A nurse is reviewing the medication record of a client who has hypertension. Which of the following medications should the nurse administer to lower the client's blood pressure?

A. Anorexia. While gastrointestinal side effects such as nausea and esophageal irritation can occur with alendronate, anorexia is not a common adverse effect. If severe nausea leads to decreased appetite, the client should report this to their provider, but it is not a primary concern compared to more serious side effects.

B. Jaw pain. Jaw pain can indicate osteonecrosis of the jaw (ONJ), a rare but serious adverse effect associated with long-term bisphosphonate use. This condition involves poor bone healing, especially after dental procedures, and can lead to bone deterioration. Clients taking alendronate should report any persistent jaw pain and undergo regular dental exams to monitor bone health.

C. Insomnia. Alendronate does not typically cause insomnia. While some medications, such as corticosteroids and stimulants, are linked to sleep disturbances, alendronate does not affect the central nervous system in a way that would disrupt sleep patterns.

D. Bruising. Alendronate does not interfere with platelet function or coagulation, making bruising an unlikely adverse effect. Clients who experience unexplained bruising should be evaluated for other underlying causes, such as blood disorders or medication interactions.

• Shortness of breath. The client is experiencing respiratory distress, which could indicate a severe allergic reaction (anaphylaxis). Immediate intervention is needed to prevent airway compromise and respiratory failure.
• Intercostal retractions. Retractions occur when breathing is labored, suggesting airway obstruction or bronchoconstriction. This is a sign of worsening respiratory distress, requiring urgent medical attention.
• Wheezing auscultated throughout lung fields. Wheezing suggests bronchospasm, which is common in anaphylaxis and asthma attacks. The presence of diffuse wheezing indicates that the airways are narrowing, making breathing more difficult.
• Diffuse, raised rash present on trunk. A new-onset rash following antibiotic administration raises suspicion for anaphylaxis or a severe allergic reaction. Immediate treatment with antihistamines and corticosteroids may be required.
• Respiratory rate 30/min. The increased respiratory rate indicates that the client is compensating for airway constriction and hypoxia. This is an early warning sign of impending respiratory failure if not treated promptly.
• Blood pressure 90/55 mmHg. The drop in blood pressure suggests anaphylactic shock, where vasodilation and fluid leakage from capillaries lead to hypotension. Immediate administration of epinephrine is necessary to prevent cardiovascular collapse.
• Oxygen saturation 91% on room air. A decrease in oxygen saturation indicates impaired gas exchange, likely due to airway swelling and bronchospasm. Supplemental oxygen therapy should be provided to prevent further desaturation.