A nurse is caring for a client who is recovering from a cerebrovascular accident in a rehabilitation facility. The client tells the nurse, "I am sick of being in here, and I want to go home." Which of the following responses should the nurse make?

A. Place the sterile dressing within 1.25 cm (0.5 in) of the edge of the sterile field: This action is not appropriate, as sterile items should be placed at least 2.5 cm (1 in) away from the edge of the sterile field to maintain sterility and prevent contamination.

B. Open the outermost flap of the sterile kit toward the body: The correct practice is to open the outermost flap away from the body. This technique helps prevent any contaminants from the nurse's clothing or body from falling into the sterile field.

C. Place the cap from the solution sterile side up on a clean surface: This is the correct action. By placing the cap sterile side up, the nurse minimizes the risk of contamination to the sterile solution and maintains the integrity of the sterile field.

D. Set up the sterile field 5 cm (2 in) below waist level: Setting up a sterile field below waist level increases the risk of contamination, as it may come into contact with non-sterile surfaces. The sterile field should be set up at waist level or higher to maintain sterility.

A. "Remove the patch for 8 hours every day to reduce the risk of tolerance.": This is incorrect. The fentanyl patch should be left in place continuously for the prescribed duration to maintain consistent pain relief and should not be removed unless instructed by a healthcare provider.

B. "Avoid hot tubs while wearing the patch.": This is an important instruction. Heat can increase the absorption of fentanyl from the patch, potentially leading to overdose. Therefore, avoiding hot tubs and other heat sources is crucial while using the patch.

C. "Avoid high-fiber foods while taking this medication.": This statement is not accurate. In fact, opioid medications like fentanyl often cause constipation, so high-fiber foods can be beneficial to help prevent this side effect.

D. "Apply the patch to your forearm.": This is not typically the recommended application site for fentanyl patches. They are usually applied to hairless areas of the upper body or upper outer arm, where they can adhere properly and be effective.