A nurse is reinforcing teaching with a client who has GERD. Which of the following instructions should the nurse include?

Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus due to decreased lower esophageal sphincter tone or delayed gastric emptying. This causes symptoms such as heartburn, regurgitation, and chest discomfort, especially after meals or when lying down. Lifestyle modifications are a major part of management and help reduce reflux episodes and esophageal irritation. Teaching focuses on avoiding triggers and promoting behaviors that decrease gastric reflux. Rationale: A. Avoiding eating snacks at bedtime is correct because lying down soon after eating increases the likelihood of gastric contents refluxing into the esophagus. Late-night meals and bedtime snacks delay gastric emptying and worsen nighttime symptoms. Clients are usually advised to avoid eating for at least 2 to 3 hours before sleep to reduce reflux episodes. B. Using peppermint extract for an upset stomach is incorrect because peppermint can relax the lower esophageal sphincter, which worsens reflux. Although peppermint may relieve some gastrointestinal discomfort, it increases the likelihood of acid moving upward into the esophagus. Clients with GERD should avoid peppermint-containing products. C. Limiting foods that contain sodium is not a primary teaching point for GERD management. Sodium restriction may be important in conditions such as hypertension or heart failure, but it does not directly reduce reflux symptoms. GERD teaching focuses more on avoiding fatty foods, caffeine, chocolate, alcohol, and acidic foods. D. Sleeping in a prone position is incorrect because lying flat or prone can worsen reflux by allowing stomach acid to move more easily into the esophagus. Clients are encouraged to elevate the head of the bed and preferably sleep with the upper body elevated. This positioning uses gravity to reduce nighttime reflux symptoms.