A nurse is reinforcing teaching for a client who presents with a pulmonary embolism. Which of the following information should the nurse provide?

A. Expiratory wheeze

Expiratory wheeze is a high-pitched, musical sound heard primarily during expiration. It occurs when air passes through narrowed airways due to bronchoconstriction, inflammation, and increased mucus production, which are characteristic features of an acute asthma exacerbation. Expiratory wheezes are commonly heard upon auscultation of the chest in individuals experiencing asthma exacerbations.

B. Pleural friction rub

Pleural friction rub is a dry, crackling or grating sound heard during both inspiration and expiration. It typically occurs when the inflamed pleural surfaces rub against each other during breathing. Pleural friction rub is associated with conditions such as pleurisy (inflammation of the pleura) or pleural effusion (accumulation of fluid in the pleural space), rather than asthma exacerbations.

C. Fine rales

Fine rales, also known as fine crackles, are brief, high-pitched, discontinuous sounds heard primarily during inspiration. They are typically associated with conditions involving the small airways and alveoli, such as pulmonary fibrosis or congestive heart failure. Fine rales are not commonly heard in asthma exacerbations.

D. Rhonchi

Rhonchi are low-pitched, snoring or rattling sounds heard primarily during expiration. They result from the passage of air through airways obstructed by thick mucus or secretions. While rhonchi may be heard in individuals experiencing asthma exacerbations, they are less characteristic than expiratory wheezes, which are more commonly associated with asthma exacerbations. Rhonchi are often associated with conditions such as chronic bronchitis or pneumonia.

A. Withhold food and liquids until the client's gag reflex returns.

This is the correct action. After a bronchoscopy, the client's throat may be numb or irritated from the procedure, which can temporarily impair the gag reflex. Withholding food and liquids until the gag reflex returns reduces the risk of aspiration, where food or liquid enters the airway instead of the stomach. Aspiration can lead to pneumonia and other serious complications. Therefore, it's essential to assess the client's gag reflex before allowing them to eat or drink.

B. Irrigate the client's throat every 4 hours.

This action is not necessary and may even be harmful. Irrigating the client's throat every 4 hours could further irritate the throat and increase discomfort for the client. Unless specifically ordered by the healthcare provider for a specific reason, such as to remove secretions or debris, routine irrigation of the throat is not recommended after a bronchoscopy.

C. Have the client refrain from talking for 24 hours.

There is typically no need for the client to refrain from talking for 24 hours after a bronchoscopy. While the client may experience some throat discomfort and hoarseness, restricting talking for such an extended period is unnecessary and may cause undue stress or anxiety for the client. Unless specifically instructed by the healthcare provider for a valid reason, such as to allow vocal cord healing, there is no need to restrict talking for such a long duration.

D. Suction the client's oropharynx frequently.

Frequent suctioning of the client's oropharynx is not indicated unless there is a specific medical reason to do so. Excessive suctioning can cause trauma to the mucous membranes, increase the risk of infection, and exacerbate throat irritation. The decision to suction should be based on clinical assessment, such as evidence of secretions or if the client is having difficulty clearing their airway, rather than being performed routinely.