The nurse reading a tuberculin skin test (TST) on a new employee who lives in the Midwest, is 20-years-old, and has no known history of contact with any people with tuberculosis (TB). The nurse should interpret the reading as positive if the area around the injection site has an induration of how many millimeters?

Correct Answer: D

Rationale: The correct answer is D (15 mm) because for a low-risk individual like the new employee, a TST is considered positive if the induration is 15 mm or greater. This is based on the guidelines from the Centers for Disease Control and Prevention (CDC) for interpreting TST results in individuals without known risk factors. Choices A, B, and C are incorrect because an induration of 0 mm, 5 mm, or 10 mm, respectively, would not meet the criteria for a positive TST in this low-risk individual. It is important to consider the individual's risk factors and follow established guidelines to accurately interpret TST results.

Correct Answer: C

Rationale: The correct answer is C: Crackles. Crackles indicate left-sided heart failure due to fluid accumulation in the lungs. This occurs when the left side of the heart is unable to efficiently pump blood, leading to fluid backing up into the lungs. Weight gain (A) may be a general sign of heart failure but is not specific to left-sided failure. Ascites (B) is more indicative of right-sided heart failure, where fluid accumulates in the abdomen. Jugular vein distention (D) is a sign of right-sided heart failure, where blood backs up into the systemic circulation causing jugular vein distention.

Correct Answer: C

Rationale: Rationale for Correct Answer (C): - Increase of lung volume results in decrease, not increase, in resistance in extra alveolar vessels due to increased recruitment of capillaries. - This is known as distension recruitment, which helps reduce resistance in extra alveolar vessels. - Increased lung volume also helps to distribute blood flow more evenly in the lungs, reducing resistance. - Therefore, statement C is false. Summary of Incorrect Choices: A: True - increase in pulmonary arterial pressure generally causes a fall in pulmonary resistance due to vessel dilation. B: True - pulmonary resistance is indeed lower than systemic circulation resistance due to shorter pulmonary vascular bed. D: True - acetylcholine causes bronchiole smooth muscle contraction, not relaxation.

Correct Answer: D

Rationale: The correct answer is D because in obstructive lung diseases like COPD, FEV1 is reduced compared to FVC due to air trapping. This is a characteristic feature of obstruction. A: Incorrect, normal FEV1/FVC ratio is around 80-85%. B: Incorrect, in lung fibrosis, both FEV1 and FVC are reduced but the reduction in FVC is typically more prominent. C: Incorrect, while expiratory effort affects FEV1 maneuver, it is not the sole determinant.

Correct Answer: B

Rationale: The correct answer is B: Develop an alternative communication method. After a total laryngectomy, the patient loses the ability to speak. Developing an alternative communication method such as using a communication board or electronic device is crucial for effective communication. Encouraging oral feeding (A) is not appropriate initially due to the risk of aspiration. Keeping the tracheostomy cuff fully inflated (C) can obstruct airflow, and keeping the patient flat in bed (D) can lead to respiratory complications. Developing an alternative communication method is essential for the patient's emotional well-being and quality of life.