Change-of-shift prioritization: which client should be assessed first?

• A. A 28-year-old with stable vitals.
• B. A 60-year-old awaiting a routine lab draw.
• C. A 76-year-old client transferred from the emergency department who requires femur pinning.
• D. A 82-year-old with constipation.

Answer: (C)

The main idea here is prioritizing care based on the risk of rapid deterioration and the need for time-sensitive intervention. The client who just arrived from the emergency department and requires femur pinning has an acute fracture that needs prompt stabilization. Delaying assessment could lead to complications such as hemorrhage, fat embolism, or neurovascular compromise, and it interrupts definitive treatment. The other patients are currently stable or have nonurgent needs: a young adult with stable vitals, someone awaiting a routine lab draw, and an elderly patient with constipation without signs of obstruction or acute distress. Because of the immediate surgical need and potential for rapid decline, the fracture patient should be assessed first.