A nurse is providing discharge teaching to a client who will be receiving total parenteral nutrition (TPN) at home.
Which of the following instructions should the nurse include? (Select all that apply.)

Choice A rationale

Lying down after meals can increase the risk of acid reflux in individuals with a hiatal hernia. Patients are often advised to remain upright after eating to minimize symptoms.

Choice B rationale

Elevating the head of the bed helps prevent gastric contents from refluxing into the esophagus, reducing symptoms of hiatal hernia and promoting better sleep.

Choice C rationale

Reducing caffeine and spicy foods can help manage symptoms, as these substances can irritate the stomach lining and exacerbate reflux in hiatal hernia patients.

Choice D rationale

Maintaining a healthy weight is important because excess weight can increase abdominal pressure and contribute to the worsening of hiatal hernia symptoms.

Choice E rationale

Drinking less fluid is not typically a recommendation for hiatal hernia. Adequate hydration is important for overall health, and reducing fluid intake may not have a significant impact on symptoms.

Choice A rationale

Stress and anxiety can contribute to gastrointestinal issues, but they are not the most likely cause of a duodenal ulcer.

Choice B rationale

Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal irritation and ulcers, but Helicobacter pylori infection is a more common cause.

Choice C rationale

Excessive alcohol consumption can irritate the stomach lining and contribute to ulcer formation, but Helicobacter pylori infection is more likely to be the primary cause.

Choice D rationale

Helicobacter pylori infection is the most common cause of duodenal ulcers. The bacteria damage the protective lining of the stomach and duodenum, leading to ulcer formation. .