During a shift change, which patient should be seen first due to instability?

• A. Arrived on the floor with new onset seizures.
• B. Blood pressure 168/90 after PRN antihypertensive.
• C. Vomited several times last night and is sleeping.
• D. Preoperative paperwork started for surgery today.

Answer: (A)

The key idea here is prioritizing patients who are unstable, especially when handoffs occur. A patient with a new-onset seizure is the most unstable because ongoing seizure activity can rapidly compromise the airway, breathing, and circulation, and can lead to brain injury or status epilepticus if not addressed immediately. This requires urgent assessment and actions: ensure safety, protect the airway, provide oxygen as needed, monitor vitals, establish IV access, and mobilize rapid assistance as needed.

The other scenarios, while important, do not present the same immediate threat to life. A high blood pressure reading after a PRN antihypertensive is a concern to monitor and address, but it doesn’t imply an immediate loss of airway or brain function. Vomiting several times while the patient is sleeping raises potential risks like dehydration or aspiration, but the patient isn’t currently showing active instability. Preoperative paperwork is administrative and not an urgent clinical threat during a shift change.