Which practice would the nurse recommend to a client who has had a cesarean delivery?

Choice A rationale Coughing and deep-breathing exercises are crucial post-surgery, including cesarean section, to promote optimal pulmonary hygiene. These exercises prevent atelectasis (collapse of alveoli) and pneumonia by encouraging full lung expansion and mobilizing respiratory secretions. Deep breaths increase intra-alveolar pressure, keeping air sacs open, which is essential because postoperative pain often causes shallow breathing, compromising gas exchange and increasing infection risk. The resulting improved ventilation-perfusion matching supports recovery. Choice B rationale Sit-ups are a strenuous abdominal exercise that places significant tension and strain on the healing surgical incision and the underlying rectus abdominis muscles and fascia. The healing process post-cesarean involves several layers, and this intense activity risks dehiscence (wound separation) or incisional hernia formation. The typical recommendation is to avoid intense abdominal exercises and heavy lifting for at least 6 weeks postpartum to allow adequate connective tissue remodeling and wound tensile strength to develop. Choice C rationale Frequent douching disrupts the normal, protective vaginal flora (primarily Lactobacillus species), altering the physiological acidic pH (typically 3.8-4.5) of the vagina. This imbalance compromises the natural defense mechanism against ascending infections. Postpartum douching is generally discouraged as it can increase the risk of introducing pathogens into the uterus via the cervix, potentially leading to endometritis or pelvic inflammatory disease (PID), and is an unnecessary practice. Choice D rationale Side-rolling exercises involve lateral movement and torso twisting, which can strain the abdominal muscles and the cesarean incision line, particularly the supporting tissues. While gentle movement is encouraged to prevent venous thromboembolism (VTE), vigorous side-rolling may cause pain and impair wound healing by placing shear stress across the incision. Early, gentle ambulation is preferred over specific side-rolling exercises for initial mobility postoperatively.