For which of the following patients directed coughing might be contraindicated?

1. Patient with poor coronary artery perfusion
2. Postoperative upper-abdominal surgery patient
3. Long-term care patient with retained secretions
4. Patient with an acute unstable spinal injury
a. 2 and 3 only
b. 1, 2, and 3 only
c. 1 and 4 only
d. 2, 3, and 4 only

ANS: C
The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 43-2.