A client returns to the nursing unit following a bronchoscopy with moderate sedation and local anesthesia to the throat. The procedure was completed 30 minutes ago. Which assessment finding requires immediate nursing intervention?

A. Mild throat discomfort, soreness, or hoarseness is common after bronchoscopy due to local anesthesia and scope manipulation. These symptoms are usually self-limiting and do not require immediate intervention. B. Small amounts of blood-tinged sputum are expected after bronchoscopy because of minor trauma to the airway during the procedure. This finding should be monitored, but it is not an emergency. C. Moderate sedation can temporarily suppress the gag reflex. Nurses should withhold oral intake until the gag reflex returns, but this is anticipated and expected shortly after the procedure. It does not require immediate intervention unless the reflex remains absent for an extended period. D. The presence of subcutaneous emphysema indicates that air is leaking into subcutaneous tissues, which may result from a bronchial or tracheal perforation. This is a serious complication of bronchoscopy and may signal pneumothorax or mediastinal injury, requiring immediate nursing intervention, monitoring, and urgent physician notification.