A nurse is preparing to administer a clients scheduled alendronate. What patient education should be included? Select all that apply.

Rationale: A. Take calcium and vitamin D supplements daily: Alendronate is a bisphosphonate that inhibits bone resorption, but adequate calcium and vitamin D are essential for optimal bone mineralization and fracture prevention. Supplementation supports the medication’s therapeutic effect and helps maintain bone health. B. Take this medication with a full glass of water: Alendronate can cause esophageal irritation or ulceration if it does not reach the stomach promptly. Taking it with a full glass of water ensures proper delivery to the stomach and reduces the risk of mucosal injury. C. After administration remain upright for at least 30 minutes: Remaining upright after taking alendronate prevents reflux of the medication into the esophagus, minimizing the risk of esophagitis, irritation, or ulcer formation. This is a critical safety measure for all patients taking oral bisphosphonates. D. Eat something prior to administration to reduce GI Upset: Alendronate should be taken on an empty stomach at least 30 minutes before the first food, beverage, or other medications. Eating prior to administration can significantly reduce absorption and diminish its effectiveness. E. Report new onset heartburn to your provider: New or worsening heartburn may indicate esophageal irritation or ulceration from alendronate. Prompt reporting allows timely evaluation and intervention to prevent serious complications such as esophagitis.