A home health nurse is assessing a client who has COPD, Which of the following findings indicates the need for a referral for pulmonary rehabilitation?

A. Pursed-lip breathing is incorrect. Pursed-lip breathing is a coping mechanism used by clients with COPD to improve ventilation and reduce air trapping. It is an expected finding and does not necessarily indicate the need for pulmonary rehabilitation referral. B. SaO₂ 92% is incorrect. An oxygen saturation of 92% is slightly below normal but may be acceptable for a client with chronic COPD, depending on their baseline. This alone does not automatically trigger referral for pulmonary rehabilitation. C. Dyspnea at rest is correct. Dyspnea at rest indicates advanced COPD and significant functional impairment, which is a key criterion for referral to pulmonary rehabilitation programs. Pulmonary rehab helps improve exercise tolerance, reduce symptoms, enhance quality of life, and teach energy-conservation techniques for clients with severe respiratory limitations. D. Clubbing of the fingers is incorrect. Clubbing is a chronic finding in some clients with long-term hypoxemia or lung disease. While it indicates chronic disease, it does not directly dictate the need for pulmonary rehabilitation; functional limitation (like dyspnea at rest) is a stronger referral indicator.