A nurse in a provider's office is teaching a client about the self-management of GERD. Which of the following instructions should the nurse include?

Gastroesophageal reflux disease (GERD) occurs when gastric contents flow backward into the esophagus due to relaxation or weakness of the lower esophageal sphincter. This causes symptoms such as heartburn, regurgitation, and chest discomfort, especially after meals or when lying flat. Management includes lifestyle modifications aimed at reducing reflux episodes and protecting the esophageal lining. Patient teaching is essential to prevent symptom worsening and long-term complications. A. Eating a light meal 1 hour before bedtime is not recommended because lying down soon after eating increases the risk of reflux. Clients with GERD should avoid eating for at least 2 to 3 hours before bedtime to reduce nighttime symptoms. Even a light meal can stimulate acid production and worsen reflux when taken too close to sleep. B. Increasing caloric intake by 250 calories per day is not a standard recommendation for GERD management. In fact, weight reduction is often encouraged in overweight clients because excess abdominal pressure worsens reflux. The goal is symptom control through dietary timing and food choices rather than increasing caloric intake. C. Sleeping with the head of the bed elevated 6 inches is an effective nonpharmacological intervention for GERD. Elevation uses gravity to help prevent gastric contents from refluxing into the esophagus during sleep. This reduces nighttime heartburn, regurgitation, and irritation of the esophageal mucosa. D. Lying down for 30 minutes after each meal is contraindicated because it promotes reflux by allowing stomach contents to move more easily into the esophagus. Clients should remain upright after meals and avoid bending over or reclining. Upright positioning improves gastric emptying and reduces symptom severity.