Which client should be assessed first in the coronary care unit after change-of-shift report?

The client with acute coronary syndrome who has experienced a 3-pound weight gain and dyspnea should be assessed first because these symptoms could indicate worsening heart failure or fluid overload, which are critical complications. A sudden weight gain of this magnitude suggests significant fluid retention, often a sign that the heart is struggling to pump effectively. Dyspnea in this context raises concerns about pulmonary congestion or edema, both of which require immediate evaluation and intervention to prevent potential respiratory failure or further cardiac compromise.

In a coronary care unit, the prioritization of care typically leans toward those who exhibit signs of acute distress or deterioration. While the other clients listed may require attention as well, the acute nature of weight gain and dyspnea in the context of acute coronary syndrome signifies an urgent situation that needs immediate assessment to guide timely management decisions.