The nurse evaluates the tuberculosis skin test results for the client who emigrated from Southeast Asia this month
Which result is consistent with the presence of tuberculosis antibodies in the client's system if the nurse reads the test 72 hours after injection? 1. Injection site is an 11-mm red, warm, swollen area.
2. Skin around the injection site is black, dry, and scaly.
3. Nurse palpates hard, dense, raised area 14 mm across.
4. Skin around injection site feels cool according to client.
3
3. A tuberculin skin test indicating the presence of antibodies results in a palpable, indurated area at the injection site greater than 10 mm in diameter for a recent immi-grant from Southeast Asia because many immigrants from that area are exposed to tuberculosis. In addition, tuberculosis immunizations are common in Southeast Asia; if a client is tested after receiving the tuberculosis vaccine, the intradermal skin test will always be positive. Clients with no know risk factors have a positive test with a 15-mm induration and an immunocompromised client has a positive test with a 5-mm induration.
1. This site is suspicious, but if it is not indurated, it does not indicate a positive re-sult.
2. Black, dry, scaly skin is consistent with necrotic tissue.
4. A cool sensation around the injection site after a tuberculin skin test is an unusual finding.
You might also like to view...
A client with a diagnosis of bipolar disorder lives with his family and discontinues taking medication when he begins feeling his symptoms are under control
Family members express their concern to the client's therapist whenever they realize the client is "off his meds." The therapist understands that within the client's family, each person's behavior is contingent on and: 1. Reflects the characteristics of the client's family. 2. Affects the behavior of others. 3. Is affected by the functionality of the group. 4. Is reflective of the client's mental illness.
A pregnant client with HIV receiving zidovudine asks the nurse why they will not test the newborn for HIV immediately after birth. Which response should the nurse provide?
A. "Since you are taking zidovudine, a test at birth will not be accurate." B. "The tests are much more accurate when your baby gets to be 1 week old." C. "Testing will continue until your baby is 1 year old." D. "The most sensitive test is the one done at 6 months of age."
Which description of a clinical pathway provided by a nursing student would indicate the best understanding of the concept?
1. Clinical pathways are tools to measure patient outcomes. 2. Clinical pathways are the same as nursing care plans. 3. Clinical pathways are developed to use in acute care settings and guide the nursing care of patients as they are admitted, treated, and discharged. 4. Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame.
How did Lillian Wald help encourage the idea of school nurses in the schools?
a. Active politically, she brought political pressure to bear on school boards. b. As a confidante of very wealthy women who persuaded their husbands to fund such positions. c. She demonstrated that school nurses decreased absenteeism by 50%. d. She used volunteer nurses until school boards were persuaded to fund such positions.