NCLEX RN Prioritization Questions - Nurselytic

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NCLEX RN Prioritization Questions Questions

Extract:


Question 1 of 5

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis?

Correct Answer: A

Rationale: The correct answer is 'Weak, nonproductive cough effort.' A weak, nonproductive cough indicates that the patient is unable to clear the airway effectively, supporting the nursing diagnosis of ineffective airway clearance. In pneumonia, secretions can obstruct the airway, leading to ineffective clearance.

Choices B, C, and D do not directly reflect ineffective airway clearance. Large amounts of greenish sputum (
Choice
B) may suggest infection or inflammation but do not specifically indicate ineffective airway clearance. The respiratory rate of 28 breaths/minute (
Choice
C) and a resting pulse oximetry (SpO2) of 85% (
Choice
D) are more indicative of impaired gas exchange or respiratory distress rather than ineffective airway clearance.

Question 2 of 5

Correct Answer:

Rationale:

Question 3 of 5

Correct Answer:

Rationale:

Question 4 of 5

Correct Answer:

Rationale:

Question 5 of 5

Correct Answer:

Rationale:

Similar Questions

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