# A 58-year-old client who underwent open cholecystectomy 18 hours ago has a respiratory rate of 22, oxygen saturation of 94% on room air, and incisional pain rated 6/10 with deep breathing. The client has smoked one pack of cigarettes daily for 30 years. Which nursing actions should the nurse include in the plan to reduce the risk of postoperative atelectasis? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=558419&lang=en > language: en > subject: System-Specific Assessments > category: ROR ## Question A 58-year-old client who underwent open cholecystectomy 18 hours ago has a respiratory rate of 22, oxygen saturation of 94% on room air, and incisional pain rated 6/10 with deep breathing. The client has smoked one pack of cigarettes daily for 30 years. Which nursing actions should the nurse include in the plan to reduce the risk of postoperative atelectasis? Select all that apply. 1 Administer prescribed analgesia 30 minutes before scheduled deep-breathing and coughing exercises. 2 Apply an abdominal binder continuously throughout the day to reduce incisional pain with movement. 3 Administer supplemental oxygen via nasal cannula to maintain oxygen saturation above 97%. 4 Assist the client to high Fowler's position before beginning incentive spirometry and coughing. 5 Encourage incentive spirometer use for 10 sustained breaths every hour while the client is awake. 6 Have the client perform coughing exercises every 15 minutes to maximize secretion clearance. ## Explanation Postoperative atelectasis prevention targets mechanical lung expansion through analgesia, upright positioning, and frequent incentive spirometry. Prescribed analgesia given before respiratory exercises reduces splinting and enables deep inspiration. High Fowler's position decreases abdominal pressure on the diaphragm, maximizing tidal volume. Incentive spirometry every hour while awake provides sustained maximal inspiration that re-expands alveoli. An abdominal binder used continuously can restrict diaphragmatic excursion despite reducing pain. Supplemental oxygen improves saturation but does not reverse alveolar collapse and may mask hypoventilation. Coughing every 15 minutes is excessive, disrupts recovery rest, and exceeds the recommended frequency of every 1 to 2 hours while awake. ## In-depth explanation Correct Answer Choices 1, 4, 5 Clinical Reasoning Postoperative atelectasis prevention targets mechanical lung expansion through analgesia, upright positioning, and frequent incentive spirometry. Prescribed analgesia given before respiratory exercises reduces splinting and enables deep inspiration. High Fowler's position decreases abdominal pressure on the diaphragm, maximizing tidal volume. Incentive spirometry every hour while awake provides sustained maximal inspiration that re-expands alveoli. An abdominal binder used continuously can restrict diaphragmatic excursion despite reducing pain. Supplemental oxygen improves saturation but does not reverse alveolar collapse and may mask hypoventilation. Coughing every 15 minutes is excessive, disrupts recovery rest, and exceeds the recommended frequency of every 1 to 2 hours while awake. Option Review - Correct — Administering prescribed analgesia before respiratory exercises reduces pain-related splinting, allowing the client to achieve the deep inspiration necessary to prevent alveolar collapse after abdominal surgery. - Incorrect — Although an abdominal binder may reduce incisional pain, continuous application can restrict diaphragmatic excursion and abdominal movement, potentially worsening atelectasis rather than preventing it in this client. - Incorrect — Supplemental oxygen treats hypoxemia but does not address the mechanical alveolar collapse of atelectasis, which requires lung expansion maneuvers such as deep breathing and incentive spirometry. - Correct — High Fowler's position minimizes abdominal pressure on the diaphragm and promotes maximal lung expansion, making incentive spirometry and coughing more effective for preventing postoperative atelectasis. - Correct — Incentive spirometry performed for 10 breaths every hour while awake provides the sustained maximal inspiration needed to re-expand alveoli and prevent progressive collapse in this postoperative client. - Incorrect — While coughing helps clear secretions, performing exercises every 15 minutes is excessive and disrupts the rest needed for recovery; the recommended frequency is every 1 to 2 hours while awake. Sources 12026 NCLEX-RN Test Plan 2MedlinePlus: Deep breathing after surgery 3AHRQ: Interventions to prevent nonventilator hospital-acquired pneumonia ## Clinical scenario A 58-year-old client on postoperative day 1 after open cholecystectomy has a respiratory rate of 22, oxygen saturation of 94% on room air, incisional pain rated 6/10 with deep breathing, and a 30-pack-year smoking history. ## Related questions - [A nurse on a medical-surgical unit reviews the morning labs for a 67-year-old male client …](https://mymerci.kr/pages/nclex_q.php?qn_id=361711&lang=en) - [A 6-year-old client is on the pediatric surgical unit on postoperative day 1 following ton…](https://mymerci.kr/pages/nclex_q.php?qn_id=361812&lang=en) - [A 45-year-old female client with severe iron-deficiency anemia is receiving the first unit…](https://mymerci.kr/pages/nclex_q.php?qn_id=361898&lang=en) - [A 72-year-old male client is receiving a continuous IV heparin infusion for a left lower-e…](https://mymerci.kr/pages/nclex_q.php?qn_id=362064&lang=en) - [A nurse is monitoring an adult client 4 hours after an open abdominal hysterectomy. 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