Which method should the practical nurse teach about pulmonary toileting for a pre-operative client?

• A. To use an incentive spirometer at least four times an hour
• B. To breathe deeply through the nose and exhale through the mouth
• C. To hold the breath after deep inhalation
• D. To cough vigorously without incentive spirometer

Answer: (A)

Pulmonary toileting after surgery focuses on keeping the lungs expanded to prevent atelectasis and reduce the risk of pneumonia. An incentive spirometer directly promotes deep, sustained breaths, helping to inflate the alveoli and reopen any collapsed small airways. Teaching the pre-operative client to use it at least four times an hour while awake provides frequent, measurable lung expansion sessions that support better ventilation and gas exchange during the perioperative period. The device gives feedback and guides the patient to inhale to a set volume and hold briefly, which is more effective for preventing postoperative atelectasis than general deep breathing without a device. Holding the breath after a deep inhale isn’t advised here because it doesn’t maximize lung inflation consistently, and coughing vigorously without the incentive spirometer doesn’t reliably promote the same level of alveolar expansion needed right after surgery.