A nurse is preparing to perform a sterile dressing change. Which of the following actions should the nurse take when setting up the sterile field?

Place the sterile dressing within 1.25 cm (0.5 in) of the edge of the sterile field.

Open the outermost flap of the sterile kit toward the body.

Place the cap from the solution sterile side up on a clean surface.

Set up the sterile field 5 cm (2 in) below waist level.

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is C

Explanation

A) A history of being in prison: While a history of incarceration can be associated with a higher risk for violence, it is not as strong a predictor as previous violent behavior. Many individuals may have been incarcerated for non-violent offenses.

B) Male gender: Although males are statistically more likely to engage in violent behavior, gender alone is not the best predictor of future violence. It does not account for individual history or behavior.

C) Previous violent behavior: This is the best predictor of future violence. Individuals who have exhibited violent behavior in the past are at a significantly increased risk of future violence. This history can be a critical indicator of potential risk.

D) Experiencing delusions: While delusions can contribute to violent behavior in some cases, they are not a reliable predictor of future violence. Not all individuals experiencing delusions will act violently, and many other factors must be considered.

A. Increase intake of milk products. B. Sweeten foods with fructose corn syrup. C. Increase intake of foods high in gluten. D. Consume foods high in fiber.

Correct Answer is D

Explanation

A) Increase intake of milk products: Many individuals with irritable bowel syndrome (IBS) may experience lactose intolerance, leading to bloating and discomfort from milk products. Therefore, increasing dairy intake is not typically recommended.

B) Sweeten foods with fructose corn syrup: Fructose can exacerbate symptoms in some people with IBS, as it can lead to digestive upset. Instead, it’s best to limit foods high in fructose corn syrup.

C) Increase intake of foods high in gluten: Gluten may cause issues for individuals with specific sensitivities or celiac disease, and for some with IBS, it may trigger symptoms. Thus, increasing gluten intake is not advisable.

D) Consume foods high in fiber: Increasing dietary fiber is generally recommended for individuals with IBS, as it can help regulate bowel movements and improve overall digestive health. Soluble fiber, in particular, is beneficial and can help alleviate symptoms.

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A nurse is preparing to perform a sterile dressing change. Which of the following actions should the nurse take when setting up the sterile field?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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