A nurse is caring for a client after a radical neck dissection. To which of the following should the nurse give priority in the immediate postoperative period?

Choice A rationale Ineffective airway clearance is the immediate priority due to the anatomical changes from the radical neck dissection and the presence of a tracheostomy. Surgical manipulation and edema can obstruct the airway. Thick, copious secretions from the respiratory tract require constant monitoring and suctioning to prevent mucous plugs and subsequent respiratory distress or arrest, making Airway, Breathing, Circulation (ABC) the paramount concern in the immediate postoperative period. Choice B rationale Impaired verbal communication is a valid concern following a tracheostomy as the client cannot phonate normally. However, this is a psychosocial and comfort need, which is secondary to maintaining a patent and clear airway. The inability to speak, while distressing, does not pose an immediate threat to the client's survival or physiological stability in the way that an obstructed airway does. Choice C rationale High risk for infection is a significant concern following any major surgery, especially a radical neck dissection with extensive tissue exposure and incision lines. Proper aseptic technique and meticulous wound care are essential. Despite this, airway management is governed by the ABC principle; a patient cannot recover from an infection if they cannot breathe adequately. Choice D rationale Malnourishment is a valid long-term concern for a client who is NPO and may have subsequent dysphagia (difficulty swallowing). However, meeting nutritional needs is a lower-priority need in the immediate postoperative phase compared to ensuring adequate tissue oxygenation through a clear and patent airway. Nutritional support will become a focus once the client is medically stable and the immediate surgical risks have passed.