Nokea
A client with pneumonia has a fever of 101.4° F (38.6° C) a nonproductive cough and an O2 saturation of 88%. The client is weak and needs assistance to get out of bed. Which client problem should the nurse assign as the priority?
Correct Answer: D
Rationale: The correct answer is D, Impaired gas exchange. This is the priority because the client's O2 saturation of 88% indicates poor oxygenation, which can lead to serious complications like hypoxemia. The fever and nonproductive cough are symptoms of pneumonia contributing to impaired gas exchange. Addressing this issue is crucial to prevent respiratory distress.
A: Fatigue - While important, fatigue is a secondary concern compared to impaired gas exchange, which directly affects oxygenation and can be life-threatening.
B: Hyperthermia - The client's fever is likely related to the pneumonia but managing impaired gas exchange takes precedence as it directly impacts oxygen delivery to tissues.
C: Impaired mobility - While assisting the client out of bed is necessary, the priority is to address the underlying problem of impaired gas exchange to prevent respiratory compromise.