An adolescent boy is admitted to the emergency department (ED) following a bee sting. He arrives with a body rash and 30 minutes later he becomes short of breath. The nurse obtains vital signs with a blood pressure of 90/52 mm Hg, heart rate 130 beats/minute, and respiratory rate 40 breaths/minute. The client is exhibiting clinical manifestations of which type of immune reaction?

Choice A reason: Shouting increases volume but may distort speech, worsening comprehension for an older adult with hearing loss. Age-related presbycusis impairs high-frequency sound perception, and shouting can cause discomfort without improving clarity, making this an ineffective communication strategy for the client.

Choice B reason: Over-enunciating syllables may help slightly but can sound unnatural, confusing the client. It does not address the primary issue of processing speed in age-related hearing loss, where slower speech allows better auditory processing, making this less effective than reducing speaking speed.

Choice C reason: Decreasing speaking speed is best, as presbycusis slows auditory processing in older adults. Slower speech allows the client to process sounds clearly, improving comprehension without distortion, addressing the client’s difficulty hearing questions effectively and enhancing communication during the assessment.

Choice D reason: Exaggerating nonverbal expressions aids visual cues but does not address auditory comprehension. Hearing loss requires auditory adjustments, and nonverbal cues alone are insufficient for understanding spoken questions, making this less effective than slowing speech to improve verbal clarity.

Choice A reason: A positive PPD skin test indicates TB exposure but not active disease, as it detects immune response to TB antigens. False positives occur in vaccinated or previously exposed individuals, making it insufficient to confirm active TB, requiring sputum culture for definitive diagnosis.

Choice B reason: Chest x-ray or CT shows lung abnormalities suggestive of TB, like cavitary lesions, but is not confirmatory. Imaging supports diagnosis but cannot identify Mycobacterium tuberculosis, making sputum culture the gold standard for confirming active infection, as imaging lacks specificity.

Choice C reason: Sputum culture positive for Mycobacterium tuberculosis confirms TB, as it directly isolates the pathogen. This test identifies active infection with high specificity, distinguishing TB from other lung diseases, making it the definitive diagnostic tool to review for accurate diagnosis and treatment.

Choice D reason: Hemoccult test on sputum detects blood, indicating hemoptysis, a TB symptom, but not the pathogen. It does not confirm TB, as bleeding can occur in other conditions, making sputum culture essential for identifying Mycobacterium tuberculosis and confirming the diagnosis.