A nurse is providing discharge education to a patient who recently experienced an acute gout attack. Which patient statement indicates they have understood the treatment plan?

Choice A rationale
While liver issues can be a concern with certain medications or diseases, they are not typically associated with GERD. GERD is a digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach. Therefore, monitoring for liver issues would not be directly relevant to a patient with GERD.
Choice B rationale
Pancreatic cancer is a serious condition, but it is not directly related to GERD. GERD is primarily an issue of the esophagus and stomach, not the pancreas. While it’s always important to be vigilant about potential health issues, there is no specific reason for a patient with GERD to watch for manifestations of pancreatic cancer.
Choice C rationale
While diabetes is a significant health concern, it is not directly linked to GERD. GERD does not increase the risk for diabetes. An endocrinologist specializes in hormonal disorders, including

diabetes, but would not typically be involved in the management of GERD unless there were other co-existing endocrine issues.
Choice D rationale
This is the correct answer. Barrett’s esophagus is a condition that can develop in people who have long-term GERD. It changes the color and composition of the esophagus lining, which can increase the risk of esophageal cancer. Therefore, it is important for patients with long-term GERD symptoms to follow up with a GI specialist for recommended surveillance for Barrett’s esophagus.

Choice A rationale

While an elevated serum ammonia level can indicate liver dysfunction, it is not typically a contraindication for liver biopsy. Ammonia is a byproduct of protein metabolism and is normally converted into urea by the liver, which is then excreted in the urine. Elevated levels can occur in liver disease, but they are not typically a direct concern in the context of a liver biopsy.
Choice B rationale
A hemoglobin level of 11 g/dL is slightly low, but it is not typically a contraindication for a liver biopsy. Hemoglobin is the protein in red blood cells that carries oxygen. While a low hemoglobin level can indicate anemia, it would not typically prevent a patient from undergoing a liver biopsy.
Choice C rationale
A white blood cell count of 14.2 x 103/uL is slightly elevated, indicating a possible infection or inflammation. However, this would not typically be a contraindication for a liver biopsy.
Choice D rationale
A prothrombin time of 32 seconds is significantly prolonged, indicating a potential problem with blood clotting. This would be a major concern for a nurse caring for a patient scheduled for a liver biopsy, as the procedure involves inserting a needle into the liver and could lead to bleeding. Patients with a prolonged prothrombin time are at an increased risk of bleeding complications.