A nurse is reinforcing nutritional teaching with a client who has COPD. Which of the following instructions by the nurse is appropriate?

Choice A rationale Bronchodilators should be used before meals, not after. Using a bronchodilator roughly 30 minutes prior to eating helps reduce shortness of breath during the act of chewing and swallowing. Chronic obstructive pulmonary disease (COPD) increases the work of breathing, which can make eating an exhausting task. By opening the airways before the meal, the client can maintain better oxygenation and have more energy to consume the necessary nutrients for their health. Choice B rationale Decreasing fiber intake is generally not recommended for clients with COPD. Many individuals with this condition suffer from constipation due to inactivity or medication side effects. Straining during bowel movements can cause significant breathlessness and put stress on the cardiovascular system. A diet rich in fiber helps maintain regular bowel habits. The only reason to limit certain high-fiber foods is if they cause excessive gas and abdominal bloating, which can push against the diaphragm. Choice C rationale Clients with COPD often have a higher metabolic demand due to the increased energy required for the work of breathing. This can lead to weight loss and muscle wasting, including the weakening of respiratory muscles. Increasing protein intake is essential for repairing tissues and maintaining the strength of the diaphragm and intercostal muscles. High-protein, high-calorie, small, frequent meals are the standard nutritional recommendation to prevent malnutrition and support overall respiratory function. Choice D rationale Carbonated beverages should be avoided by clients with COPD. The carbonation can lead to gastric distention and bloating. Because the diaphragm is already flattened in many COPD patients due to hyperinflated lungs, an enlarged stomach can press upward against the diaphragm, further restricting lung expansion and worsening dyspnea. Clients are encouraged to choose non-carbonated, nutrient-dense fluids and to drink them between meals rather than with meals to prevent early satiety.