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Nonrestrictive clauses add extra information that does not change the core meaning and must be set off by commas. Option C correctly brackets “which was sterile” with commas, leaving a complete sentence when removed (“The syringe remained sealed”). In formal American English, which typically introduces nonrestrictive clauses and that introduces restrictive (essential) clauses without commas; hence D misuses that and adds commas improperly. A omits the necessary commas, making the clause appear restrictive (implying there were multiple syringes and only the sterile one remained sealed), which changes meaning. B places a comma after which, creating a disruptive and ungrammatical pause. On TEAS, determine whether the clause identifies (restrictive) or describes (nonrestrictive). If the sentence still makes sense and retains its main point without the clause, treat it as nonessential and use commas. This rule promotes clarity in clinical documentation: “The catheter, which was inserted at 0900, remains patent” (extra detail) versus “The catheter that occluded was replaced” (identifies which catheter). Consistent punctuation prevents ambiguity about which item or condition your note refers to, reducing risk of misinterpretation.