The nurse is caring for a client.

For each assessment finding, click to specify if the assessment finding is consistent with pulmonary embolism, pneumonia, or pneumothorax. Each finding may support more than one disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

A. High Fowler's: High Fowler’s position can assist with respiratory effort and comfort, but it does not specifically optimize cardiac output in a pregnant client. Upright positioning alone may not relieve pressure from the gravid uterus on major vessels.

B. Left lateral: Placing the client in the left lateral position relieves pressure of the uterus on the inferior vena cava and aorta, enhancing venous return to the heart and improving cardiac output. This position is especially important in clients with cardiac disease to reduce the risk of supine hypotensive syndrome and optimize maternal and fetal circulation.

C. Standing: Standing does not provide support for venous return and can increase the workload on the heart, potentially exacerbating cardiac compromise. It is not recommended for prolonged periods in clients with cardiac disease during pregnancy.

D. Supine: Supine positioning can compress the inferior vena cava and aorta, reducing venous return and cardiac output. This can lead to hypotension and decreased perfusion to both the mother and fetus, making it unsafe for pregnant clients with cardiac disease.

Rationale for correct choices

• Pneumonia: The child has shallow respirations, diminished breath sounds at the bases, and repeated refusal to use the incentive spirometer, all of which decrease lung expansion. Postoperative abdominal pain further limits deep breathing, increasing atelectasis risk that can progress to pneumonia.

• Shallow breathing: Shallow respirations reduce alveolar ventilation and impair airway clearance, predisposing the child to atelectasis and subsequent pneumonia. Pain from the abdominal incision discourages deep breathing, worsening shallow breathing over time. The diminished breath sounds at the lung bases confirm reduced expansion.

Rationale for incorrect choices

• Wound infection: The abdominal dressing remains dry and intact throughout the shift, with no redness, swelling, or drainage. The child’s temperature is only mildly elevated and does not reflect a pattern typical of surgical site infection. Pain is generalized postoperative discomfort rather than localized wound changes. No wound findings suggest progression toward infection.

• Peritonitis: Although abdominal tenderness is present, this is expected after appendectomy and shows no signs of guarding, rigidity, or rebound tenderness. The child remains alert and interactive, which is inconsistent with systemic peritoneal infection. Vital signs remain stable aside from mild tachycardia that can accompany pain. These findings argue against peritonitis.

• Temperature: The temperature remains below the threshold for concern and is only slightly elevated, which is common postoperatively and not specific to pneumonia. Temperature changes alone do not provide clear evidence for the identified risk. More reliable indicators include respiratory patterns and breath sound changes.

• Bowel sounds: Absent bowel sounds are expected for several hours postoperatively and do not relate to respiratory complications such as pneumonia. This finding reflects postoperative ileus rather than pulmonary risk.