A patient is admitted with a diagnosis of blunt trauma to the abdomen after a motor vehicle collision. What should the nurse assess first when the patient arrives in the emergency department?
1. Airway patency
2. Abdomen for external signs of injury
3. Cervical spine for tenderness
4. Capillary refill
1
Rationale 1: Assessment of the airway, including patency, is the highest priority in the trauma patient.
Rationale 2: This is not the priority assessment.
Rationale 3: The nurse should assess the cervical spine area after the initial ABC assessment.
Rationale 4: Capillary refill is an assessment of circulation but is not the highest priority.
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