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A nurse is reading a tuberculin skin test for a client who received a purified protein derivative test 72 hr ago. Which of the following findings indicates a positive test?

A reddened area measuring 10 mm

A reddened area measuring 5 mm

An induration measuring 5 mm

An induration measuring 10 mm

Answer and Explanation

The Correct Answer is D

A. A reddened area without induration is not a positive result.

B. A reddened area without induration is not considered positive.

C. An induration of 5 mm is positive only for high-risk groups (e.g., immunocompromised clients).

D. An induration measuring 10 mm is considered positive in most adults, indicating TB exposure.

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Correct Answer is D

Explanation

A. Steatorrhea (fatty stools) is not typically associated with pneumonia; it is more commonly linked to gastrointestinal disorders.

B. Tinnitus (ringing in the ears) is not a common symptom of pneumonia but may be related to ear infections or other conditions.

C. Dysphagia (difficulty swallowing) is not typically a hallmark symptom of pneumonia, though it can occur in severe cases if there is aspiration.

D. Fever is a common symptom of bacterial pneumonia due to the body’s response to infection.

A. "What has helped you through difficult times in the past?" B. "Has anyone in your family committed suicide?" C. "Are you thinking about ending your life?" D. "Is there anyone you would like involved in your care?"

Correct Answer is C

Explanation

A. "What has helped you through difficult times in the past?": Important but not the priority in a potential crisis.

B. "Has anyone in your family committed suicide?": Relevant but not the first question.

C. "Are you thinking about ending your life?": Directly assesses the client's safety and risk for suicide.

D. "Is there anyone you would like involved in your care?": Supports coping but is not urgent.

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A nurse is reading a tuberculin skin test for a client who received a purified protein derivative test 72 hr ago. Which of the following findings indicates a positive test?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

A nurse is caring for a client whose child died from cancer. The client states, "It's hard to go on without him." Which of the following questions should the nurse ask the client first?

Correct Answer is C

Explanation

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