The client with which conditions requires immediate nursing intervention? (Select all that apply.)
a. Shortness of breath
b. Sternal retractions
c. Pulse oximetry reading of 95%
d. Occasional expiratory wheeze
e. Respiratory rate of 8 breaths/min
f. Arterial blood gas showing a pH of 7.35
g. Stridor
A, B, E, G
The client with sternal retraction is experiencing serious respiratory difficulty, as is the client with stridor. The client who reports shortness of breath needs immediate assessment, as does the client with a respiratory rate of 8 . A pulse oximetry of 95% is within normal limits, as is a pH of 7.35 . The client with expiratory wheezes needs to be assessed, but not immediately.
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