An older client is being screened for tuberculosis. The client's family questions why purified protein derivative (PPD) testing is done twice. Which of the following is the most appropriate response by the nurse?
1. "The treatment for TB is 6 months of medication, and we want to make sure the first PPD was done correctly prior to starting the medication.".
2. "Different medication is used in the second PPD.".
3. "The first PPD was not interpreted in the correct time frame of 48 to 72 hours.".
4. "The second PPD provides a more accurate reading because the older person's immune system may be sluggish and not adequately react to the first exposure.".
4. "The second PPD provides a more accurate reading because the older person's immune system may be sluggish and not adequately react to the first exposure.".
Rationale:
PPD testing is done in a 2-step process due to the slowing of the older adult's immune system response. Treatment for TB for 6 months is not a reason to complete the PPD twice. PPD testing is not done twice because different medication is used. Evaluating the test at the wrong interval is not the reason that the PPD is done twice on the elderly client.
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