# The nurse has just received report on 4 clients. Which client should the nurse assess first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522686&lang=en  
> language: en  
> subject: Establishing Priorities  
> category: MOC

## Question

The nurse has just received report on 4 clients. Which client should the nurse assess first?

## Option

1. A client 6 hours after thyroidectomy who reports tightness when swallowing **✔ Correct answer**
2. A client 1 day after hip replacement whose pain score has risen from 4 to 7
3. A client with pneumonia whose oxygen saturation is 92% on room air
4. A client with cirrhosis whose abdominal girth increased by 2 cm today

**Correct answer: 1**

## Explanation

Tightness on swallowing after thyroidectomy may signal a neck hematoma compressing the airway. Airway risk outranks pain, a borderline saturation, and a slow fluid change.

## In-depth explanation

Quick answer
See the client after thyroidectomy who reports neck tightness.

Why this is correct
Bleeding into the closed space of the neck compresses the airway before oxygen saturation falls. Swallowing tightness is the early complaint, and waiting for a measured change means meeting the problem after it is established.

Easy analogy or mental picture
It is a rising water level inside a sealed box: the outside looks calm until the box gives way. The picture explains the hidden progression and does not mean the other clients are stable indefinitely.

Memory hook
After neck surgery, tightness is an airway complaint.

NCLEX decision rule
Rank a possible airway threat above pain, a borderline number, and a slow trend. Symptoms from a closed surgical space count as airway problems until proven otherwise.

Why the other choices are wrong
Rising pain, a saturation of 92%, and increasing girth all deserve assessment on this round, but none of them threatens the airway within minutes.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]MedlinePlus: Thyroid Gland RemovalU.S. National Library of Medicine

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