A nurse is caring for a client who has osteoporosis and a new prescription for alendronate. Which of the following should the nurse assess prior to initiating therapy?

Here are the indications for each teaching statement:

1. “It is expected for your stools to be black while taking this medication.”
   • Indicated: This is a common side effect of iron supplements like ferrous sulfate.
2. “Take this medication with an antacid if you experience heartburn from the medication.”
   • Contraindicated: Antacids can interfere with the absorption of iron. It’s better to take the iron supplement with vitamin C or a source of vitamin C to enhance absorption.
3. “Drinking orange juice with this medication decreases the absorption of the medication.”
   • Contraindicated: This statement is incorrect. Vitamin C, found in orange juice, actually enhances the absorption of iron.
4. “You can take this medication with meals if you experience discomfort when taking it on an empty stomach.”
   • Indicated: Taking iron supplements with food can help reduce gastrointestinal discomfort, although it may slightly reduce absorption.

Choice A rationale:
The client’s temperature has decreased from 37.8°C (100°F) to 37.2°C (99°F). While this is a slight reduction, it indicates a move towards a more normal body temperature. Elevated temperatures can be associated with stress, anxiety, or other underlying conditions. A decrease in temperature suggests that the client’s body is stabilizing and that any potential underlying issues causing the elevated temperature are being managed effectively.

Choice B rationale:
The client’s mood has improved as she appears less anxious and more composed during the physical examination. Anxiety can significantly impact a person’s overall well-being, and a reduction in anxiety levels is a positive indicator of improvement. The client also expresses optimism about her recovery, which is a good sign of mental health improvement.
Choice C rationale:
The client has gained weight, increasing from 53 kg (117 lb) to 55 kg (121 lb). Weight gain in this context is a positive sign, indicating that the client’s body is responding well to treatment and that her nutritional status is improving. Unintentional weight loss can be a symptom of underlying health issues, so reversing this trend is a good indicator of recovery.
Choice D rationale:
The client reports better sleep, which is a significant improvement from her previous insomnia. Sleep is crucial for physical and mental health, and improved sleep patterns can lead to better overall health outcomes. Insomnia can exacerbate anxiety and other health issues, so better sleep is a positive sign.
Choice E rationale:
The client’s heart rate has decreased from 120/min to 95/min. A high heart rate can be a sign of anxiety, stress, or other health issues. A reduction in heart rate indicates that the client’s anxiety levels are decreasing and that her cardiovascular system is stabilizing. This is a positive sign of improvement in her overall health.