Question

A nurse in a community center is preparing to administer a tuberculin skin test to multiple clients to screen for TB. Which action should the nurse take?

a. Inject 0.1mL of purified protein derivative
b. Advocacy
c. the need for the program
d. Child maltreatment is more common in homes where partner violence is present

Answer 1

The nurse should inject 0.1mL of purified protein derivative as part of the tuberculin skin test. This test assesses exposure to tuberculosis through a delayed hypersensitivity reaction, with a positive result indicating an immune response to the bacterium. BCG vaccination could cause false-positive results.

Step-by-step explanation:

A nurse preparing to administer a tuberculin skin test should take the action of injecting 0.1mL of purified protein derivative into the skin of the clients. The injection should produce a raised wheal initially, and the test must be read within 48-72 hours. A positive result is indicated by redness, swelling, or hardness; the size of the responding region is measured to determine the final result.

The tuberculin skin test uses bacterial proteins from Mycobacterium tuberculosis to test for delayed hypersensitivity. A positive result indicates that the patient has been exposed to the bacteria and has a cellular immune response against it. However, in areas where the BCG vaccine is used, a positive tuberculin skin test might reflect prior vaccination rather than an active infection.