Question

While preparing to administer a PPD skin test, the nurse learns that the client received the BCG vaccine while she was living in a foreign country. What action should the nurse take? A. Obtain an order for a chest \(\mathrm{x}\)-ray B. Administer the PPD skin test C. Obtain a sputum specimen D. Request an order for isoniazid

Short answer

Answer: A. Obtain an order for a chest x-ray

Step-by-step solution

Understand the terms and main concepts

In this question, we need to understand what the PPD skin test and the BCG vaccine are, as well as the possible implications on the PPD test when a client has received the BCG vaccine. A PPD skin test (Purified Protein Derivative) is a test used to diagnose tuberculosis (TB) by injecting a small amount of tuberculin into the skin and observing the reaction after about 48-72 hours. The BCG vaccine is a vaccination against tuberculosis. It is often given in countries with a high prevalence of TB. However, one of the side effects of the BCG vaccine is that it can cause indeterminate or false positive PPD skin test results.

Understand the given options

Now that we understand the implications of the BCG vaccine on PPD tests, let's examine each available option: A. Obtain an order for a chest x-ray: This option is suggesting that instead of administering the PPD skin test, the nurse should request a different type of test to check for TB. Chest x-rays are often used to diagnose or rule out TB. B. Administer the PPD skin test: This option promotes conducting the PPD test despite knowing the client received a BCG vaccine, potentially resulting in false positive results. C. Obtain a sputum specimen: This option suggests collecting sputum from the client to do a sputum test, which may also be used in TB diagnosis. D. Request an order for isoniazid: Isoniazid is a medication used to treat TB infection. This option implies the client is already suspected to have TB and that the nurse should request an order for TB treatment.

Choose the correct answer

As stated before, the BCG vaccine may cause false-positive PPD skin test results. Therefore, administering the PPD test (option B) could lead to a false positive, which may not be the best course of action. Option D is not appropriate since it implies treating the client without proper diagnosis. Since the BCG vaccine may cause false-positive results on the PPD skin test, the best course of action is to obtain a different test, more reliable in this situation, for TB diagnosis. Chest x-rays (option A) and sputum tests (option C) are other diagnostic tools for TB. Among these two, the chest x-ray is better as the first step in diagnosing TB in individuals with prior BCG vaccination. Sputum tests are typically conducted after an abnormal chest x-ray raises suspicion of TB. Thus, the correct answer is: A. Obtain an order for a chest x-ray