After an incisional cholecystectomy for cholelithiasis, which nursing intervention is the highest priority for the client?

• A. Assisting the client to ambulate the evening of the operative day
• B. Teaching the client to choose low-fat foods from the menu
• C. Assisting the client to turn, cough, and deep breathe every 2 hours
• D. Performing range-of-motion (ROM) leg exercises hourly while the client is awake

Answer: (C)

The key concept is protecting breathing after abdominal surgery. After an incisional cholecystectomy, anesthesia and pain can cause shallow breathing and poor lung expansion, putting the patient at high risk for atelectasis and pneumonia. Assisting the client to turn, cough, and deep breathe every two hours promotes full lung expansion, helps mobilize secretions, and prevents collapsed areas of the lung. This pulmonary hygiene directly reduces a common and potentially serious postoperative complication, making it the highest priority.

Ambulating the first evening and performing leg exercises help prevent circulatory problems like DVT, and teaching dietary choices supports recovery, but they don’t address the most immediate threat to the patient’s stability—adequate ventilation and clear airways. Pain control and splinting the incision with a pillow can further aid deep breathing, but the action that most effectively prevents postoperative respiratory complications is the regular turning and deep breathing.