Which action made by the nurse indicates a need for correction regarding preparing a sterile field quizlet?

Tendons are fibrous bands connecting muscles to bone
Tendons are strong, flexible, and inelastic

-Tendons are fibrous bands connecting muscles to bone. They are strong, flexible, and inelastic. Cartilage is nonvascular, supportive connective tissue located in the joints and thorax, trachea, larynx, nose, and ear. Ligaments help to hold joints together, and connect bones and cartilage. Some ligaments may also protect two bony surfaces against friction.

You should provide a vitamin D-rich diet for your child.

-Outward bending of the legs at the knee indicates bowlegs. It is generally associated with rickets, which occurs due to deficiency of vitamin D. Therefore, the child should be provided with foods that are rich in vitamin D. Phosphorus reduces the risk of rickets in the children. Therefore, parents should not limit phosphorus in a child's diet. Limiting mobility in a child with rickets can impair mobility permanently. A Denis Browne splint is used to reduce the risk of clubfoot; however, it is not useful as a treatment for rickets.

Test-Taking Tip: Key words or phrases in the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care.

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While preparing to do a sterile dressing change, the nurse accidentally sneezes over the sterile field that is on the over-the-bed table. Which principles of surgical asepsis, if any, has the nurse violated?

A sterile field becomes contaminated by prolonged exposure to air.

Rationale
Avoid activities that create air currents, such as sneezing. When you sneeze, microorganisms travel through the air by droplets, contaminating the sterile field . Therefore, "a sterile field becomes contaminated by prolonged exposure to air" is the principle violated. The other two choices are correct but they do not describe the principle violated.

Which type of specimen is collected by using a sterile tongue blade?

Stool sample

Stool specimens are collected with sterile tongue blades. Urine specimens are collected with needleless safety syringes. Blood specimens are collected with 20-mL needle-safe syringes. Wound specimens are collected with sterile cotton-tipped swabs or syringes and collection tubes.

A registered nurse teaches a nursing student about preparing a patient for a sterile procedure. Which statements made by the nursing student indicate effective learning? Select all that apply.

"I should inform the patient to avoid touching the sterile supplies and gown."
"I should administer ordered analgesics half an hour before surgery begins if a patient is in pain."
"I should inform the patient to avoid sudden movements of any parts of the body covered by sterile drapes."

The nurse should provide guidelines to the patient to avoid contamination while performing the surgery. The patient should avoid touching sterile supplies, drapes, and the nurse's gown and gloves to prevent contamination. If a patient is in pain, the nurse should administer ordered analgesics about half an hour before a sterile procedure begins. The patient should be informed to avoid sudden movements of any body parts that are covered by sterile drapes. The nurse should explain how the surgical procedure is being carried out and what can the patient do to avoid contaminating the sterile objects. The nurse should place a surgical mask on the patient in conditions such as respiratory infections, but this action is not necessary in all cases.

Arrange the steps of the preparation of a sterile field chronologically.

First, the sterile kit containing the sterile items should be placed on a work surface above waist level and the outside cover should be opened and placed on the work surface. The outer edge of the tip of the outermost flap should be grasped and the outermost flap should be opened away from the body while keeping the arm stretched away from the sterile field. The outer edge of the first side of the flap should be grasped and the side flap should be opened by pulling the side. The nurse should allow the kit to lie flat on the table surface. The arm should not be extended over the sterile surface. The outer edge of the second side of the flap should be grasped and the opening of the second side of the package should be pulled. The outer edge of the last and innermost flap should be grasped. Finally, the nurse should stand away from the sterile package and the flap should be pulled back, allowing the items to fall on the work surface.
28%

While performing hand hygiene, the nurse avoids wearing rings. What is the rationale behind this action?

To prevent a Staphylococcus aureus infection.

Gram-negative bacilli such as Enterobacter and Staphylococcus aureus are more common under rings; therefore, the nurse should not wear rings to avoid infections. The nurse rubs the hands together by covering all the surfaces of the hands and fingers with antiseptic to ensure complete antimicrobial action. The nurse's fingernails should be less than a quarter-inch long to decrease the number of bacteria residing on hands. The nurse rubs his or her hands together with an antiseptic for several seconds and allows his or her hands to dry before applying gloves to provide enough time for the antimicrobial solution to be effective.

Which extrinsic factors increase the risk for falls among older adults? Select all that apply.

Poor lighting.
Inappropriate footwear.
Improper use of assistive devices.
Unfamiliar environment of a hospital room.

Poor lighting, inappropriate footwear, improper use of assistive devices, and the unfamiliar environment of a hospital room are extrinsic factors that increase the risk for falls among older adults. Poor lighting makes it difficult to see properly. Inappropriate footwear also increases the chance of falling. The improper use of assistive devices such as walkers may lead to falling. The unfamiliar environment of a hospital room may contain barriers to movement, causing the older adult to fall. An adverse medication reaction is an intrinsic factor, not an extrinsic factor.

The registered nurse teaches an unlicensed assistive person (UAP) about preventing falls in health care settings. Which statements made by the UAP indicate effective learning? Select all that apply.

"I should use specific environmental safety precautions."
"I should use fall prevention measures that match the patient's mobility limitations."
Correct 5
"I should report patient behaviors that are precursors to falls to the registered nurse."

The nurse should use specific environmental safety precautions to prevent falls in a health care setting. The nurse should use fall prevention measures that match patient's mobility limitations. The nurse should report changes inpatient behavior that may be precursors to falls to the registered nurse. Orienting the environment to the patient's beliefs would not be performed by the UNP. The nurse, not the UNP, reports any signs and symptoms of the patient resisting the restraints.

What is the correct order of steps for administering the "timed get up and go" (TUG) test to determine a patient's risk of falls?

The nurse should perform the TUG test if the patient is able to walk. The first step is to have patient walk 10 feet as quickly as possible and turn around to sit back on the chair. Next, the patient should be instructed to rise from a straight back chair without using the arms for support and begin counting. The nurse should then check for unsteadiness in the patient's gait. Then, the patient is asked to sit on the chair without using arms for support. Finally, the nurse checks the elapsed time.

A registered nurse supervises a nursing student who is performing oral care for a patient who is on anticoagulant therapy. Which nursing actions indicate the need for further education? Select all that apply.

Flossing vigorously near the gum line
Using a lemon-glycerin sponge to clean after brushing

Flossing vigorously should be avoided in patients on anticoagulant therapy because it can cause gum bleeding. Using lemon-glycerin sponges should also be avoided because the sponges may dry the mucous membranes and erode tooth enamel. Using fluoride toothpaste prevents the formation of dental caries. Using a rounded, soft-bristled toothbrush will help prevent bleeding. Rinsing with chlorhexidine gluconate liquid enhances oral hygiene and prevents infections.

A registered nurse supervises a nursing student who is performing oral care for an unconscious patient. Which action indicates the need for correction?

Brushing the tongue to stimulate the gag reflex

An unconscious patient should not have his or her gag reflex stimulated because the patient may aspirate. Using topical chlorhexidine gluconate for rinsing enhances oral hygiene and prevents infections. Placing the patient in the semi-Fowler's position while performing oral care prevents the risk of aspiration. The patient's mouth should be opened with a small oral airway or a padded tongue blade. If the fingers are used to hold the mouth open, the patient may bite and microorganisms may be transferred to the patient's mouth.

A nurse provides care for a patient with diabetes mellitus. Which home care instructions regarding foot care should the nurse provide the patient? Select all that apply.

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Which action would the nurse perform to ensure preparation of a sterile field?

While preparing a sterile field, a nurse opens the outermost flap by stretching his or her arm away from the sterile field.

Which action by the nurse will result in contamination of a sterile object or sterile field?

The nurse must NEVER have the sterile field below the waist level. Coughing or sneezing over the sterile field contaminates the sterile field. The nurse must maintain a one-inch border around the sterile field that is not sterile.

Which action is appropriate in surgical hand asepsis?

Two guidelines recommend that artificial nails and jewelry be removed prior to cleaning and soiled hands be washed with soap and water prior to surgical hand antisepsis. Surgical hand antisepsis techniques and agents include surgical hand scrubs with antiseptic soap or alcohol- based hand rubs.

Which precautions should the nurse follow while performing surgical asepsis?

Safety considerations: Hand hygiene is a priority before any aseptic procedure. When performing a procedure, ensure the patient understands how to prevent contamination of equipment and knows to refrain from sudden movements or touching, laughing, sneezing, or talking over the sterile field.