A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery?

Choice A reason: Venous thromboembolism is a contraindication for taking SERMs. SERMs are drugs that act like estrogen in some tissues and block estrogen in others. They can help prevent bone loss and fractures in postmenopausal women, but they can also increase the risk of blood clots in the veins, such as deep vein thrombosis and pulmonary embolism. Therefore, women who have a history of or are at high risk for venous thromboembolism should not take SERMs.

Choice B reason: Breast cancer is not a contraindication for taking SERMs. In fact, some SERMs, such as tamoxifen and raloxifene, are used to treat or prevent breast cancer in women who have estrogen receptor-positive tumors. These SERMs block the effects of estrogen in the breast tissue and reduce the growth of cancer cells.

Choice C reason: Hypocalcemia is not a contraindication for taking SERMs. Hypocalcemia is a low level of calcium in the blood. SERMs do not affect calcium levels directly, but they can help prevent calcium loss from the bones by mimicking the effects of estrogen in the bone tissue. However, women who take SERMs should also take adequate calcium and vitamin D supplements to maintain bone health.

Choice D reason: Stress fractures are not a contraindication for taking SERMs. Stress fractures are small cracks in the bones that result from repeated stress or overuse. SERMs can help prevent stress fractures by strengthening the bones and reducing the risk of osteoporosis. However, women who take SERMs should also avoid excessive or inappropriate physical activity that can cause stress fractures.

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.