A patient with a partial obstruction who can cough forcefully is encouraged to keep coughing and is not interrupted.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is assessing a child with suspected upper airway obstruction. A loud, high-pitched crowing sound is heard on inspiration without a stethoscope. What does this finding indicate, and what is the priority action?
Answer: B. Stridor is a harsh, high-pitched inspiratory sound caused by obstruction of the upper airway (larynx or trachea). It signals a potentially life-threatening airway emergency, so the priority is to ensure airway patency and notify the provider immediately.
Question 2 of 5
A nurse is assessing a client in the PACU and notes a high-pitched crowing sound during inspiration. Which is the nurse's priority interpretation and action?
Answer: A. Stridor, a high-pitched crowing sound, indicates upper airway obstruction or laryngospasm, an airway emergency in the PACU. The nurse must act immediately to support the airway, including repositioning, applying oxygen, and summoning help, because airway compromise is the highest priority.
Question 3 of 5
A nurse is assessing a child for foreign-body aspiration after a sudden coughing and choking episode while eating peanuts. Which finding most strongly suggests a partially obstructing airway foreign body?
Answer: B. A partial airway obstruction from an aspirated foreign body typically produces unilateral decreased breath sounds, localized wheezing, and persistent cough on the affected side. Symmetric clear breath sounds would argue against significant obstruction.
Question 4 of 5
A client in the post-anesthesia care unit (PACU) is being assessed. Which finding is the highest priority for the nurse to address first?
Answer: B. Airway and breathing always come first. Oxygen saturation of 85 percent with snoring respirations suggests airway obstruction, the most life-threatening problem, and is addressed first. Pain, mild hypothermia, and minimal drain output are important but secondary to airway and oxygenation.
Question 5 of 5
For an unconscious adult with a foreign-body airway obstruction who becomes unresponsive, what should the rescuer do?
Answer: B. When a choking adult becomes unresponsive, the rescuer should lower the person to the ground and begin CPR, checking the mouth for the object before each set of breaths and removing it only if visible.
Keep the streak going with more questions like these, each with a full rationale.
What is choking and airway obstruction?
A complete obstruction is a true emergency requiring immediate abdominal thrusts. The priority is restoring a patent airway because oxygenation is the most basic survival need.
Key points to remember
- A patient with a partial obstruction who can cough forcefully is encouraged to keep coughing and is not interrupted.
- Complete obstruction is marked by the universal choking sign, inability to speak, silent cough, and cyanosis.
- Abdominal thrusts (Heimlich maneuver) are used for conscious choking adults and children over 1 year.
- Infants under 1 year receive 5 back blows followed by 5 chest thrusts, never abdominal thrusts.
- If the patient becomes unresponsive, lower them to the floor and begin CPR, checking the mouth for the object before breaths.
- Chest thrusts replace abdominal thrusts in pregnant or obese patients.
Signs & symptoms
- No air, cyanosis, silence
- Pregnant/obese → chest thrusts
Nursing priorities
- Assess whether the cough is effective; encourage coughing if air exchange is present.
- Deliver abdominal thrusts for a conscious adult with complete obstruction until the object clears.
- Begin CPR if the patient becomes unresponsive and check for a visible object before each set of breaths.
- Give high-flow oxygen and reassess airway patency once the object is removed.
- Anticipate the need for suction, laryngoscopy, or emergency cricothyrotomy if obstruction persists.
Patient teaching
- Cut food into small pieces, chew thoroughly, and avoid talking or laughing while eating.
- Keep small objects, balloons, and hard foods like grapes and nuts away from young children.
- Learn to recognize the universal choking sign and how to perform abdominal thrusts.
Red flags: report now
- A silent cough, inability to speak, or cyanosis indicates complete obstruction - intervene now.
- Never perform blind finger sweeps, as they can push the object deeper.
- Never use abdominal thrusts on an infant under 1 year.
- Report stridor or worsening respiratory distress immediately.
References
Clinical references for this topic
