A nurse is providing teaching to a client who has osteoporosis and a new prescription for alendronate. Which of the following adverse effects should the nurse instruct the client to report to the provider? (Select all that apply.)

A. Drowsiness: Alendronate does not typically cause central nervous system depression or drowsiness. Reporting this is unnecessary, as it is not recognized as an adverse effect of the medication. B. Blurred vision: Visual disturbances such as blurred vision or eye pain can signal ocular inflammation, a rare but serious adverse effect of alendronate. The client should report this promptly for evaluation and possible discontinuation. C. Dysphagia: Difficulty swallowing can indicate esophageal irritation or ulceration, a significant risk associated with alendronate if the medication is not taken correctly. Reporting this symptom is critical to prevent further injury. D. Tinnitus: Tinnitus (ringing in the ears) is not a known or common adverse effect of alendronate. It is more commonly associated with other medications, such as salicylates (aspirin) and certain loop diuretics. E. Jaw pain: Jaw pain can indicate osteonecrosis of the jaw, a rare but serious complication of bisphosphonates like alendronate. This requires immediate reporting and medical evaluation to prevent worsening bone damage.