Based on the assessment findings, which of the following actions should the nurse take? Select all that apply.

Rationale for correct choices:

• Administer metoclopramide 10 mg IM: The client is experiencing nausea and vomiting, and metoclopramide is an antiemetic that can help alleviate these symptoms. Managing nausea is crucial for preventing further dehydration and discomfort, especially as the client is refusing to eat or drink anything and has been vomiting most of the night.
• Administer diazepam 10 mg PO: Diazepam is a benzodiazepine used to manage alcohol withdrawal symptoms, such as anxiety and the risk of seizures. It should be administered to prevent severe withdrawal symptoms and ensure the client’s safety, once nausea is managed.

Rationale for incorrect choices:

• Offer ice chips and fluids: While ice chips may help with hydration, the priority is to address the nausea and alcohol withdrawal symptoms first. Administering metoclopramide is the first step to manage nausea, making fluid intake more tolerable.
• Do a CBC and basic metabolic profile: These tests are important for monitoring the client’s condition but are not as urgent as managing nausea and alcohol withdrawal symptoms. These tests should be completed once the acute symptoms are addressed.
• Perform alcohol use disorders identification test (AUDIT): The AUDIT is useful for assessing the severity of alcohol use disorder, but it is not an immediate priority. Managing the client's physical symptoms takes precedence before conducting assessments.
• Begin substance use group therapy: Group therapy is an essential part of treatment but should not be initiated before addressing the client’s immediate physical needs, particularly nausea and alcohol withdrawal symptoms.

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.