A client is admitted to the long-term care facility after a brief hospitalization. The Braden Scale is completed to assess the client's risk for the development of pressure ulcers.
After completion of the assessment, the nurse notes the clients has a score of 18. Based upon your understanding, what is the best interpretation of this finding?
A) This client is at a low risk for the development of a pressure ulcer.
B) This client is at a high risk for the development of a pressure ulcer.
C) This client's score is inconclusive and does not reflect a significant risk for the development of a pressure ulcer.
D) The client's score is inconclusive, indicating the need for a repeated assessment using the Braden Scale within the next 3 days.
Question 2
The nurse is performing an assessment on a dark-skinned individual. After completing the assessment, the nurse records the findings. Which of the findings indicates a problems requiring further action?
A) Bluish gums
B) Bluish tones noted on the soles of the feet
C) Freckle-like spots on the borders of the tongue
D) Bluish tones to the lips
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