When the nurse discontinues a 24-hour postoperative client’s patient-controlled analgesia (PCA) pump, the client asks to go to the hospital’s smoking area to smoke a cigarette. Which response should the nurse provide?

Choice A reason: Keeping pressure on the abdomen and coughing is incorrect for diaphragmatic breathing, which enhances lung expansion, not airway clearance. Coughing is for post-drainage. The client’s incorrect technique (abdominal expansion on exhalation) requires correction, as this reverses mechanics, reducing ventilation efficiency in conditions like COPD.

Choice B reason: The client’s technique is incorrect, expanding the abdomen on exhalation, not inhalation, reducing diaphragmatic efficacy. Confirming it as correct is wrong, as it impairs lung expansion. Demonstrating proper technique corrects the error, ensuring effective breathing to improve oxygenation, addressing the physiological need for ventilation.

Choice C reason: Documenting success is inaccurate, as the client’s technique is reversed, expanding the abdomen on exhalation. Diaphragmatic breathing requires inhalation expansion to lower the diaphragm, increasing lung capacity. Correcting the technique via demonstration ensures proper mechanics, not documenting an ineffective method that hinders ventilation.

Choice D reason: Demonstrating proper diaphragmatic breathing corrects the client’s error of exhalation expansion. Inhaling expands the abdomen via diaphragmatic descent, increasing tidal volume; exhaling relaxes it. This optimizes ventilation, addressing the need for effective breathing in conditions requiring enhanced lung function, ensuring the client learns the correct technique.

Choice A reason: Observing chest wall shape assesses for abnormalities like barrel chest, not tactile fremitus. Fremitus involves feeling vocal vibrations, increased in pneumonia due to consolidated lung tissue. Visual inspection does not evaluate vibration transmission, making it irrelevant for assessing fremitus in suspected pneumonia.

Choice B reason: Tactile fremitus is assessed by placing the palm on the chest while the client speaks, feeling vibrations through consolidated lung tissue in pneumonia. Fluid-filled alveoli enhance sound transmission, increasing fremitus. This directly evaluates lung pathology, confirming consolidation, critical for diagnosing pneumonia’s extent and severity.

Choice C reason: Using a stethoscope assesses breathing sounds like crackles, not tactile fremitus, which requires palpation of vocal vibrations. While breath sounds aid pneumonia diagnosis, fremitus specifically evaluates consolidation via vibration, making stethoscope use incorrect for this physical assessment technique focused on lung tissue density.

Choice D reason: Compressing tissue for crackling assesses crepitus or subcutaneous emphysema, not fremitus. In pneumonia, fremitus increases due to consolidation, not tissue compression. This method is irrelevant, as fremitus relies on vocal vibration transmission through palpation, making it inappropriate for assessing pneumonia-related lung changes.