The nurse is caring for a client with pneumonia has a fever of 38.4°C (101.1°F), a nonproductive cough, and an oxygen saturation of 89%. The client is very weak and needs assistance to get out of bed. Which of the following nursing diagnoses is priority?
A)Hyperthermia related to increase in metabolic rate (illness)
B)Impaired transfer ability related to insufficient muscle strength
C)Ineffective airway clearance related to retained secretions
D)Ineffective breathing pattern related to respiratory muscle fatigue

Question

Quizplus · Accepted Answer

All these nursing diagnoses are appropriate for the client, but the client's oxygen saturation indicates that all body tissues are at risk for hypoxia unless their breathing pattern is improved.

The Nurse Is Caring for a Client with Pneumonia Has