A male client removes the covering from an ice pack applied to his knee. What should the nurse do first?

• A. Observe the appearance of the skin under the ice pack.
• B. Instruct the client regarding the need for the covering.
• C. Reapply the covering after filling with fresh ice.
• D. Ask the client how long the ice was applied to the skin.

Answer: (A)

This situation tests safety with cold therapy. When a patient exposes skin that has been covered by an ice pack, the nurse’s first step is to assess the skin for signs of cold injury before doing anything else. Look for color changes (pallor, white or mottled skin), redness, blistering, or numbness—these indicate the tissue may be damaged or at risk. This quick observation is essential to decide whether it’s safe to continue with the ice pack, re-cover it, or stop therapy altogether. If the skin appears intact and sensation is normal, you can proceed with re-covering and continuing the treatment as prescribed, keeping the recommended duration and barriers between skin and ice. If there are signs of frostbite or skin compromise, remove the ice, protect the area, and follow the protocol for managing cold injury.