An adult client is admitted with AIDS and oral candidiasis manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide the UAP?

Choice A reason: Lying on each side with abdominal breathing may aid relaxation but does not optimize gas exchange in emphysema. Pursed-lip breathing better maintains airway pressure, preventing alveolar collapse, which is critical for improving oxygenation and CO2 elimination in COPD.

Choice B reason: Increasing breathing rate for 30 seconds causes hyperventilation, worsening CO2 retention in emphysema by reducing effective tidal volume. This exhausts respiratory muscles, impairing gas exchange, making it counterproductive compared to pursed-lip breathing, which enhances alveolar ventilation.

Choice C reason: Pursed-lip breathing, inhaling through the nose and exhaling slowly through pursed lips, maintains positive airway pressure, preventing alveolar collapse in emphysema. This improves gas exchange by enhancing oxygenation and CO2 removal, making it the most effective instruction for dyspnea relief.

Choice D reason: Raising hands above the head may stretch the chest but does not address emphysema’s airflow limitation. It can strain respiratory muscles, worsening dyspnea, unlike pursed-lip breathing, which directly improves alveolar ventilation and gas exchange, making this choice ineffective.

Choice A reason: Testing for Helicobacter pylori is irrelevant, as vomiting and anorexia 8 days post-laparotomy suggest postoperative complications like ileus or obstruction, not peptic ulcer disease. H. pylori causes gastritis, not acute surgical issues, making this action inappropriate for the client’s current presentation.

Choice B reason: Giving intravenous fluids is critical, as vomiting and refusal to eat post-laparotomy risk dehydration and electrolyte imbalances. Fluids restore volume, stabilize hemodynamics, and support recovery from potential ileus or obstruction, addressing the client’s acute symptoms and preventing further deterioration.

Choice C reason: Inserting a rectal tube is inappropriate, as vomiting indicates upper gastrointestinal issues, not lower bowel obstruction. Post-laparotomy vomiting suggests ileus or adhesion, and rectal tubes do not address gastric or small bowel complications, making this action ineffective.

Choice D reason: Monitoring hemoglobin assesses blood loss, relevant post-laparotomy, but vomiting and anorexia prioritize fluid replacement to prevent dehydration. Hemoglobin checks are secondary, as fluid loss is the immediate threat, making IV fluids the more urgent intervention for stabilization.