relieve itching.
Choice D rationale:
The patient should not return to work or school until all lesions are crusted over and they are no longer contagious. Typically, this occurs about 6-7 days after the rash first appears. Returning too early can increase the risk of spreading the virus to others.
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