A nurse is planning care for a client who has tuberculosis. Which of the following precautions should the nurse implement for this client?

Rationale:
A. "Lie down after meals.": Lying down after eating increases the risk of gastric contents refluxing into the esophagus due to gravity. Clients with GERD should remain upright for at least 2 to 3 hours after meals to minimize symptoms.
B. "Elevate the head of the bed while sleeping.": Elevating the head of the bed by 6 to 8 inches helps prevent nighttime reflux by using gravity to reduce backward flow of stomach acid into the esophagus, which is a key strategy in GERD management.
C. "Eat a snack 1 hour before going to bed.": Eating close to bedtime can exacerbate GERD symptoms by increasing gastric volume and acid production, especially when the client lies down soon after eating. A longer gap between the last meal and sleep is advised.
D. "Eat three large meals each day.": Large meals increase gastric pressure and acid production, worsening reflux symptoms. Clients with GERD should eat smaller, more frequent meals to reduce gastric distension and minimize acid reflux episodes.

Rationale:
A. Ferrous sulfate: Ferrous sulfate is an iron supplement and does not directly interact with warfarin's anticoagulant effect. While some mild interactions are possible, it is not generally contraindicated unless specifically advised due to individual clinical conditions.

B. Aspirin: Aspirin has antiplatelet effects and can increase the risk of bleeding when taken with warfarin. The combination enhances anticoagulation and significantly raises the chance of gastrointestinal or systemic bleeding.

C. Naproxen: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can interfere with platelet function and irritate the gastrointestinal lining, increasing the risk of bleeding when combined with warfarin.

D. Echinacea: Echinacea may interfere with liver enzyme activity and affect the metabolism of warfarin, potentially altering its effectiveness. Herbal supplements can cause unpredictable interactions and should generally be avoided while on warfarin.

E. Dextromethorphan: Dextromethorphan is a common cough suppressant and does not have significant interactions with warfarin. It is generally considered safe for occasional use in clients taking anticoagulants.