Free NCLEX RN Practice Questions Practice Question
The nurse is assessing a client upon arrival to the emergency department. Partial airway obstruction is suspected. Which clinical manifestation is a late sign of airway obstruction?
Correct Answer: C
Rationale: Cyanotic ear lobes indicate a significant lack of oxygen, suggesting advanced airway obstruction. This late sign reflects severe hypoxia and requires immediate intervention.
In contrast, rales (A) are associated with fluid in the lungs and do not specifically indicate airway obstruction. Restlessness (B) is an early sign of distress and may occur before airway obstruction becomes critical. Inspiratory stridor (D) is also an early indicator of upper airway obstruction, characterized by a high-pitched sound during inhalation. Recognizing these distinctions is crucial for timely and effective treatment.
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