A nurse working in a long-term care facility is assigned care of four clients following the 0700 morning change-of-shift report. Which of the following clients should the nurse attend to first?

Choice A rationale A temperature of 38.3 C is an expected finding in a client with an active respiratory infection like bronchitis who has just started antibiotic therapy. Standard fever management involves antipyretics and monitoring, but this does not represent an immediate physiological crisis. The client is already receiving treatment for the underlying cause. While assessment is necessary, this client is stable compared to someone experiencing a metabolic emergency with potential neurological consequences or rapid decline. Choice B rationale For a client with chronic obstructive pulmonary disease, an oxygen saturation of 90 percent is often considered an acceptable and expected baseline. These clients frequently maintain lower saturation levels due to chronic carbon dioxide retention and altered respiratory drive. While it requires monitoring, it does not typically signify an acute, life threatening change in status unless it drops significantly below their personal baseline. Consequently, this client does not take priority over a hypoglycemic emergency. Choice C rationale Restlessness during the night in a client with Alzheimers disease is a common behavioral manifestation of the disease, often related to sundowning or sleep cycle disturbances. While it requires a follow up assessment to ensure the client is safe and comfortable, it does not indicate an acute physiological instability. The nurse should address this client after stabilizing those with urgent metabolic or respiratory needs. Behavioral changes are significant but usually not immediately life threatening. Choice D rationale A blood glucose level of 60 mg/dL is below the normal range of 70 to 110 mg/dL and indicates hypoglycemia. This is a medical priority because the brain requires a constant supply of glucose to function. Acute hypoglycemia can lead to seizures, coma, or permanent brain damage if not corrected immediately with fast acting carbohydrates. Because this represents an acute threat to the clients neurological and physiological stability, it is the most urgent issue.