A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD). The client tells the nurse. "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?

Rationale: A. Maintaining a semi-Fowler's position as often as possible is partially helpful because it promotes lung expansion, improves ventilation, and eases breathing by reducing pressure on the diaphragm. It can also assist with airway clearance, but it does not directly alter the thickness or viscosity of bronchial secretions. While positioning is an important supportive intervention in COPD care, it is not sufficient alone for mobilizing thick mucus. B. Administering oxygen via nasal cannula at 2 L/min is important if the client is hypoxic, as supplemental oxygen can help maintain adequate oxygen saturation. However, oxygen therapy does not thin mucus or facilitate its removal from the airways. In clients with COPD, oxygen should be administered carefully to avoid suppressing the hypoxic respiratory drive. This intervention addresses oxygenation, not secretion clearance. C. Helping the client select a low-salt diet can help manage fluid balance and prevent edema, which is beneficial in heart failure or fluid overload scenarios, but it does not have a direct effect on mucus production or consistency. Reducing sodium intake may improve overall health but will not relieve tenacious bronchial secretions. D. Encouraging the client to drink 2 to 3 L of water daily is the most effective action for helping with tenacious bronchial secretions. Adequate hydration is essential because it thins mucus, making it less sticky and easier to expectorate. In COPD, thick mucus can obstruct airways, decrease gas exchange, increase the risk of infection, and exacerbate shortness of breath. Drinking sufficient fluids, combined with other airway clearance techniques—such as controlled coughing, chest physiotherapy, or using a humidifier—supports pulmonary hygiene and improves respiratory comfort. Nurses should educate clients about spacing fluids throughout the day, avoiding caffeine and alcohol which can be dehydrating, and monitoring for signs of fluid overload in cases of comorbid heart or kidney disease.