A client with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the client's ventilation?

A. Place the client in the Trendelenburg position with pillows behind the head: Trendelenburg position (head lower than feet) is not appropriate for clients with COPD because it decreases diaphragmatic efficiency, increases work of breathing, and can worsen dyspnea and gas exchange. This position may also increase risk for aspiration. B. Have the client rest in bed with the head elevated 15 to 20 degrees: While slightly elevating the head of the bed can provide minimal comfort, 15–20 degrees is insufficient to optimize diaphragmatic excursion and lung expansion in COPD patients, making this suboptimal for supporting ventilation. C. Encourage the client to sit up at the bedside in a chair and lean forward: Sitting upright and leaning forward (tripod position) maximizes diaphragmatic movement, reduces accessory muscle fatigue, and improves lung expansion, tidal volume, and overall ventilation. This is an evidence-based intervention to enhance oxygenation and support gas exchange in clients with COPD. D. Ask the client to rest in bed in a high-Fowler position with the knees flexed: High-Fowler position improves lung expansion, but flexing the knees can increase intra-abdominal pressure, limiting diaphragmatic movement and slightly decreasing the efficiency of ventilation compared with leaning forward. Sitting forward is superior for promoting gas exchange.