A child presents to the emergency department with cutaneous manifestations of an allergic response. Which nursing diagnosis takes priority?
A. Altered comfort related to itching lesions
B. Impaired tissue integrity related to lesions
C. Knowledge deficit related to unknown condition
D. Risk for impaired airway secondary to edema
ANS: D
Usually, actual nursing diagnoses take priority over "risk for" diagnoses, but in this case, risk for impaired airway is the priority. The child's airway can quickly become compromised due to laryngeal edema. The nurse places priority on frequent assessments of the child's airway. The other diagnoses are relevant, but not as important as the potential for compromised airway.
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