A nurse is assessing a client who received a purified protein derivative (PPD) skin test 48 hr ago and notes erythema with induration of 12 mm at the injection site. Which of the following instructions should the nurse provide to the client?

"You will need to have the skin test annually."

"You will need to follow up with your provider."

"You will need to return in 48 hours for re-evaluation."

"Your test will need to be repeated at this time."

Answer and Explanation

The Correct Answer is B

B. The client's PPD skin test result of 12 mm induration is considered positive for individuals who are at increased risk of tuberculosis, such as those with recent exposure to tuberculosis or immunocompromised individuals. A positive PPD result typically requires follow-up with a healthcare provider for further evaluation, which may include chest X-rays, sputum cultures, and treatment for latent tuberculosis infection if indicated.
A. Annual PPD testing may be indicated for certain populations, such as healthcare workers or individuals at high risk of exposure to tuberculosis. However, the decision to repeat the PPD test annually should be based on individual risk factors and healthcare provider recommendations.
C. The PPD skin test is typically read 48-72 hours after administration to assess for induration.
D. A PPD skin test result of 12 mm induration is considered positive for individuals at increased risk of tuberculosis, but it does not necessarily indicate that the test needs to be repeated immediately.

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Correct Answer is D

Explanation

D. Propofol is an emulsion formulation that contains egg lecithin as an ingredient. Therefore, individuals with an egg allergy may be at risk for allergic reactions to propofol. It is essential for the nurse to identify any egg allergies in preoperative clients to prevent potential adverse reactions to propofol.
A. Propofol is not derived from strawberries, and there is no cross-reactivity between propofol and strawberries.
B. While shellfish allergies are common, there is no known cross-reactivity between shellfish and propofol.
C. Avocado allergy is not associated with potential reactions to propofol.

A. Initiate IV fluid replacement. B. Measure the client's urinary output. C. Administer insulin. D. Teach the client about manifestations of HHS

Correct Answer is A

Explanation

A. Initiate IV fluid replacement is the highest priority intervention. HHS is characterized by severe dehydration due to osmotic diuresis resulting from hyperglycemia. IV fluid replacement is essential to correct dehydration and restore intravascular volume, which can help improve tissue perfusion and prevent further complications.
B. Monitoring urinary output is important in assessing renal function and response to fluid replacement therapy. However, it is not the highest priority intervention.
C. While insulin therapy is an essential part of managing hyperglycemia in HHS, it is not the highest priority intervention at the immediate onset of HHS.

D. Patient education about the manifestations and management of HHS is important for long-term management and prevention of recurrence. However, it is not the highest priority when the client is experiencing an acute episode of HHS.

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A nurse is assessing a client who received a purified protein derivative (PPD) skin test 48 hr ago and notes erythema with induration of 12 mm at the injection site. Which of the following instructions should the nurse provide to the client?

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Naxlex Comprehensive Predictor Exams

A nurse is asking a preoperative client about food allergies. Which of the following food allergies indicates a potential reaction to propofol?

Correct Answer is D

Explanation

A nurse is caring for a client who has a new onset of hyperglycemic hyperosmolar state (HHS). Which of the following interventions by the nurse is the highest priority?

Correct Answer is A

Explanation

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