Which client with chronic obstructive pulmonary disease (COPD) will the nurse assess first?

Choice A reason: Maintaining ideal weight supports health in chronic bronchitis but is not the priority. Excess weight increases respiratory workload, but smoking cessation directly reduces airway irritation and mucus production, slowing disease progression more effectively, making weight maintenance a secondary consideration in management.

Choice B reason: Annual influenza immunization prevents exacerbations in chronic bronchitis by reducing infection risk, which worsens airway inflammation. While important, it is less critical than smoking cessation, which addresses the primary cause of chronic bronchitis, making immunization a supportive, not primary, priority.

Choice C reason: Smoking cessation is the priority in chronic bronchitis, as tobacco smoke causes airway inflammation, mucus hypersecretion, and cilia dysfunction. Stopping smoking halts further damage, slows disease progression, and improves lung function, making it the most critical intervention for long-term management of chronic bronchitis.

Choice D reason: Moderate exercise improves endurance and respiratory muscle strength in chronic bronchitis but is secondary to smoking cessation. Exercise supports symptom management but does not address the root cause—smoking-induced airway damage—making it less critical than cessation, which prevents further bronchial irritation.

Choice A reason: Explaining that all people feel anxious minimizes the client’s concerns, potentially dismissing valid fears. This does not address specific anxieties, which may escalate, impacting recovery or consent. Encouraging expression fosters therapeutic communication, making this a less effective approach for addressing preoperative anxiety.

Choice B reason: Suggesting the client talk to the provider may clarify surgical concerns but delays immediate emotional support. Nurses can address anxiety through therapeutic communication, making it more appropriate to encourage expression of feelings rather than deferring to the provider initially for emotional support.

Choice C reason: Distracting the client by changing the subject avoids addressing anxiety, which may worsen emotional distress and affect surgical outcomes. Unresolved anxiety increases stress hormones, impacting recovery, making this ineffective compared to encouraging open expression of the client’s concerns.

Choice D reason: Encouraging the client to express feelings addresses preoperative anxiety, reducing stress hormones like cortisol that impair healing. Therapeutic communication validates fears, promotes coping, and enhances trust, making this the most effective nursing action to support emotional and physical preparation for surgery.