During an abdominal assessment, which of the following findings would be considered abnormal and warrant further investigation? (Select all that apply)

A. Muscle spasms: Muscle spasms are more commonly associated with hypocalcemia or electrolyte imbalances rather than the use of aluminum hydroxide. While clients with renal failure may experience spasms due to their condition, this is not a primary adverse effect.

B. Constipation: Aluminum hydroxide is known to cause constipation as a common adverse effect because it neutralizes stomach acid and slows gastrointestinal motility. Teaching the client to expect and manage constipation, such as increasing fluid and fiber intake if permitted, is essential.

C. Headache: Headaches are not a typical adverse effect of aluminum hydroxide. While clients may experience them due to other conditions, they are not specifically related to this phosphate-binding medication.

D. Metallic taste: Aluminum hydroxide can cause minor gastrointestinal disturbances, but a metallic taste is uncommon. It is not considered a primary adverse effect that requires patient teaching for routine therapy.

Rationale:

• "I will notify my health care provider if I have severe or persistent heartburn.": Alendronate can cause esophageal irritation and heartburn. Reporting severe or persistent symptoms ensures safe continuation or adjustment of therapy.
• "If I miss a dose, I can take it later in the day.": Alendronate should be taken on the scheduled day, and the next dose should only be taken at the next weekly interval; taking extra doses can increase risk of adverse effects.
• "I will take my medication the same time and day every week.": Consistency in weekly dosing maintains therapeutic levels and effectiveness in preventing bone loss and fractures.
• "I can take an antacid with my medication to reduce heartburn.": Antacids interfere with absorption of alendronate and should not be taken within 30–60 minutes before or after the medication.
• "I can drink my coffee right after taking my medication.": Coffee, as well as other beverages like milk or juice, can reduce absorption of alendronate. Only plain water should be used, and the client should avoid other beverages for at least 30 minutes after ingestion.
• "I need to sit upright for 30 minutes after I take my medication.": Remaining upright prevents esophageal irritation and allows proper absorption, which is a key safety measure when taking alendronate.