A nurse receives the following medication orders while caring for multiple clients. Which medication should the nurse plan to administer first?

A) Administering oxygen via nasal cannula at 2 L/min:
Oxygen therapy may be necessary for clients with COPD, but in this case, the primary concern is thick, tenacious bronchial secretions that the client cannot clear. Administering oxygen may be appropriate if the client has low oxygen saturation, but it does not directly address the difficulty in expectorating sputum. The focus should be on hydration and mobilization of secretions, rather than oxygen administration alone.

B) Helping the client select a low-salt diet:
While a low-salt diet is important for clients with conditions like hypertension or heart failure, it is not directly relevant to the issue of tenacious bronchial secretions in COPD. The priority in this scenario is to improve the client’s ability to clear the thick mucus, which is more effectively addressed by hydration rather than dietary changes.

C) Maintaining a semi-Fowler's position as often as possible:
Positioning the client in a semi-Fowler's position can help improve lung expansion and facilitate breathing. It can also reduce the work of breathing and increase comfort. However, while this is a helpful positioning strategy, it is not the most direct intervention to address the client’s difficulty with expectoration. The client’s difficulty with mucus clearance is best addressed with hydration to thin the secretions.

D) Encouraging the client to drink 2 to 3 L of water daily:
Hydration is one of the most important interventions for clients with COPD who have tenacious bronchial secretions. Adequate fluid intake helps to thin mucus, making it easier to cough up and clear from the airways. This intervention directly addresses the client’s complaint of not being able to bring up mucus, making it the most appropriate action to take.

A) Associated with recent vaccination:
Vaccinations, particularly those for influenza and other viral infections, have been linked to an increased risk of GBS in some cases. This association is believed to be due to an immune response that may trigger the autoimmune attack on the peripheral nervous system, leading to GBS.

B) Associated with tobacco use:
While smoking has been associated with various health conditions, including respiratory and cardiovascular diseases, there is no established direct link between tobacco use and the development of GBS. The pathophysiology of GBS is more strongly related to infections and certain immune responses rather than lifestyle factors like smoking.

C) Recent surgical experience:
It is believed that the stress from surgery, particularly in the presence of an infection or immune response, may trigger the development of GBS. Infections, especially bacterial infections like those caused by Campylobacter jejuni, which is a common antecedent of GBS, can sometimes occur after surgery.

D) Presence of a thymus gland:

The thymus is involved in the immune system, particularly in the development of T-cells, but there is no direct correlation between the thymus gland and the onset of GBS. GBS is more closely related to infections (viral or bacterial), recent vaccinations, or surgery rather than anatomical features like the thymus.

E) Associated with exposure to a recent viral infection:
Viral infections such as Zika virus, Epstein-Barr virus, cytomegalovirus (CMV), influenza, and others can trigger an autoimmune response that leads to the development of GBS. Infections are the most common precipitating factor for GBS, and the immune system’s response to the viral infection may cause the body to mistakenly attack its own peripheral nerves, leading to the symptoms of GBS.