# Clinical context A 72-year-old with osteoporosis is scheduled for the first oral alendronate dose; the nurse reviews swallowing ability, calcium level, fasting instructions, water intake, and ability to remain upright. Which findings or behaviors require clarification before administering oral alendronate? Select exactly 3 responses.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=603007&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
A 72-year-old with osteoporosis is scheduled for the first oral alendronate dose; the nurse reviews swallowing ability, calcium level, fasting instructions, water intake, and ability to remain upright.

Which findings or behaviors require clarification before administering oral alendronate? Select exactly 3 responses.

Select exactly 3 responses.

1

The dose will be taken with plain water after an overnight fast.

2

Serum calcium is below the laboratory reference range.

3

The client can swallow the tablet whole.

4

The client cannot sit or stand upright for 30 minutes.

5

The client will remain upright until after the first food of the day.

6

The client has an esophageal stricture that delays emptying.

## Explanation

Oral alendronate is contraindicated with esophageal emptying abnormalities, inability to remain upright, and hypocalcemia. It is taken after an overnight fast with plain water and followed by an upright interval.

## In-depth explanation

Quick answer
Check esophagus, upright ability, and calcium before alendronate.

Why this is correct
Correct administration reduces severe esophageal irritation but does not overcome a contraindication.

Easy analogy or mental picture
Build a medication-safety chain: identify the new cue, connect it to the drug mechanism or labeled limitation, stop preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, substitute an unauthorized dose, or delay escalation leave the client at risk.References
1DailyMed: Alendronate Sodium TabletsEsophageal and hypocalcemia contraindications plus administration technique

## Clinical scenario

Clinical context
A 72-year-old with osteoporosis is scheduled for the first oral alendronate dose; the nurse reviews swallowing ability, calcium level, fasting instructions, water intake, and ability to remain upright.

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