During the assessment of a client recovering from surgery, the nurse n

During the assessment of a client recovering from surgery, the nurse notes decreased breath sounds in both lower lobes bilaterally. What should the nurse do?

1. Coach the client to deep-breathe and cough.
2. Restrict fluids.
3. Remind the client to perform leg exercises.
4. Maintain on bed rest.

ANSWER

Correct Answer: 1
Rationale 1: The reduction of breath sounds could indicate the pooling of secretions in the lower lobes. The nurse should coach the client to deep-breathe and cough.
Rationale 2: Restricting fluids could cause the pulmonary secretions to thicken, making them more difficult for the client to cough and remove.
Rationale 3: Leg exercises will not improve breath sounds.
Rationale 4: Bed rest will not improve the client’s breath sounds.