A client with a history of cirrhosis of the liver and renal insufficiency presents with epigastric pain and early satiety. The nurse suspects peptic ulcer disease. Which additional finding would further increase the nurse's suspicion for PUD in this client?

A. Use of NSAIDs for arthritic pain: NSAIDs inhibit prostaglandin synthesis, which reduces the protective mucus layer of the stomach and increases the risk of PUD. Clients with chronic NSAID use are at significantly higher risk for gastric ulcers. B. Smoking history for 10 years: Smoking can delay healing of ulcers and contribute to recurrence, but it is not as direct a risk factor for developing PUD as NSAID use. C. History of rheumatoid arthritis: RA itself does not directly cause PUD. However, clients with RA may take NSAIDs, which increases risk; the condition alone is not a primary risk factor. D. Family history of peptic ulcer disease: While genetic predisposition may play a minor role, family history alone is not as significant as active NSAID use or other direct risk factors in increasing suspicion for PUD.