A client with rheumatoid arthritis (RA) is scheduled for a joint replacement surgery. The nurse should teach the client to discontinue which medication before the surgery to prevent bleeding complications?

Pursed-lip breathing is a technique that helps to slow down the breathing rate, reduce air trapping, and improve gas exchange in clients with COPD. It also helps to relieve dyspnea and anxiety.

Incorrect options:

B) Administer oxygen via nasal cannula at 6 L/min. - This is an incorrect intervention, as clients with COPD are at risk of developing oxygen-induced hypercapnia, a condition where high levels of oxygen reduce the drive to breathe and cause carbon dioxide retention. Oxygen therapy should be administered cautiously and titrated to maintain a target oxygen saturation of 88-92% in clients with COPD.

C) Position the client in a supine position with the head elevated. - This is an incorrect intervention, as a supine position can increase the pressure on the diaphragm and impair lung expansion, worsening dyspnea and hypoxemia in clients with COPD. A semi-Fowler's or high-Fowler's position is preferred, as it allows for maximal lung expansion and reduces the work of breathing.

D) Instruct the client to cough forcefully every hour. - This is an incorrect intervention, as forceful coughing can increase airway resistance, cause bronchospasm, and increase dyspnea in clients with COPD. A more effective coughing technique is to use huff coughing, which involves exhaling forcefully through an open mouth while making a "huff" sound.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used to treat pain and inflammation in clients with RA. However, NSAIDs can also inhibit platelet aggregation and prolong bleeding time, increasing the risk of hemorrhage during and after surgery. Therefore, ibuprofen should be discontinued at least 7 days before the surgery.

Incorrect options:

A) Prednisone - This is an incorrect option, as prednisone is a corticosteroid that is used to suppress inflammation and immune responses in clients with RA. Prednisone does not affect bleeding time or platelet function. However, prednisone can increase the risk of infection and delay wound healing, so it should be tapered gradually before the surgery to avoid adrenal insufficiency and withdrawal symptoms.

B) Methotrexate - This is an incorrect option, as methotrexate is a disease-modifying antirheumatic drug (DMARD) that is used to slow down the progression of joint damage and reduce inflammation in clients with RA. Methotrexate does not affect bleeding time or platelet function. However, methotrexate can increase the risk of infection and bone marrow suppression, so it should be discontinued at least 2 weeks before the surgery.

D) Hydroxychloroquine - This is an incorrect option, as hydroxychloroquine is an antimalarial drug that is used to treat mild to moderate RA. Hydroxychloroquine does not affect bleeding time or platelet function. However, hydroxychloroquine can cause ocular toxicity, so it should be monitored regularly by an ophthalmologist.