A nurse is reviewing the medical history of a client who is luted for surgery. Which of the following findings places the client at risk for a complication of incisional hematoma forming?

A) Heart failure:
While heart failure can cause a variety of symptoms, including shortness of breath, fatigue, and nocturnal respiratory disturbances, it is not a direct cause of obstructive sleep apnea (OSA). However, heart failure can exacerbate the effects of sleep apnea, particularly in individuals who already have OSA, leading to a condition known as "central sleep apnea with Cheyne-Stokes respiration.

B) Brainstem injury:
Brainstem injury can affect the regulation of breathing and may lead to central sleep apnea, where the brain fails to send the proper signals to the muscles that control breathing. However, brainstem injury does not directly cause obstructive sleep apnea, which is typically caused by physical blockages or obstructions in the upper airway.

C) Recent weight loss:
Recent weight loss is generally not associated with the development of obstructive sleep apnea. In fact, weight loss can sometimes reduce the severity of OSA in overweight or obese individuals. OSA is more commonly associated with excess weight and fat deposits around the neck and throat, which can contribute to airway obstruction during sleep.

D) Enlarged tonsils:
Enlarged tonsils, especially in children, are a well-known cause of obstructive sleep apnea (OSA). The enlarged tonsils can block the upper airway during sleep, leading to periods of apnea or hypopnea (reduced airflow). This obstruction can result in snoring, choking, and interrupted sleep.

A) Prepares the sterile field 2 hours before it is needed:
A sterile field should be prepared as close to the time it will be used as possible, typically within 15 to 30 minutes before the procedure, to ensure its sterility is maintained. Preparing a sterile field 2 hours in advance increases the risk of contamination, as airborne particles and bacteria can settle on the field during that time.

B) Uses a surface that is at waist height:
A waist-height surface is the most appropriate for setting up a sterile field. This is because it allows the nurse to maintain a proper stance and reduces the likelihood of contamination by minimizing the risk of the nurse accidentally reaching over or leaning into the sterile field. The correct height ensures that sterile items are not contaminated by being positioned too high or too low, both of which can increase the risk of contamination.

C) Places the sterile field against a wall in the client's room:
Placing the sterile field against a wall is not advisable, as it may increase the likelihood of contamination. A wall is not a sterile surface, and anything in close proximity to the wall (e.g., furniture, equipment) could inadvertently contaminate the sterile field. A sterile field should be placed on a clean, flat surface that is free from any potential contaminants, away from traffic or other surfaces that could compromise sterility.

D) Opens the first flap of the sterile package towards the nurse's body:
When opening a sterile package, the first flap should always be opened away from the body, not towards it. This action ensures that the nurse does not risk contaminating the sterile field by inadvertently touching it with their body or clothing. The nurse should open each flap of the sterile package away from themselves, then discard it, continuing to open the remaining flaps in a way that maintains the sterility of the items within.