Final answer:
The nurse should first assess the 23-year-old patient with type 1 diabetes who has a life-threatening blood glucose level of 40 mg/dL, indicating hypoglycemia. This requires immediate intervention to prevent serious complications. The other patients’ conditions, although serious, are not as immediately life-threatening.
Step-by-step explanation:
After a change-of-shift report, the nurse should assess the 23-year-old patient with type 1 diabetes who has a blood glucose level of 40 mg/dL first. This is a medical emergency because the patient is hypoglycemic, which can lead to symptoms such as confusion, seizures, unconsciousness, and even death if not treated promptly. The patient needs immediate intervention, potentially including the administration of glucose, to raise their blood sugar to a safe level.
The other patients, while they may have issues that require attention, do not present with an immediate life-threatening situation like the hypoglycemic patient. A haemoglobin A1c of 12% indicates very poorly controlled diabetes and requires medical intervention, but not as urgently as hypoglycemia. A pregnant patient with an oral glucose tolerance test of 202 mg/dL is indicative of gestational diabetes and also requires follow-up. The patient using exenatide and complaining of acute abdominal pain should also be assessed, but after the hypoglycemic patient is stabilized, this could indicate pancreatitis or another significant issue.