The nurse enters the client's room and before he can take vital signs,he hears a piercing,high-pitched sound coming from the client when he breathes.The nurse's initial next best action is to:

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These sounds are known as stridor and indicate that the client is in respiratory distress or has an obstructed airway.The nurse's initial action is to assess the patency of the airway.Coughing would help if the problem involved rhonchi.Stridor requires an immediate assessment of the client's airway patency.

The Nurse Enters the Client's Room and Before He Can