The reliable indicator of respiratory status of a patient is :

Appeared in: IGNOU PB Bsc Entrance-2023

Explanation

This is the most direct method to confirm ventilation (air exchange) is occurring.
It is a core component of the 'Look, Listen, and Feel' technique used in basic life support and initial patient assessment.
Feeling exhaled air on the cheek and hearing breath sounds provides immediate, definitive evidence of a patent airway and active breathing.
Unlike other signs which can be misleading or delayed, confirming airflow is the most reliable indicator of immediate respiratory function.

Option A: Observing chest symmetry only confirms respiratory effort, not effective air exchange. A patient can have chest movement without any air entering the lungs, such as in an airway obstruction.
Option B: Cold and clammy skin is a sign of circulatory compromise (shock) or a sympathetic nervous system response. It is not a primary or direct indicator of respiratory status.
Option D: Determining a pulse assesses the circulatory system, not the respiratory system. It checks for cardiac output and blood flow.

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment of Respiratory Status to guide bedside assessment, documentation, and the next nursing action.
In any emergency, a nurse's first step is to assess the ABCs: Airway, Breathing, and Circulation. 'Listen and feel' directly assesses 'Breathing'.
Failure to quickly and accurately assess breathing can lead to delayed intervention, resulting in hypoxia, brain damage, or death.
This skill is not just for emergencies. On the ward, a nurse might use this technique to quickly check on a post-operative patient who is heavily sedated or a patient with a known respiratory condition.

How to Approach the Question

First, identify the core concept of the question: assessing 'respiratory status'. This means you are looking for an indicator of breathing or air exchange.
Analyze the keyword 'reliable'. This implies you need to find the most direct and foolproof indicator among the choices.
Evaluate each option based on the ABCs (Airway, Breathing, Circulation).
Option A (Chest symmetry) relates to 'Breathing' but can be misleading.
Option B (Clammy skin) relates more to 'Circulation' (shock).
Option C (Listen and feel air movement) is a direct assessment of 'Breathing'.

Concept Tested & Keywords

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E6 Nursing Vital Signs pp. 68-70, 69-71

E6 Nursing Fundamentals Taylor p. 714-716

Practise the full IGNOU PB Bsc Entrance-2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.