A nurse is caring for a client who has COPD. Which of the following actions should the nurse take?

Choice A rationale Clients with COPD actually require a high-protein, high-calorie diet because the work of breathing significantly increases their metabolic rate. Chronic respiratory distress can lead to muscle wasting and weight loss, a condition known as pulmonary cachexia. Reducing protein intake would be detrimental to muscle strength, including the strength of the diaphragm and intercostal muscles. Adequate protein is essential to maintain lean body mass and support immune function, helping to prevent frequent respiratory infections. Choice B rationale Instructing a client with COPD to cough only every 4 hours is insufficient for effective airway clearance. These clients often have impaired mucociliary clearance and excessive mucus production. They should be encouraged to perform controlled coughing techniques, such as huff coughing, or use airway clearance devices more frequently as needed. Long intervals between coughing sessions can lead to secretions becoming stagnant in the bronchioles, increasing the risk of atelectasis and bacterial pneumonia due to impaired gas exchange. Choice C rationale Advising a client with COPD to lie down after eating is contraindicated. Eating can cause gastric distention, which pushes the diaphragm upward and further restricts lung expansion. Lying flat exacerbates this pressure and increases the risk of gastroesophageal reflux, which can trigger bronchospasms or aspiration. Clients should remain upright for at least 30 minutes to an hour after meals to ensure the diaphragm has maximum room to move, thereby easing the increased respiratory effort following digestion. Choice D rationale Encouraging the intake of at least 2 to 3 liters of fluid daily, or approximately 8 glasses, is a standard intervention for COPD. Hydration is critical for thinning thick, tenacious pulmonary secretions, making them easier to expectorate. When secretions are thin, the client can clear the airway more effectively with less physical effort, reducing the risk of mucus plugging and infection. Unless the client has a co-existing condition like heart failure, increasing fluid intake is a primary non-pharmacological treatment.