A nurse in a provider's office is assessing a client who has dementia. Which of the following findings should the nurse expect?

Rationale for correct choices:

• Fingernail assessment: Broken fingernails can be a sign of a struggle, as the client may have tried to defend themselves during the assault. Such injuries are commonly seen in cases of sexual assault, where victims may attempt to resist or protect themselves.
• Diagnostic results: The positive urine drug screen for GHB is key as it is often used as a "date rape drug" due to its ability to cause sedation, memory loss, and impaired judgment. Its presence supports the possibility of the client being drugged as part of a sexual assault.

Rationale for incorrect choices:

• Blood pressure: Blood pressure readings are typically not indicative of sexual assault. While anxiety or trauma can affect blood pressure, this measurement alone does not provide information directly related to sexual assault. Her BP is also within normal range.
• Abdominal examination: Mild tenderness in the abdomen could be incidental or related to other causes but is not directly linked to the typical findings in a sexual assault case. Abdominal examination would generally not be the primary assessment for identifying sexual assault unless there was significant trauma or injury to the abdomen.
• Temperature: A normal temperature of 37°C (98.6°F) does not indicate anything specific to sexual assault. While fever may occur in cases of infection, it is not a defining characteristic of sexual assault and doesn't help in confirming the occurrence.

A. Avoid over-the-counter magnesium when taking this medication: There is no specific contraindication between doxepin and magnesium supplements. However, clients should consult their healthcare provider before using any over-the-counter products.
B. Eat a snack before going to bed: While this is not incorrect for some medications, it is not a primary teaching point for doxepin. The medication's primary side effect concerns are sedation and orthostatic hypotension, not hunger-related issues.
C. Sit on the side of the bed for a few minutes before standing: Doxepin, a tricyclic antidepressant, can cause orthostatic hypotension, leading to dizziness when standing. Sitting on the side of the bed before standing helps reduce this risk by allowing the body to adjust to the change in position.
D. Decrease the prescribed dose by half when mood improves: Clients should never adjust their prescribed medication dose without consulting their provider. Abruptly stopping or reducing the dose can cause withdrawal symptoms or a relapse of depressive symptoms.