A nurse is teaching a client who is to begin taking tamoxifen to treat breast cancer. The nurse should instruct the client to expect which of the following findings as an adverse effect of the medication?

Choice A reason: This is incorrect because orally administered decongestants do not have an immediate onset. They take longer to act than nasal sprays because they have to be absorbed through the gastrointestinal tract. Nasal sprays act directly on the nasal mucosa and have a faster onset.

Choice B reason: This is correct because orally administered decongestants do not cause rebound congestion. Rebound congestion is a condition in which the nasal passages become more swollen and congested after the effect of the nasal spray wears off. This can lead to overuse and dependence on the nasal spray. Orally administered decongestants do not have this effect because they act systemically and not locally.

Choice C reason: This is incorrect because orally administered decongestants do not have a shorter duration. They have a longer duration than nasal sprays because they are metabolized more slowly by the liver. Nasal sprays have a shorter duration because they are eliminated more quickly by the nasal mucosa.

Choice D reason: This is incorrect because orally administered decongestants are not more potent than nasal sprays. They have a similar potency, but they have a different mechanism of action. Orally administered decongestants act on the alpha-adrenergic receptors in the blood vessels, causing vasoconstriction and reducing congestion. Nasal sprays act on the beta-adrenergic receptors in the bronchial smooth muscle, causing bronchodilation and improving airflow.

Choice A reason: This is incorrect because alendronate is not safe during pregnancy, as it may harm the fetus or cause birth defects. The client should inform the provider if they are pregnant or planning to become pregnant before taking this medication.

Choice B reason: This is incorrect because the client should not lie down for at least 30 minutes after taking alendronate, as this may cause esophageal irritation, ulceration, or bleeding. The client should take alendronate with a full glass of water and swallow it whole, without chewing or crushing.

Choice C reason: This is incorrect because the client should not continue smoking while on alendronate, as smoking can worsen the bone loss and increase the risk of fractures. The client should quit smoking or reduce the amount of cigarettes they smoke.

Choice D reason: This is correct because the client should avoid alcohol with alendronate, as alcohol can also worsen the bone loss and increase the risk of fractures. Alcohol can also interact with alendronate and cause side effects, such as stomach upset, drowsiness, or liver damage.

Choice E reason: This is correct because the client should sit up for at least 30 minutes after taking alendronate, as this can prevent the medication from refluxing back into the esophagus and causing irritation, ulceration, or bleeding. The client should also avoid eating or drinking anything other than water for at least 30 minutes after taking alendronate, as this can reduce its absorption and effectiveness.