A nurse is caring for a client who is crying after receiving a terminal cancer diagnosis. Which of the following responses should the nurse make?

Rationale:

A. "You should eat three large meals and two snacks per day." Eating large meals increases gastric pressure and can worsen reflux symptoms by promoting the backflow of stomach acid into the esophagus. Clients with GERD are advised to consume smaller, more frequent meals to reduce gastric distention.

B. "You should elevate the head of the bed while sleeping." Elevating the head of the bed helps prevent nighttime reflux by using gravity to reduce the likelihood of stomach acid flowing back into the esophagus. This is a key non-pharmacologic strategy in managing GERD symptoms during sleep.

C. "You should only drink 2 cups of coffee per day." Coffee, regardless of the quantity, can relax the lower esophageal sphincter and stimulate acid production. Rather than limiting intake to two cups, clients with GERD are often advised to avoid coffee altogether or monitor symptoms closely.

D. "You should lay down for 1 hour following a meal." Lying down after eating increases the risk of acid reflux due to the horizontal position reducing the effect of gravity. Clients should remain upright for at least 2 to 3 hours after meals to minimize reflux episodes.

Rationale:

D. Inspection: This is always the first step in any physical assessment. The nurse observes the abdomen for contour, symmetry, skin condition, and any visible movements or abnormalities.

C. Auscultation: Performed before palpation to avoid altering bowel sounds. Listening to bowel and vascular sounds provides key information about gastrointestinal activity and blood flow.

B. Light palpation: Conducted next to assess for tenderness, guarding, and superficial masses. This helps ensure client comfort and provides a baseline before deeper pressure is applied.

A. Deep palpation: Done last to evaluate organ size, deep masses, or tenderness. It can stimulate peristalsis or discomfort, so it follows the less invasive steps to minimize changes to assessment findings.