Which client meets the goal "client will maintain patent airway"?
1. The client snores sleeping on the back.
2. Client unable to raise thick, yellow sputum.
3. Client oxygen saturation is 98% on room air.
4. The client has rhonchi in trachea and bronchi.
3
3. The client with an oxygen saturation of 98% on room air has adequate ventilation without supplemental oxygen, impossible without an adequate airway.
1. Partial, intermittent airway occlusion leads to snoring while sleeping on the back.
2. If thick, yellow sputum accumulates in airways, the affected airways will occlude. If the client cannot cough out the secretions, the client is not maintaining a patent airway.
4. Rhonchi indicate fluid or turbulence in the trachea and bronchi and are evidence of ineffective airway clearance.
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