Which of the following signals a need for suctioning?

The correct choice indicates that signs and symptoms of respiratory distress are a clear indication that suctioning may be necessary. Respiratory distress can manifest as increased work of breathing, such as rapid or shallow breaths, use of accessory muscles, cyanosis, or stridor. In such situations, the airway may be compromised due to secretions or obstruction, necessitating suctioning to maintain patient safety and adequate oxygenation.

The other options do not directly suggest a need for suctioning. A pulse rate of 90 beats per minute may be normal or indicative of other issues but does not intrinsically point to airway blockage or the need for clearing secretions. The orthopneic position, which is often adopted by patients with respiratory issues for better airflow, does not necessarily require suctioning unless accompanied by one of the warning signs of distress. Lastly, being unable to speak could imply an airway issue, but it needs to be assessed in conjunction with other signs or symptoms to determine if suctioning is required. The presence of respiratory distress is a more definitive signal for immediate intervention.