A client is diagnosed with a pulmonary embolism (PE) on postoperative day 4 after undergoing a total knee replacement.
The nurse knows that a PE is most likely to occur as a result of which postoperative complication?

Choice D rationale

During a bronchoscopy, a local anesthetic is typically sprayed onto the back of the throat to suppress the gag reflex and allow the scope to pass. It is unsafe for the client to ingest food or fluids until this reflex has fully returned, as there is a high risk of aspiration and choking. The nurse must manually test for the return of the gag reflex using a tongue blade or by observing a successful swallow before allowing oral intake.

Choice A rationale

There is no fixed rule that a client must wait exactly 8 hours after a bronchoscopy before they can eat. The recovery period is entirely dependent on how quickly the local anesthetic wears off and the gag reflex returns. For some patients, this might happen in 2 hours, while for others it may take longer. Setting a rigid 8-hour timeframe is not evidence-based and could unnecessarily delay nutrition or fail to account for a delayed recovery of airway protection.

Choice B rationale

Waiting 24 hours to consume anything other than cold liquids is an unnecessary restriction following a standard bronchoscopy. Cold liquids are sometimes used to soothe a sore throat, but they are not a requirement for a full day. The primary clinical concern is the safety of the airway. Once the gag reflex is present, the client can usually progress to a normal diet as tolerated, provided there are no other surgical complications or specific orders from the physician.

Choice C rationale

It is common for a client to have small amounts of blood-tinged sputum or "pink" secretions for a short time after a bronchoscopy due to tissue irritation or biopsy. While the nurse should monitor for heavy bleeding, the presence of minor streaks of blood is not a contraindication for eating. The determining factor for the safety of oral intake remains the functional status of the swallow and gag reflexes rather than the total absence of any blood in sputum.

Choice A rationale

If a person is able to run from the room, it indicates that they still have some level of functional consciousness and physical coordination. While the person may be in distress or panicking, the act of running suggests that their airway is not yet completely obstructed to the point of immediate collapse. However, the nurse should still follow the individual to ensure they do not lose consciousness in a private area where help is unavailable.

Choice B rationale

Waving hands and experiencing tachypnea, which is a respiratory rate typically greater than 20 breaths per minute, suggests that the individual is still moving air in and out of the lungs. Although the person is clearly distressed and may have a partial airway obstruction, the presence of rapid breathing means oxygen is still reaching the alveoli. The nurse should monitor them closely and encourage them to cough forcefully to dislodge any potential foreign body.

Choice C rationale

Vigorous coughing is a highly positive sign that the airway is only partially obstructed. A forceful cough indicates that the individual can generate enough subglottic pressure to attempt to expel the object. Scientific protocols for choking state that as long as the person is coughing or speaking, the nurse should not perform the Heimlich maneuver, as external pressure could inadvertently push the object deeper into the trachea, causing a total and fatal obstruction.

Choice D rationale

The universal sign for choking is when a person clutches their throat with one or both hands. If they are also unable to speak, cry, or breathe, it signifies a total upper airway obstruction. In this state, no air is passing through the vocal cords, making sound production impossible. This is a life-threatening emergency requiring immediate intervention with abdominal thrusts to create an artificial cough and force the object out using the residual air.