A home health nurse is teaching a client who has a latex allergy about items typically found in the home that can trigger an allergic reaction. Which of the following items should the nurse instruct the client to avoid? (Select all that apply.).
Dishwashing gloves.
Adhesive tape.
Macadamia nuts.
Bananas.
Rubber bands.
Correct Answer : A,B,E
Choice A rationale:
Dishwashing gloves are often made of latex, which can trigger an allergic reaction in individuals with a latex allergy. Direct contact with latex-containing items should be avoided to prevent allergic responses.
Choice B rationale:
Adhesive tape commonly contains latex and can lead to allergic reactions in individuals with a latex allergy. Avoiding contact with latex-containing items is crucial to prevent potential allergic symptoms.
Choice C rationale:
Macadamia nuts and bananas do not typically contain latex and are not known to trigger latex allergies. While these items can cause allergic reactions in some individuals, they are not relevant to a latex allergy.
Choice D rationale:
While macadamia nuts and bananas can cause allergies in some people, they do not contain latex and are not associated with latex allergies. Therefore, they are not items that the nurse needs to instruct the client to avoid due to their latex allergy.
Choice E rationale:
Rubber bands are often made from latex, which can provoke an allergic reaction in individuals with a latex allergy. Encouraging the client to steer clear of items like rubber bands helps prevent potential allergic responses.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Instructing the client to remain supine for 10 minutes after inserting a vaginal suppository helps ensure proper absorption of the medication. This position allows the suppository to stay in contact with the vaginal mucosa, promoting optimal drug absorption. This is an essential nursing action to maximize the therapeutic effect of the medication.
Choice B rationale:
Applying sterile gloves after cleansing the perineal area is not necessary when administering a vaginal suppository. While maintaining cleanliness is important, the use of sterile gloves is not typically required for this procedure. Clean, non-sterile gloves are sufficient to maintain aseptic technique during the administration.
Choice C rationale:
Inserting the suppository 3 to 4 cm (1 to 1.5 in) into the vagina is an appropriate depth for vaginal suppository insertion. The nurse should follow this guideline to ensure that the medication reaches the appropriate location within the vaginal canal, optimizing absorption and effectiveness.
Choice D rationale:
Placing the client in the lateral semi-prone recumbent position is not a standard position for administering a vaginal suppository. The suppository is typically administered with the client lying on their back (supine) to facilitate insertion and medication absorption. Placing the client in the position described would not provide the optimal angle for insertion.
Correct Answer is B
Explanation
Choice A rationale:
Lying down while practicing pursed-lip breathing is not the correct instruction. Pursed-lip breathing is usually performed in a sitting or standing position. Lying down can restrict lung expansion and may not effectively support the purpose of this breathing technique, which is to improve airway pressure and reduce air trapping.
Choice B rationale:
"Exhale slowly through your mouth" is the correct instruction for pursed-lip breathing. This technique involves inhaling through the nose for a count of two and exhaling slowly and steadily through pursed lips for a count of four. The goal is to promote better exhalation, prevent airway collapse, and improve oxygen exchange. The rationale behind this choice is grounded in the mechanics of pursed-lip breathing, which helps create backpressure in the airways, maintaining them open and aiding in proper exhalation.
Choice C rationale:
Inhaling through pursed lips contradicts the proper sequence of pursed-lip breathing. The technique involves inhaling through the nose and exhaling through pursed lips. Inhaling through pursed lips would not provide the intended benefits of the technique.
Choice D rationale:
"Puff your cheeks when exhaling" is not the correct instruction. Puffing the cheeks during exhalation does not contribute to the effectiveness of pursed-lip breathing. This action could potentially impede proper exhalation and defeat the purpose of the technique, which is to control airflow and improve breathing efficiency.
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