A nurse is caring for several clients at a community clinic. Which of the following clients is most at risk for developing type 2 diabetes mellitus?

Choice A Reason:
A 10 mm wheal is not indicative of TB infection. A wheal is a raised, often itchy area of skin that usually signifies an allergic reaction, not an infection. The TST looks for induration, which is a firm swelling, as a sign of TB infection.

Choice B Reason:
A 5 mm induration is considered positive in certain high-risk groups, such as people living with HIV, recent contacts of TB patients, or those with a history of organ transplants. For individuals without these risk factors, a 5 mm induration is not considered a positive result.

Choice C Reason:
A 15 mm induration is considered a positive TST result for individuals with no known risk factors for TB. This indicates that the person's immune system has reacted to the tuberculin purified protein derivative (PPD) injected under the skin, suggesting exposure to TB bacteria.

Choice D Reason:
Erythema, or redness of the skin, is not measured when interpreting TST results. The test measures induration, which is a palpable, raised, hardened area or swelling. Therefore, a 4 mm erythema does not indicate TB infection.

Choice A reason:
Advising to avoid exercise during flare-ups of fibromyalgia can be beneficial. During flare-ups, symptoms such as muscle pain and fatigue are heightened, and rest may be necessary. However, gentle exercises like stretching or water aerobics might still be recommended to maintain muscle flexibility and strength.

Choice B reason:
Establishing a regular sleep pattern is crucial for managing fibromyalgia. Sleep disturbances are common in fibromyalgia, and poor sleep can exacerbate pain and fatigue. Good sleep hygiene, including a consistent sleep schedule and a comfortable sleep environment, can help improve sleep quality and overall symptom management.

Choice C reason:
While regular exercise is important in managing fibromyalgia, jogging or running may not be suitable for all individuals, especially during periods between flare-ups. Low-impact exercises are generally recommended to reduce stress on the joints and muscles.

Choice D reason:
There is no specific recommendation to increase calcium intake as a self-care strategy for fibromyalgia. While maintaining a balanced diet is important, there is no direct link between calcium intake and fibromyalgia symptom management.