A patient has a respiratory rate of 24 and is complaining of shortness of breath. What should the nurse do first?

When a patient reports shortness of breath with an elevated respiratory rate, the nurse's priority first action is to assess oxygen saturation. Obtaining a pulse oximetry reading is a rapid, non-invasive assessment that provides objective data about the patient's oxygenation status and guides all subsequent interventions. Without this data point, the nurse cannot determine the severity of the problem or choose the appropriate level of intervention. Elevating the head of the bed is a helpful comfort measure that improves lung expansion, but it should not precede assessment. Administering 100% oxygen may be harmful to certain patients — for example, those with chronic obstructive pulmonary disease who rely on hypoxic drive — so it should not be initiated without assessing the clinical picture first. Notifying the healthcare provider is important but should come after an initial assessment so that the nurse can report objective data. The nursing process dictates that assessment always precedes intervention. The keyed answer of elevating the head of the bed is therefore incorrect; obtaining an oxygen saturation level is the correct first action because it follows the assess-before-act principle and yields essential clinical information.