NCLEX Question of the Day – Sunday, May 17, 2026

Today’s question targets priority action in a changing patient condition, a skill that matters on every unit. Nurses often see the first sign that something is going wrong. The real challenge is not just noticing it, but choosing the safest next step fast. This question focuses on that judgment in a common med-surg situation.

Clinical Scenario

A 68-year-old client is on a medical-surgical unit 8 hours after a right total hip arthroplasty. The client has a history of osteoarthritis, hypertension, and obesity. Earlier in the shift, the client was alert, talking with family, and using the incentive spirometer with coaching. Now the nurse enters the room and finds the client suddenly restless and saying, “I can’t catch my breath.”

Assessment findings include respiratory rate 30/min, heart rate 118/min, blood pressure 146/84 mm Hg, oxygen saturation 88% on room air, and temperature 37.1 C. The client reports sharp chest pain that worsens with inhalation. The operative dressing is dry and intact. The right leg has expected postoperative swelling, but the calf appears more firm than it did 2 hours ago.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Assist the client to a high-Fowler position and apply oxygen per protocol
2. B. Encourage the client to use the incentive spirometer 10 times each hour
3. C. Administer prescribed PRN opioid medication for postoperative pain
4. D. Reassess the surgical dressing and document the calf measurement

Correct Answer

A. Assist the client to a high-Fowler position and apply oxygen per protocol

Detailed Rationale

This client may be experiencing a pulmonary embolism. The clues matter: sudden shortness of breath, pleuritic chest pain, tachypnea, tachycardia, low oxygen saturation, restlessness, and a firm postoperative calf. After hip surgery, the risk for deep vein thrombosis and embolization is significant because surgery, immobility, and tissue injury all increase clot formation.

The nurse’s first action is to support oxygenation. Positioning the client upright helps expand the lungs and reduces the work of breathing. Applying oxygen addresses immediate hypoxemia. This follows the airway, breathing, circulation approach. When a client shows signs of acute respiratory compromise, the nurse does not start with documentation, routine postoperative teaching, or pain medication.

After oxygen is applied, the nurse should quickly stay with the client, perform focused reassessment, and notify the provider or rapid response team based on facility policy and the client’s stability. Important follow-up assessment includes lung sounds, skin color, level of consciousness, worsening chest pain, and trends in oxygen saturation and vital signs. The nurse should also assess for signs of hemodynamic decline such as hypotension, cyanosis, or increasing anxiety, because these can signal worsening gas exchange and impaired circulation.

The nurse should limit unnecessary activity. If a clot has dislodged, excessive movement may worsen cardiopulmonary stress. The client should remain on bed rest until further evaluation. Expect additional interventions such as continuous pulse oximetry, arterial blood gases, ECG, chest imaging, anticoagulation, or transfer to a higher level of care depending on severity and provider orders.

This question is really testing priority thinking. The nurse is not being asked to diagnose the embolism with certainty. The nurse is being asked what to do first when the client shows signs of sudden respiratory distress. In NCLEX terms, the best answer is the one that protects life in the next few minutes.

Why the Other Options Are Wrong

B. Encourage the client to use the incentive spirometer 10 times each hour

This is a good routine postoperative intervention for preventing atelectasis, but it is not the priority in an acutely unstable client. Incentive spirometry is preventive and supportive. It does not address sudden hypoxemia and chest pain that suggest a more urgent problem.

C. Administer prescribed PRN opioid medication for postoperative pain

The client’s pain is not the main issue here. The sharp chest pain with breathing is a red flag for pulmonary involvement, not simple incisional pain. An opioid could also mask symptoms and, in some cases, worsen respiratory status. The nurse must address oxygenation first.

D. Reassess the surgical dressing and document the calf measurement

The calf finding is clinically important because it supports possible deep vein thrombosis. Still, documenting or measuring is not the first action when the client is short of breath and hypoxic. Assessment details can continue after the nurse begins immediate supportive care.

Key Takeaways

• After orthopedic surgery, sudden dyspnea, pleuritic chest pain, tachycardia, and low oxygen saturation should raise concern for pulmonary embolism.
• Use ABC priorities. If breathing is threatened, support oxygenation first.
• High-Fowler positioning and oxygen are immediate nursing actions that buy time and improve gas exchange.
• Restlessness can be an early sign of hypoxia, even before severe visible distress appears.
• Do not get pulled toward routine postoperative tasks when the client is showing acute deterioration.

• On-shift mini-checklist: Stay with the client, sit them up, apply oxygen, obtain full vital signs, reassess respiratory effort and mentation, call for help, and prepare for urgent diagnostics and escalation of care.

Quick Practice Extension

1. A postoperative client has mild shortness of breath, a low-grade fever, and diminished breath sounds at the bases the morning after abdominal surgery. Which finding would make atelectasis more likely than pulmonary embolism?
2. A client receiving anticoagulation for confirmed deep vein thrombosis reports new gum bleeding and dark stools. Which nursing assessment and action should come first?

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