After six days on a mechanical ventilator, a client is extubated and placed on 40% oxygen via face mask. The client is awake and cooperative, but reports having a severe sore throat. While sipping water to swallow a medication, the client begins coughing, as if airway is restricted. Which intervention is most important for the nurse to implement?

Rationale: A. Hold oral intake until swallow evaluation is done: The client is exhibiting signs of potential dysphagia or airway compromise after extubation. Continuing oral intake could lead to aspiration, airway obstruction, or respiratory complications, making it the most urgent safety concern. B. Administer PRN IV pain medication: Pain management is important for comfort and to facilitate breathing and mobility, but it does not address the immediate risk of aspiration or airway compromise. C. Elevate the head of the bed at least 45 degrees: Elevating the head helps reduce aspiration risk and supports respiratory function, but it is a supportive measure that does not replace the need to withhold oral intake until swallowing is formally assessed. D. Titrate the oxygen to keep saturation above 92%: Maintaining oxygenation is important, but the client’s immediate risk is airway obstruction and aspiration. Oxygen supplementation alone will not prevent these complications if oral intake continues unsafely.