A charge nurse is observing a nurse perform a sterile dressing change for a client. Which of the following actions should the charge nurse identify as demonstrating sterile technique?
The nurse places the sterile package with the top flap opening away from the body.
The nurse pinches the flap on the inside of the package first to open it.
The nurse reaches over the package to open the left flap.
The nurse pulls the last flap of the package away from the body.
The Correct Answer is A
Choice A rationale:
Placing the sterile package with the top flap opening away from the body is the correct choice. This technique helps maintain the sterility of the contents by preventing potential contamination from the nurse's body and clothing.
Choice B rationale:
Pinching the flap on the inside of the package first to open it is not a recommended sterile technique. It could potentially introduce contamination from the nurse's hand into the sterile field when pinching the inner flap.
Choice C rationale:
Reaching over the package to open the left flap is not the ideal technique. Reaching over the sterile field can introduce the risk of contamination, as the nurse's arm and body might come into contact with the sterile supplies.
Choice D rationale:
Pulling the last flap of the package away from the body is not the most effective technique. This action could potentially lead to the nurse's hand coming close to or over the sterile field, increasing the risk of contamination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Answer is b. Frequent use of restroom.
a. Spends free time conversing with other staff at the nurses' station: Socializing with colleagues during free time at the nurses' station is a common and acceptable behavior in many healthcare settings. While excessive socializing could potentially interfere with productivity, it does not necessarily indicate impairment. Engaging in conversations with coworkers can serve as a stress-reliever and contribute to a supportive work environment, rather than being a sign of impairment.
b. Frequent use of restroom: Correct. Frequent restroom use can be a red flag for substance abuse or other health issues. Individuals who are working while impaired may frequently visit the restroom to use drugs, manage their effects, or experience side effects of substance use. This behavior may be a tactic to conceal substance abuse from coworkers or supervisors, as frequent restroom breaks could be perceived as a normal bodily function. Therefore, the charge nurse should pay close attention to staff members who exhibit a pattern of frequent restroom use, especially if there are other signs of impairment or behavior changes.
c. Depends on other nurses to administer pain medication to their clients: While relying on other nurses to administer pain medication to clients could potentially raise concerns about the staff nurse's competence or workload management, it does not necessarily indicate impairment. There could be various reasons for a nurse to delegate medication administration tasks, such as being assigned to other critical tasks, adhering to hospital policies, or seeking assistance during busy periods. Without further evidence or observation of impaired behavior, depending on others to administer medications cannot be solely attributed to working while impaired.
d. Delegates tasks to assistive personnel: Delegating tasks to assistive personnel is a standard nursing practice and does not inherently suggest impairment. Nurses often delegate tasks to other healthcare team members, including certified nursing assistants or patient care technicians, to ensure efficient and effective patient care delivery. Delegation is guided by nursing standards, patient acuity, and the scope of practice of assistive personnel. Therefore, observing a nurse delegating tasks alone is not sufficient evidence to suspect impairment.
In summary, the correct answer is b because frequent use of the restroom can be indicative of substance abuse or other health issues, especially when observed in conjunction with other signs of impairment or behavior changes. The charge nurse should carefully monitor and investigate any concerning behaviors displayed by staff nurses to ensure patient safety and provide appropriate support and intervention.
Correct Answer is C
Explanation
Choice A rationale:
Child Protective Services would not be the appropriate agency to refer the guardian of the newborn who requires apnea monitoring at home. Child Protective Services deals with child abuse, neglect, and welfare concerns, which are not related to the specific medical needs of the newborn.
Choice B rationale:
Public Health is the correct choice. Public Health agencies are responsible for promoting and protecting the health of the community. They often provide services such as education, vaccinations, and resources for newborn care. Referring the guardian to Public Health can ensure that they receive appropriate guidance on how to manage the newborn's apnea monitoring needs at home and any other relevant health-related information.
Choice C rationale:
Home Health is not the most suitable agency in this context. Home Health agencies generally provide healthcare services directly in patients' homes, often for individuals who require medical assistance or supervision due to illnesses or post-surgical care. However, for a newborn requiring apnea monitoring, the focus is more on education and support rather than direct medical care.
Choice D rationale:
Women, Infants, and Children (WIC) is not the appropriate agency for referring the guardian of the newborn needing apnea monitoring. WIC is a program that provides supplemental nutrition and support to pregnant women, breastfeeding mothers, and young children. While it is important for the overall health of the newborn, it is not directly related to apnea monitoring or home care.
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