A nurse is caring for a client who is postoperative following a thoracotomy with lung resection 24 hr ago. Exhibits Complete the following sentence by using the lists of options. The client is at highest risk for developing dropdown due to dropdown postoperatively.

Rationale: Pneumothorax: Pneumothorax presents with sudden respiratory distress, unilateral absent breath sounds, or tracheal deviation. This client has bilateral breath sounds and a functioning chest tube, making this condition less likely. Atelectasis: Atelectasis is a common complication after thoracic surgery, especially when the client is hypoventilating. Shallow breathing, decreased oxygen saturation, crackles, and refusal to use the incentive spirometer all point to developing alveolar collapse. Pulmonary embolism: PE often presents with sudden chest pain, dyspnea, and possibly hemoptysis or hypotension. This client’s symptoms have developed gradually and lack hallmark features of PE. Sanguineous chest tube drainage: This is expected within 24–48 hours post-thoracotomy and does not indicate a specific respiratory complication unless the volume is excessive or suddenly increases. Morphine use for pain management: Morphine can contribute to shallow respirations but is a routine part of postoperative care. It is not the most direct factor responsible for the client’s worsening pulmonary status. Failure to use the incentive spirometer: This is a direct contributor to hypoventilation and secretion retention, leading to atelectasis. The client’s discomfort has prevented lung expansion, setting the stage for alveolar collapse and impaired gas exchange.