A nurse is caring for a group of clients. Which of the following clients should the nurse assess first?

Priority nursing assessment is based on identifying the client with the greatest risk for immediate deterioration, using principles such as airway, breathing, circulation (ABC), and age-related vulnerability. Infants, especially newborns, can decompensate rapidly when respiratory distress is present. Substernal retractions indicate increased work of breathing and possible airway compromise, which requires urgent evaluation. The nurse must prioritize life-threatening respiratory problems over pain, chronic conditions, or non-emergent findings. Rationale: A. A 12-year-old child reporting pain as 8 out of 10 requires prompt assessment and intervention, but pain alone does not take priority over respiratory compromise. Severe pain is important to manage; however, the child is older and there is no indication of airway or breathing instability. ABC priorities place breathing concerns before pain management. B. A 3-week-old infant with substernal retractions should be assessed first because retractions are a sign of respiratory distress and increased effort to breathe. Newborns have limited respiratory reserve and can deteriorate quickly if airway obstruction or impaired ventilation progresses. Immediate assessment is necessary to prevent hypoxia and possible respiratory failure. C. A 6-year-old child with hypokalemia requires monitoring because low potassium can affect cardiac and neuromuscular function. However, without signs of active dysrhythmia, weakness, or instability, it is not the highest immediate priority. Respiratory distress in a newborn presents a more urgent threat to life than a stable electrolyte imbalance. D. A 4-month-old infant with plagiocephaly does not require urgent assessment because it is generally a non-emergent condition involving flattening of part of the skull due to positioning. It is commonly managed with repositioning and monitoring over time. It does not indicate immediate physiologic instability or life-threatening risk.