A nurse is planning to administer a tuberculin skin test to a client who has had an exposure to tuberculosis. Which of the following actions should the nurse plan to take?
Select an injection site that is free of scar tissue.
Massage the site following the injection.
Hold the needle at a 30 angle during injection
Inject 0.3 to 0.5 mL of the solution.
The Correct Answer is A
A. When administering a TST, the nurse should select an injection site that is free of scar tissue and areas with excessive hair, veins, or visible lesions. The preferred site for TST administration is the volar aspect of the forearm, approximately 2-4 inches below the elbow.
B. After administering the TST, the nurse should not massage or manipulate the injection site. Massaging the site can cause irritation or spread the solution, leading to inaccurate results.
C. he TST is administered intradermally, typically with a 27-gauge needle. The needle should be inserted with the bevel facing upward at a 5-15-degree angle.
D. The standard dose of tuberculin solution (e.g., purified protein derivative, PPD) for a TST is 0.1 mL containing 5 tuberculin units (TU).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Sitting upright after taking the medication is not a standard recommendation.
B. Sustained-release verapamil tablets should not be crushed, chewed, or broken. Crushing a sustained- release tablet can disrupt the extended-release mechanism, leading to an immediate release of the entire dose, which can increase the risk of adverse effects and toxicity.
C. While monitoring is essential for some medications, anemia is not a specific concern related to sustained-release verapamil.
D. Verapamil has been reported to cause constipation as a side effect. This is one of the most commonly reported side effects of verapamil. It is suggested that this effect may be due to a delay in colonic transit.
Correct Answer is A
Explanation
A. Furosemide can decrease the renal clearance of lithium, leading to increased lithium levels in the blood. This can potentiate the toxic effects of lithium, such as neurotoxicity and cardiac toxicity. Therefore, concurrent use of furosemide and lithium is generally contraindicated, and caution is advised. The nurse should identify lithium carbonate as contraindicated in this scenario.
B. Albuterol is a bronchodilator commonly used to treat respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). There are no significant contraindications between albuterol and furosemide.
C. Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. There are no significant contraindications between levothyroxine and furosemide.
D. Cetirizine is an antihistamine used to treat allergies and allergic reactions. There are no significant contraindications between cetirizine and furosemide. They are generally considered safe to use together.
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