Which subjective assessment data supports the nurse's conclusion that a client is experiencing orthopnea?

A. "It doesn't take much activity before I'm out of breath.": This statement describes exertional dyspnea, which is shortness of breath with physical activity. It is often seen in heart or lung conditions but does not point to orthopnea, which occurs when lying flat.

B. "I sleep on three pillows at night.": Using multiple pillows to sleep is a compensatory behavior for orthopnea. Orthopnea is defined as difficulty breathing while lying flat, often related to heart failure and pulmonary congestion, and is relieved by elevating the head.

C. "I cough a lot at night and it keeps me up half the night.": Nocturnal coughing may indicate asthma, GERD, or postnasal drip. While it disrupts sleep, it does not clearly signify orthopnea, which is specifically related to positional shortness of breath.

D. "I have multiple attacks of wheezing almost daily.": Frequent wheezing attacks are more consistent with conditions like asthma or COPD. This symptom does not suggest orthopnea, which involves positional breathing difficulty, not episodic wheezing.

A. He would have difficulty falling to sleep, and sleep very lightly with more frequent arousals: Nicotine is a stimulant that can interfere with sleep by increasing heart rate and causing difficulty in falling asleep. Smokers also tend to experience more fragmented sleep, with frequent awakenings and lighter sleep stages due to withdrawal symptoms during the night which include restlessness, irritability, and difficulty relaxing.

B. He would sleep soundly during the first half of the night, with increased arousals during the second half: This is not typically associated with smoking. While nicotine withdrawal can cause sleep disruption, it does not usually result in sound sleep in the first half of the night followed by arousals. Smoking-related sleep disturbances are more generalized throughout the night.

C. Increase sleep latency, and reduce total sleep time: While nicotine can increase sleep latency (the time it takes to fall asleep), smoking is more likely to cause fragmented sleep and increased arousals rather than just reducing total sleep time. The effect on sleep is often more about poor-quality sleep than simply reduced duration.

D. Decrease the need for rapid eye movement (REM) sleep: Nicotine does not decrease the need for REM sleep, but it disrupts the sleep cycle, including REM sleep, by causing lighter sleep and more frequent awakenings. Smokers tend to have a lower proportion of REM sleep due to these disruptions, but not necessarily a decreased need for it.