Postoperative Exercises: Diaphragmatic Breathing and Controlled Coughing

6. When the nurse is demonstrating deep-breathing exercises, the patient should be instructed to place his or her hands in which position? A. Along the lower borders of the anterior rib cage B. Straight down by the sides of the body C. Behind the back, to maximize chest expansion D. Flat across the upper half of the chest wall

A. Along the lower borders of the anterior rib cage Rationale: Positioning the hands along the lower borders of the anterior rib cage allows the patient to feel movement of the abdomen as the diaphragm descends and the lungs expand inside the chest wall. This reinforces the teaching by giving the patient an understanding of the technique while also providing the memory of how it should feel. Positioning the hands straight down by the sides of the body, behind the back, or across the upper half of the chest wall will not provide this teaching reinforcement.

10. When a nurse is teaching a patient about diaphragmatic breathing, which teaching technique is most effective? A. Demonstration, then coaching B. Explanation, then providing pamphlets C. Pictures, then explanation D. Pamphlets, then coaching

A. Demonstration, then coaching Rationale: Demonstration should always be used when teaching a patient about diaphragmatic breathing. Coaching the patient after demonstration will reinforce the techniques. Explanation, pamphlets, and pictures may all help reinforce education, but demonstration with coaching allows the patient to see the technique, then practice it with feedback.

8. Which patient is at the greatest risk for postprocedure respiratory complications? A. A 6-year-old child having a tonsillectomy B. A 73-year-old woman having a laparoscopic cholecystectomy C. A 48-year-old man having a lumbar fusion of L1 and L2 D. A 29-year-old woman having a laparoscopic appendectomy

B. A 73-year-old woman having a laparoscopic cholecystectomy Rationale: Age greater than 60 years negatively affects chest wall movement and puts a patient at greater risk for respiratory complications after surgery. Young children have natural responses of crying that maintain lung expansion. The 48-year-old man and the 29-year-old woman are not at greater risk for respiratory complications, as gender and type of surgery do not affect the risk of respiratory complications unless a surgery lasts more than 3 hours.

3. Diaphragmatic breathing and controlled coughing should be taught to a patient postprocedure to prevent which of these respiratory complications? A. Pleuritic pain B. Atelectasis C. Prolonged inhalation and expirations D. Increased lung volumes

B. Atelectasis Rationale: Diaphragmatic breathing and controlled coughing should be taught to a patient postprocedure to prevent atelectasis, which occurs when the alveoli deflate or become filled with alveolar fluid or secretions. A buildup of secretions can cause a bacterial secondary infection that may result in pneumonia. Diaphragmatic breathing and controlled coughing are not used to prevent pleuritic pain, prolonged inhalation and expiration, or increased lung volumes.

5. When assessing a patient for the presence of pulmonary complications, the nurse should consider which finding or situation? A. Whether patient's lung sounds are clear after coughing B. Time of day when the patient produces sputum C. Color of sputum D. Length of time between the patient's periods of coughing and deep breathing

C. Color of sputum Rationale: The color of sputum may indicate that the patient has an infection, which may lead to pulmonary complications. The time of day when a patient produces sputum has no relationship to the presence of pulmonary complications, nor does the length of time between periods of coughing and deep breathing. If the patient's lung sounds are clear after coughing, this is a good sign, but it does not necessarily indicate whether or not the patient is experiencing pulmonary complications.

2. The nurse is preparing to teach the patient diaphragmatic breathing. Into which position should the nurse assist the patient? A. Side-lying position B. Supine position C. High-Fowler position D. Trendelenburg position

C. High-Fowler position Rationale: The patient should maintain an upright (high-Fowler) position when practicing controlled coughing to facilitate diaphragm excursion and enhance thorax and abdominal expansion. Supine, side-lying, and Trendelenburg positions are not recommended for controlled coughing because these positions do not facilitate diaphragm excursion and do not enhance thorax and abdominal expansion.

1. The nurse is educating a patient who has a thoracic or abdominal incision about how to perform postprocedure controlled coughing. Which instruction is appropriate for this patient? A. Cough two or three times and inhale between each cough. B. Repeat the breathing exercises twice each day. C. Place a pillow over the incision site for splinting. D. Use the chest and shoulder muscles while inhaling during diaphragmatic breathing.

C. Place a pillow over the incision site for splinting. Rationale: The patient can be taught to splint the incision site either by placing a pillow over the incision site and then placing his or her hands over the pillow before coughing or by simply placing his or her hands directly over the incision site before coughing. The patient should be instructed to cough fully for a few consecutive coughs without inhaling between coughs; such consecutive coughs help remove mucus more effectively and completely than one forceful cough. The nurse should instruct the patient to avoid using chest and shoulder muscles while inhaling during diaphragmatic breathing because using these muscles during breathing results in unnecessary energy expenditure and does not promote full lung expansion.

7. Which intervention has a positive influence on a patient's postprocedure recovery and helps improve the patient's physical and psychological outcomes? A. Written postprocedure instructions B. "Just in time" postprocedure education C. Structured preprocedure education D. Recorded preprocedure education

C. Structured preprocedure education Rationale: Structured preprocedure teaching has a positive influence on a patient's postprocedure recovery and helps improve the patient's physical and psychological outcomes. By learning techniques before the operative or invasive procedure, the patient has a chance to ask questions and practice the techniques. Written postprocedure instructions, "just in time" postprocedure teaching, and recorded preprocedure teaching alone do not provide the patient with same opportunities to learn as structured preprocedure teaching.

9. Which technique should be used to assist a postprocedure patient who needs to expectorate mucus from deeper airways? A. Clearing the throat B. One forceful cough C. Quick shallow breaths D. Consecutive coughs

D. Consecutive coughs Rationale: Consecutive coughs help remove mucus most effectively and less painfully for the postprocedure patient. Clearing the throat will not remove mucus from the deeper airways. One forceful cough will be more painful and less effective than consecutive coughs. Quick shallow breaths will not assist in bringing up mucus.

4. When the nurse is explaining how to perform diaphragmatic breathing, what type of breaths should he or she instruct the patient to take? A. Four rapid breaths through the nose B. Several shallow breaths through the mouth C. Short, deep breaths through the mouth D. Slow, deep breaths through the nose

D. Slow, deep breaths through the nose Rationale: Instructing the patient to take slow, deep breaths, inhaling through the nose, allows for more complete lung expansion, thus preventing panting or hyperventilation. Taking several shallow breaths or rapid breaths does not allow the lungs to expand fully and increases the patient's risk for developing respiratory complications such as atelectasis.