Which patient should the nurse assess first based on the presentation of symptoms?

The priority for assessment should focus on the patient with smoke inhalation who is exhibiting wheezing and altered mental status. These symptoms are indicative of respiratory compromise and potential airway obstruction. In burn cases, particularly those involving smoke inhalation, the risk for airway edema and the development of respiratory distress is significant. Wheezing suggests bronchospasm or airway narrowing, while altered mental status may indicate inadequate oxygenation or carbon monoxide poisoning.

Given these factors, the immediate concern is the airway and breathing. Addressing respiratory issues promptly is crucial since they can lead to life-threatening conditions. In burn management, particularly following an incident involving smoke inhalation, ensuring the patient maintains a secure airway and adequate oxygenation is vital.

The other patients listed, while they may have significant concerns, do not have immediate threats to their airway that need rapid intervention as does the patient with symptoms from smoke inhalation. The dressing change for the patient with full-thickness leg burns is important but can wait compared to airway issues. Severe pain from abdominal burns, while distressing, typically does not present an immediate life-threatening situation. Additionally, the patient with major burns receiving IV fluids needs monitoring but does not present with acute distress that necessitates immediate reassessment.