A mother brings her newly adopted non-English-speaking 8-year-old daughter to the clinic for follow-up after a complete physical and immunizations before starting school. The child's tuberculin skin test results in redness and induration of 12 mm
Which response by the nurse is best?
A.
Ask the mother what country the child was adopted from.
B.
Give the child a mask to wear while in the clinic.
C.
Instruct the mother on directly observed TB therapy.
D.
Tell the mother the result does not show tuberculosis.
ANS: D
An induration of 10 mm or more is a positive result in children under 4 years of age, so this result is not diagnostic for TB in an 8-year-old child. Knowing what country the child was from originally might provide useful information because if the child received bacille Calmette-Guerin vaccine for TB (common in some foreign countries) the skin test results will be inaccurate. However, the nurse would need to know which countries use the vaccine in order for this information to be useful. Because the result is not positive for TB, the child does not need to wear a mask, nor does the mother need instruction on directly observed therapy.
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