The nurse is providing discharge instructions for a slightly overweight client seen in the Emergency Department with gastroesophageal reflux disease (GERD). Which instruction should the nurse give for management of this disease process?

Choice A reason: Dark-colored stools are an adverse effect of orlistat, a medication that blocks the absorption of fat in the intestines. The unabsorbed fat can cause the stools to become oily, foul-smelling, and dark in color. This can indicate a serious condition called steatorrhea, which can lead to malnutrition and vitamin deficiencies.

Choice B reason: Constipation is not an adverse effect of orlistat. In fact, orlistat can cause the opposite problem of diarrhea, especially if the client consumes too much fat in their diet. Constipation may be caused by other factors, such as dehydration, lack of fiber, or medication side effects.

Choice C reason: Nausea is not an adverse effect of orlistat. Nausea may be a symptom of other conditions, such as gastritis, gastroenteritis, or pregnancy. Nausea may also be caused by other medications, such as antibiotics, opioids, or chemotherapy drugs.

Choice D reason: Abdominal pain is not an adverse effect of orlistat. Abdominal pain may be a sign of other conditions, such as appendicitis, gallstones, or kidney stones. Abdominal pain may also be caused by other medications, such as NSAIDs, steroids, or oral contraceptives.

Choice A reason: Including foods high in starch and proteins is not a specific dietary instruction for a client who has biliary colic from chronic cholecystitis. Starch and protein intake may vary depending on the client's overall nutritional needs and preferences.

Choice B reason: Including foods high in fiber is a general dietary recommendation for most people, but it is not directly related to biliary colic or cholecystitis. Fiber helps with bowel regularity and may lower the risk of some chronic diseases, but it does not affect the production or flow of bile.

Choice C reason: Avoiding foods high in sodium is a dietary instruction for clients who have hypertension, heart failure, or kidney disease, but it is not relevant for biliary colic or cholecystitis. Sodium intake does not influence the formation or dissolution of gallstones, which are the main cause of biliary colic.

Choice D reason: Avoiding foods high in fat is a dietary instruction for clients who have biliary colic from chronic cholecystitis. Fat intake stimulates the contraction of the gallbladder, which can cause pain and inflammation if there are gallstones blocking the bile ducts. Reducing fat intake can help prevent or reduce the frequency and severity of biliary colic episodes.