The nurse is reviewing a newly admitted patient’s electronic health record, which notes a history of orthopnea. What nursing action is most clearly indicated?

Choice A reason: Deep breathing and coughing exercises are standard pulmonary hygiene interventions to prevent atelectasis and pneumonia. While beneficial for overall lung health, they do not directly address the mechanical and physiological distress caused by orthopnea, which is specifically related to patient positioning and hydrostatic pressure within the pulmonary vasculature. Choice B reason: Supplemental oxygen is a medical intervention for hypoxemia but is not the primary nursing action for orthopnea unless the patient's oxygen saturation is low. Orthopnea is a postural symptom, and while oxygen may alleviate the sensation of breathlessness, it does not correct the underlying positional cause of respiratory distress. Choice C reason: Limiting activity level is often necessary for patients with congestive heart failure or severe chronic obstructive pulmonary disease who experience exertional dyspnea. However, orthopnea refers specifically to difficulty breathing while lying flat, making activity limitation a secondary consideration compared to the immediate need for proper nocturnal and resting positioning. Choice D reason: Orthopnea is characterized by respiratory distress when lying flat due to the redistribution of fluid from the lower extremities to the central circulation, increasing pulmonary capillary wedge pressure. Avoiding the supine position and using pillows to elevate the head and thorax decreases venous return and optimizes lung expansion.