A nurse is preparing a client for intradermal tuberculin skin testing (TST). Which of the following statements should the nurse make?
“An indurated area of 4 millimeters indicates a positive result.”.
“The injection site will be evaluated within 24 hours.”.
“A positive result does not always indicate active disease.”.
“The test will not be administered if you have had a previous negative result.”. .
The Correct Answer is C
Choice A rationale
An indurated area of 4 millimeters is not considered a positive result for tuberculin skin testing. The size of induration considered positive varies based on the individual’s risk factors and health status.
Choice B rationale
The injection site for a tuberculin skin test should be evaluated between 48 and 72 hours after administration, not within 24 hours. Evaluating it too early may not provide accurate results.
Choice C rationale
A positive result in a tuberculin skin test indicates that the person has been infected with TB bacteria, but it does not necessarily mean they have active TB disease. Further tests are needed to determine if the disease is active.
Choice D rationale
A previous negative result does not preclude the administration of a new tuberculin skin test. Individuals can be retested if there is a new risk of exposure or if it is required for medical or occupational reasons.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A high protein diet is not recommended for clients with biliary colic from chronic cholecystitis as it can increase bile production and exacerbate symptoms.
Choice B rationale
A high fiber diet is beneficial for overall health but does not specifically address the needs of clients with biliary colic.
Choice C rationale
A low sodium diet is beneficial for overall health but does not specifically address the needs of clients with biliary colic.
Choice D rationale
A low fat diet is recommended for clients with biliary colic from chronic cholecystitis as it reduces the workload on the gallbladder and decreases the risk of gallstone formation.
Correct Answer is A
Explanation
Choice A rationale
A high-purine diet is a known risk factor for urolithiasis (kidney stones). Purines are broken down into uric acid, which can form crystals and stones in the kidneys.
Choice B rationale
Low levels of serum calcium are not a risk factor for urolithiasis. In fact, high levels of calcium in the urine (hypercalciuria) are more commonly associated with kidney stones.
Choice C rationale
Female gender is not a significant risk factor for urolithiasis. Men are generally more likely to develop kidney stones than women.
Choice D rationale
Drinking large quantities of fluids is not a risk factor for urolithiasis. In fact, adequate hydration is recommended to help prevent the formation of kidney stones.
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