A nurse on a pediatric unit is assisting with the care of a preschooler who is 1 day postoperative following an open appendectomy. Complete the following sentence by using the lists of options. The preschooler is at greatest risk for developing dropdownas evidenced by the child's dropdownanddropdown.

Rationale for correct choices: • pneumonia: The preschooler is at increased risk for pneumonia due to shallow breathing and refusal to use the incentive spirometer. Postoperative pain, especially after abdominal surgery, can limit deep breaths and effective coughing, leading to decreased lung expansion, retained secretions, and atelectasis, which can progress to pneumonia if unaddressed. • breathing effort: Shallow respirations are noted throughout assessments, indicating that the child is not ventilating fully. Limited chest expansion compromises oxygenation and clearance of pulmonary secretions, increasing the risk of lower respiratory tract infections such as pneumonia. • refusal to use incentive spirometer: The child’s refusal to use the incentive spirometer further reduces the effectiveness of lung expansion exercises. Incentive spirometry encourages deep breathing to prevent atelectasis and pulmonary complications; without its use, the risk for pneumonia remains elevated. Rationale for incorrect choices: • peritonitis: Peritonitis would present with increasing abdominal pain, rigidity, rebound tenderness, and systemic signs of infection. While the child has some abdominal tenderness, there is no evidence of acute diffuse peritoneal inflammation or severe systemic instability at this time. • wound infection: The surgical dressing is dry and intact, with no redness, swelling, or purulent drainage noted. Although wound infection is a potential postoperative complication, current findings do not suggest infection. • temperature: The child’s temperature is mildly elevated but remains below 38 °C (100.4 °F), which is not a significant indicator of infection at this stage. Slight postoperative elevation can be normal and does not alone indicate risk for pneumonia. • abdominal tenderness: Abdominal tenderness is expected postoperatively and is being managed with analgesics. It is not a primary indicator for pneumonia risk in this scenario but rather a normal post-surgical finding. • surgical dressing: The dressing remains dry and intact, indicating no current wound compromise. It does not contribute to the preschooler’s risk for pneumonia.