A nurse is reinforcing teaching for a client who has flail chest about ways to prevent further respiratory complications. Which of the following statements indicates a need for further teaching?

A. Flail chest occurs when two or more adjacent ribs are fractured in multiple places, resulting in a segment of the chest wall that moves paradoxically with respiration. This condition causes severe pain with every breath, leading clients to take shallow breaths to minimize discomfort. Shallow breathing reduces alveolar expansion, increases the risk of atelectasis, and prevents effective coughing, which can result in retained secretions and pneumonia. Pain management—through opioids, NSAIDs, or regional anesthesia—is essential to enable deep breathing, coughing, and mobility, all of which help maintain oxygenation and prevent respiratory complications. Avoiding pain medication is counterproductive and potentially dangerous in this context. B. Encouraging frequent coughing is appropriate. Coughing helps mobilize and expel secretions that can accumulate in the lungs due to shallow breathing, thereby reducing the risk of pneumonia and hypoxia. Clients with flail chest need guidance on effective coughing techniques to minimize pain and maximize airway clearance. C. Deep breathing is crucial to promote lung expansion, prevent atelectasis, and maintain adequate oxygenation. Techniques such as diaphragmatic breathing or paced deep breaths are often taught to clients with flail chest. Without deep breathing, the lungs are at risk of collapse, hypoxemia, and infection. D. Incentive spirometry is an evidence-based intervention that monitors lung capacity and encourages deep breathing. Regular use helps the client achieve maximal lung expansion, reduces alveolar collapse, and facilitates airway clearance, which are all critical in preventing respiratory complications in flail chest.