The nurse has received report on four children. Which child should the nurse assess first?

• A. A preschool child with a head injury and decreasing level of consciousness
• B. A school-age child in a coma with stable vital signs
• C. An adolescent admitted after a motor vehicle accident who is oriented to person and place
• D. A toddler in a persistent vegetative state with a low-grade fever

Answer: (A)

The key idea here is that in pediatric head injury, the most urgent concern is a child whose level of consciousness is falling. A preschool child with head injury and decreasing LOC signals potential airway compromise and evolving intracranial problems, which can deteriorate rapidly. This situation demands immediate assessment and stabilization—airway, breathing, and circulation—before addressing others.

In comparison, a school-age child who is in a coma but has stable vital signs is still serious, but the current stability allows a bit more time for careful evaluation rather than immediate life-support actions. An adolescent who is oriented to person and place shows intact cognitive function, so there’s less immediate risk to airway or brain function. A toddler in a persistent vegetative state with fever raises concern for infection, but without signs of acute airway or rapid neurological deterioration, it’s not as urgent as the decreasing LOC scenario.

So, the preschool child with decreasing level of consciousness represents the highest risk and should be assessed first.