Page 1593 - Saunders Comprehensive Review For NCLEX-RN

An individual who has received a BCG vaccine will have a

positive tuberculin skin test result and should be evaluated for
tuberculosis with a chest x-ray.
F. Clinical manifestations
1. May be asymptomatic in primary infection
2. Fatigue
3. Lethargy
4. Anorexia
5. Weight loss
6. Low-grade fever
7. Chills
8. Night sweats
9. Persistent cough and the production of mucoid and
mucopurulent sputum, which is occasionally streaked
with blood
10. Chest tightness and a dull, aching chest pain may
accompany the cough.
G. Chest assessment
1. A physical examination of the chest does not provide
conclusive evidence of tuberculosis.

2. A chest x-ray is not definitive, but the presence

of multinodular infiltrates with calcification in the
upper lobes suggests tuberculosis.
3. If the disease is active, caseation and inflammation
may be seen on the chest x-ray.
4. Advanced disease
a. Dullness with percussion over involved
parenchymal areas, bronchial breath
sounds, rhonchi, and crackles indicate
advanced disease.
b. Partial obstruction of a bronchus
caused by endobronchial disease or
compression by lymph nodes may
produce localized wheezing and
dyspnea.
H. QuantiFERON-TB Gold test
1. A blood analysis test by an enzyme-linked
immunosorbent assay
2. A sensitive and rapid test (results can be available in
24 hours) that assists in diagnosing the client
I. Sputum cultures
1. Sputum specimens are obtained for an acid-

fast smear.
2. A sputum culture identifying M. tuberculosis confirms

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