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?

A. Drinking orange juice regularly: Citrus juices are acidic and can relax the lower esophageal sphincter and directly irritate the esophagus, worsening reflux and heartburn. B. Sleeping on a large wedge-style pillow: Sleeping upright or with head elevated reduces nighttime reflux by using gravity to keep gastric contents in the stomach - this is helpful, not a contributor. C. Consuming low-fat meats: Low-fat meats decrease gastric emptying delay related to fatty meals and reduce reflux risk; they are generally not a contributing factor. D. Eating dinner early in the evening: Eating earlier (allowing 2–3 hours before lying down) reduces reflux at night; this is protective rather than contributory.