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A nurse is observing a newly licensed nurse prepare a sterile field. For which of the following actions should the nurse intervene?

A.

Positions the wrapped package on the bedside table so the outer flap is away from her.

B.

Holds gauze packages 15 cm (6 in) above the sterile field.

C.

Holds a bottle of solution with the label away from the palm of the hand.

D.

Wears sterile gloves when moving sterile items on the sterile field.

Answer and Explanation

The Correct Answer is C

A. Positions the wrapped package on the bedside table so the outer flap is away from her: This action is correct because opening the flap away from the body minimizes the risk of contaminating the sterile field.

B. Holds gauze packages 15 cm (6 in) above the sterile field: This action is correct. Dropping sterile items from a height of 6 inches or more prevents contamination by ensuring they do not touch the edges or outside surfaces of the sterile field.

C. Holds a bottle of solution with the label away from the palm of the hand: When pouring a solution, the label should be held toward the palm of the hand to protect it from damage caused by spills. A damaged label could make it difficult to identify the solution, increasing the risk of error.

D. Wears sterile gloves when moving sterile items on the sterile field: This action is appropriate. Sterile gloves help maintain the sterility of the field and are required when manipulating sterile items.


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Related Questions

Correct Answer is D

Explanation

A. Lactated Ringer's does not provide the necessary glucose to prevent hypoglycemia in clients receiving TPN.
B. 3% sodium chloride is hypertonic and not appropriate for preventing hypoglycemia.
C. 0.9% sodium chloride does not provide the necessary glucose.
D. Dextrose 10% in water (D10W) provides a glucose source to help prevent hypoglycemia in clients when TPN is temporarily unavailable.

Correct Answer is C

Explanation

A. Labeling the feeding bag is important for ensuring the safety and monitoring of feeding times, but it is not the first action.
B. Hanging the feeding bag at the correct height ensures proper flow of the feeding but is not the first action.
C. Aspirating the client's stomach contents is the first action to check for residuals and ensure the placement of the NG tube is correct, preventing aspiration.
D. Warming the feeding to room temperature is important for client comfort but is not the first action.

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