The nurse is caring for a group of patients. Which patient will the nurse see first?
a. A patient with a Stage IV pressure ulcer
b. A patient with a Braden Scale score of 18
c. A patient with appendicitis using a heating pad
d. A patient with an incision that is approximated
ANS: C
The nurse should see the patient with an appendicitis first. Warm applications are contraindicated when the patient has an acute, localized inflammation such as appendicitis because the heat could cause the appendix to rupture. Although a Stage IV pressure ulcer is deep, it is not as critical as the appendicitis patient. The total Braden score ranges from 6 to 23; a lower total score indicates a higher risk for pressure ulcer development. A score of 18 can be assessed later. A healing incision is approximated (closed); this is a normal finding and does not need to be seen first.
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