The patient undergoing middle ear surgery should be instructed to use the incentive spirometer every hour to prevent postoperative pneumonia and atelectasis. While many patients should be taught to cough regularly, this patient should not cough to prevent damage to the middle ear. Placing hands on either side of the head to cough is not helpful; the nurse should instruct the patient to request ice chips or cough suppressants. All jewelry must be removed before surgery, not just the earrings.