Care Manager Certification Practice Exam

During a Mantoux tuberculin skin test, which action by the nurse would indicate a need for intervention?

1. Creating a 6 mm bleb in the skin

2. Withdrawing the needle and massaging the site

3. Stretching the skin tightly during injection

4. Visualizing the needle tip under the skin

The correct answer is: Withdrawing the needle and massaging the site

In the administration of a Mantoux tuberculin skin test, the integrity of the procedure is crucial to obtaining accurate results. When performing the test, injecting the purified protein derivative (PPD) intradermally creates a small bleb; this indicates that the medication has been delivered into the correct layer of the skin. Massaging the injection site after withdrawing the needle is inappropriate. This action can disperse the PPD, leading to inaccurate results and potentially causing the test to be invalid. The objective of the Mantoux test is to have the PPD remain in the dermis, where it can provoke a localized immune response if the person has been exposed to tuberculosis. By massaging the area, the nurse compromises the ability to read the test effectively after 48 to 72 hours, as it may result in diminished or altered induration. In contrast, creating a 6 mm bleb is part of the standard procedure to confirm proper technique. Stretching the skin tightly during injection is also proper practice, as it allows for a more controlled injection. Finally, visualizing the needle tip under the skin is common in achieving intradermal placement and does not indicate a procedural error when done appropriately. Each of these actions supports proper technique and