After receiving change of shift report, which client should the nurse assess first?

A. Client with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes: A magnesium level of 1.1 mEq/L is below the normal range (1.5–2.5 mEq/L), indicating hypomagnesemia. Tremors and hyperactive deep tendon reflexes are signs of neuromuscular excitability and can progress to seizures, laryngospasm, or life-threatening arrhythmias. B. Client with serum sodium level of 145 mEq/L who has a dry mouth and is asking for a glass of water: A sodium level of 145 mEq/L is at the upper end of normal, and dry mouth is a mild symptom of dehydration. While this requires monitoring and hydration, it is not immediately life-threatening compared with neuromuscular instability due to hypomagnesemia. C. Client with serum potassium level of 5.0 mEq/L who is complaining of abdominal cramping: A potassium of 5.0 mEq/L is at the upper limit of normal (3.5–5.0 mEq/L). Mild abdominal cramping alone does not indicate acute cardiac risk, although hyperkalemia can become dangerous if levels rise further. This client requires monitoring but is not the priority. D. Client with serum phosphorus level of 4.5 mg/dL: A phosphorus level of 4.5 mg/dL is within the normal range (2.5–4.5 mg/dL), and without additional symptoms, this client is stable and does not require urgent intervention.