A charge nurse is educating a newly licensed nurse about fluid and electrolyte balance. Which of the following manifestations should the newly licensed nurse identify as a sign of magnesium sulfate toxicity?

A. Apply splints to the child's extremities during the day: Splints are typically used at night to support proper joint positioning and reduce stiffness during rest. Using them during the day may limit the child’s mobility and interfere with normal activity, which is not ideal for joint health.
B. Keep the child on bedrest as long as pain persists: Prolonged bedrest can lead to increased joint stiffness and muscle wasting. Maintaining activity within comfort levels is encouraged to promote mobility and joint flexibility.
C. Have the child take a tub bath each morning: Warm tub baths in the morning help to relieve joint stiffness, improve circulation, and make it easier for the child to move comfortably throughout the day. This non-pharmacologic intervention supports daily function.
D. Encourage the child to take naps during the day: While adequate rest is important, excessive daytime napping may reduce physical activity, which is necessary to maintain joint function and overall well-being in juvenile idiopathic arthritis.

Rationale for Correct Choices:

• Compartment syndrome: Occurs when pressure within a closed muscle compartment compromises circulation and tissue function. The client presents with classic signs: pain out of proportion, pallor (cool foot), pulselessness (non-palpable pulses), paresthesia (numbness), and paralysis (inability to move foot/toes) which are hallmark signs of compromised perfusion.

• Osteomyelitis: The presence of drainage from the splint site, increasing temperature, and markedly elevated WBC count (from 14,000 to 28,000/mm³) strongly suggest developing bone infection. The client’s open fracture and internal fixation increase susceptibility, especially with new signs of systemic infection and localized inflammation at the injury site.

Rationale for Incorrect Choices:

• Deep vein thrombosis (DVT): While trauma and immobility increase DVT risk, there is no evidence of unilateral leg swelling, calf tenderness, or redness. The primary concern here is neurovascular compromise, not venous thromboembolism, and the symptoms point more urgently to compartment syndrome and infection.

• Fat embolism syndrome: Fat embolism is a risk with long bone fractures, typically presenting within 24–72 hours with respiratory distress, hypoxia, confusion, and a petechial rash. This client is alert and not in respiratory distress, with normal oxygen saturations and no mental status changes, making fat embolism less likely at this stage.