The nurse is assessing a patient taking lactulose to treat chronic constipation. Which adverse effect should the nurse immediately report to the healthcare provider?

A. Lying down 1 hour after eating: Lying down after eating can worsen symptoms of heartburn and acid reflux, so it is generally discouraged for patients with hiatal hernia.

B. Eating three well-balanced meals: While eating balanced meals is important, it's not specifically recommended for reducing heartburn or regurgitation in patients with a hiatal hernia. Smaller, more frequent meals are generally better.

C. Eating nothing for several hours before bedtime: Avoiding food for several hours before bedtime allows the stomach to empty, reducing the risk of acid reflux, heartburn, and regurgitation.

D. Sleeping without pillows: Patients with hiatal hernias are often advised to sleep with the head elevated (using pillows) to prevent acid reflux while sleeping.

A. Sharp: This type of pain is typically associated with more acute or localized conditions, such as in an injury or inflammation, but not with peptic ulcer disease.

B. Burning: This is the most characteristic description of pain associated with peptic ulcer disease. The burning sensation is often related to acid irritation of the ulcerated tissue in the stomach or duodenum.

C. Stabbing: Stabbing pain is more likely to be associated with conditions such as acute pancreatitis or peritonitis, but it's not typical for peptic ulcers.

D. Dull: A dull ache is often seen in conditions such as chronic muscle pain or arthritis, but it’s not the typical presentation for peptic ulcer disease, which usually involves more intense, burning pain.