A client after abdominal surgery says, "I will not cough because my incision might open." Which action by the nurse best supports effective coughing and comfort?
1Give prescribed analgesia, sit the client upright, and splint the incision with a pillow✓ Correct answer
2Delay coughing until the next day and continue quiet bed rest for full incision protection
3Keep the client supine and use rapid shallow breaths to limit abdominal movement
4Secure an abdominal binder tightly and avoid coughing until the pain has resolved
Explanation
Analgesia, upright positioning, and gentle pillow splinting reduce discomfort while allowing deep breathing and coughing. Avoiding pulmonary exercises or using shallow breathing increases retained secretion and postoperative respiratory risk.
Quick answer Provide prescribed pain relief, position the client upright, and support the incision with a pillow during coughing. This improves comfort without sacrificing lung expansion and secretion clearance.
Why this is correct Abdominal pain can make clients guard the incision and breathe shallowly after surgery. Supporting the incision reduces movement-related discomfort, while upright positioning and analgesia help the client take deeper breaths and cough more effectively.
Easy analogy or mental picture A pillow acts like a gentle external hand supporting a door frame while the door moves. It does not seal or immobilize the incision; it only reduces uncomfortable pulling while breathing and coughing continue.
Memory hook Control pain, sit up, support the incision, then breathe deeply and cough.
NCLEX decision rule When postoperative pain limits coughing, improve comfort and mechanics rather than eliminating the pulmonary exercise. Use ordered analgesia, upright positioning, and gentle splinting, then reassess breathing and pain.
Why the other choices are wrong Delaying coughing and maintaining bed rest promote secretion retention. Supine shallow breathing reduces lung expansion, and a tightly secured binder with continued cough avoidance substitutes restriction for safe pulmonary hygiene.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
MedlinePlus: Deep Breathing After SurgeryU.S. National Library of Medicine, reviewed 2025