NCLEX-PN® ExaminationSafety and Infection ControlMedium
An LPN is preparing to insert an indwelling urinary catheter for a female client. Which action is most important for the LPN to take to maintain surgical asepsis during the procedure?
- AKeep the client's labia separated with the non-dominant hand throughout the insertion.
- BDon sterile gloves after opening the catheterization kit.
- CCleanse the perineal area with antiseptic solution using a single stroke for each wipe.
- DPosition the sterile drape so that it covers the entire perineal area.
Show answer & explanationAnswer & explanation
Correct answer: A. Keep the client's labia separated with the non-dominant hand throughout the insertion.
Maintaining separation of the labia with the non-dominant hand, which becomes contaminated after initial cleansing, is crucial to prevent contamination of the sterile field and the catheter as it is inserted. This hand must not touch any sterile items once it has touched the client's skin.
Why the other options are wrong
- B. Sterile gloves are donned after the kit is opened and the sterile field is established, but other actions are also critical for maintaining asepsis.
- C. This describes a correct cleansing technique, but maintaining separation is more critical for preventing contamination during insertion.
- D. Proper draping is important, but if the labia are not kept separated, contamination can still occur during insertion.
Maintaining Sterile Field
The practice of creating and preserving an area free from all microorganisms during invasive procedures to prevent infection.
- All items within the sterile field must be sterile.
- Edges of a sterile field are considered contaminated.
- A sterile field must never be turned away from or left unattended.
- A contaminated hand must not touch sterile items.
Memory trick: Sterile Stays Safe, Separated