A nurse is collecting data from a client who has gastroesophageal reflux disease (GERD) and reports having heartburn every night. Which of the following actions should the nurse identify as a contributing factor to the client's heartburn?

Gastroesophageal reflux disease (GERD) is a condition characterized by the backflow of stomach acid into the esophagus, causing symptoms such as heartburn. Orange juice is highly acidic, and consuming acidic foods and beverages can exacerbate the symptoms of GERD. The acidic nature of orange juice can irritate the esophagus and contribute to increased acid reflux, leading to heartburn.

Sleeping on a large wedge-style pillow can actually help alleviate symptoms of GERD by elevating the head and upper body, reducing the likelihood of acid reflux during sleep.

Eating dinner early in the evening is generally recommended for individuals with GERD as it allows sufficient time for digestion before lying down. This can help prevent acid reflux during sleep.

Consuming low-fat meats is also a favorable choice for individuals with GERD as fatty foods can relax the lower esophageal sphincter, allowing stomach acid to flow back into the esophagus. However, the options provided do not include any fatty foods, so it is not the primary contributing factor to the client's heartburn in this case.

When reinforcing teaching with a client who has a duodenal ulcer and a new prescription for sucralfate, the nurse should include the following instructions:

"Take the medication on an empty stomach.": Sucralfate is most effective when taken on an empty stomach, usually 1 hour before meals and at bedtime. Taking it with food or other medications may reduce its effectiveness.

"Remain upright for 30 minutes after taking this medication.": To enhance the efficacy of sucralfate, it is important to remain upright for at least 30 minutes after taking the medication. This helps to prevent the medication from being washed away by stomach acid and allows it to form a protective coating over the ulcer.

The following statements are incorrect or not applicable:

"Stop taking this medication if you develop constipation.": Constipation is a common side effect of sucralfate. However, abruptly stopping the medication is not necessary if constipation occurs. The nurse should instruct the client to increase fluid intake, consume a high-fiber diet, and discuss any concerns with the healthcare provider. If constipation becomes severe or persists, the healthcare provider can provide further guidance on managing this side effect.

"Take an antacid at the same time you take this medication.": Sucralfate can interact with antacids and other medications, reducing its effectiveness. It is recommended to take sucralfate at least 2 hours before or after taking antacids or other medications to avoid interference with its absorption.