The nurse is preparing to read the Mantoux tuberculin skin test placed on the forearm of a patient with HIV. Which finding should the nurse report as a positive test for this patient?
a. 2 mm
b. 3 mm
c. 4 mm
d. 5 mm
ANS: D
Mantoux tuberculin skin test (TST) with tuberculin purified protein derivative should be performed at least yearly in patients with HIV infection. Induration of 5 mm or more is defined as a positive result in patients with HIV infection. A. B. C. D. Induration of less than 5 mm is not a positive test.
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Assessment of altered skin integrity in the preterm infant is made difficult because of the immature immune system that cannot produce a(n) __________ reaction
ANS:
While caring for a patient who is receiving oxygen therapy for pneumonia, what should the nurse assess to determine if the patient is hypoxic?
A) Restlessness B) Cold hands C) Confusion D) Noncompliance
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights
" The nurse should perform which action based on this assessment? a. Check the patient for other symptoms of digitalis toxicity. b. Withhold the next dose of furosemide. c. Continue to monitor the patient for heart failure. d. Document the findings and reassess in 1 hour.
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past
What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."