A nurse explains to you that a certain neuromuscular patient cannot develop a good cough. Which of the following would you consider to manage this patient's clearance problem?

1. Combining manual chest compression with suctioning
2. Coordinating the coughing regimen with pain medication
3. Using the autogenic drainage method
4. Using mechanical insufflation-exsufflation
a. 1 and 4 only
b. 1, 2, and 3 only
c. 2 and 3 only
d. 1, 2, and 4 only

ANS: A
If this problem results in retained secretions, there are only three options: (1) placement of an ar-tificial airway and removal of secretions by tracheobronchial suctioning (see Chapter 33), (2) manually assisted cough, and (3) mechanical insufflation-exsufflation.