A 25 years old patient at 38 weeks gestation who is in labor is being treated with magnesium sulfate for preeclampsia. Which nursing intervention does not correspond with this medication's toxicity? Select one:
Assess and record urine output.
Assess cervix dilation
Assess deep tendon reflexes
Check respiratory rate
The Correct Answer is B
a. This is an important nursing intervention when a patient is receiving magnesium sulfate, as the medication can affect renal function.
b. Assessing cervix dilation is not related to magnesium sulfate toxicity.
c. This is an important nursing intervention when a patient is receiving magnesium sulfate, as the medication can affect neuromuscular function.
d. This is an important nursing intervention when a patient is receiving magnesium sulfate, as the medication can affect respiratory function.
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Related Questions
Correct Answer is C
Explanation
a. The client should also be placed in Trendelenburg or knee-chest position to reduce cord compression.
b. This is not the first action to take when the umbilical cord is prolapsed.
c. This is a medical emergency that requires immediate intervention to prevent fetal hypoxia and death. The nurse should insert a gloved hand into the vagina and apply upward pressure on the presenting part to lift it off the cord until delivery.
d. This may be necessary if the cord compression cannot be relieved, but the first priority is to relieve the cord compression.
Correct Answer is B
Explanation
a. A posterior presentation is when the fetus's back is toward the mother's back, and the fetal heart tones are usually heard on either side of the mother's abdomen.
b. A breech presentation is when the fetus's buttocks or feet are closest to the cervix. The fetal heart tones are usually heard above the umbilicus, at the midline, in a breech presentation.
c. A cephalic presentation is when the fetus's head is closest to the cervix, and the fetal heart tones are usually heard below the umbilicus, in either quadrant.
d. An oblique presentation is when the fetus's head or buttocks are angled toward one side of the pelvis, and the fetal heart tones are usually heard off-center, above or below the umbilicus.
e. A transverse presentation is when the fetus's spine is perpendicular to the mother's spine, and the fetal heart tones are usually heard on one side of the abdomen.
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