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. Stop the procedure: Stopping the blood transfusion immediately is the priority to prevent further exposure to the potentially harmful blood product causing the wheezing. This action helps minimize the risk of progression to a more severe transfusion reaction or anaphylaxis.
B. Administer an antihistamine: Antihistamines may relieve allergic symptoms but should only be given after the transfusion is stopped and the client is assessed. Administering medication without stopping the transfusion first could worsen the reaction.
C. Administer oxygen: Providing oxygen supports the client’s respiratory function during wheezing, which may indicate hypoxia. Oxygen administration is important but secondary to stopping the transfusion to eliminate the cause.
D. Initiate an infusion of 0.9% sodium chloride using new tubing: Starting a saline infusion with new tubing helps maintain IV access and prevent clotting after stopping the transfusion. This action is necessary but follows stopping the transfusion as the first priority.

• Hypoxia: Hypoxia is a key feature of epiglottitis due to airway obstruction from supraglottic swelling. It also occurs in RSV, where inflammation and mucus obstruct small airways, reducing oxygen exchange. Both conditions can require supplemental oxygen and prompt respiratory support.
• Tachypnea: Increased respiratory rate is a compensatory mechanism for hypoxia and respiratory distress. In epiglottitis, it results from airway narrowing, while in RSV, it's due to bronchiolar inflammation, mucosal edema, and increased airway resistance.
• Fever: Fever is a nonspecific but consistent sign in all three conditions. In epiglottitis, it’s often high-grade and abrupt. In RSV, it tends to be low to moderate. In streptococcal pharyngitis, fever accompanies tonsillar inflammation and systemic infection.
• Exudate on pharynx: Purulent or white exudate on swollen tonsils is a hallmark of streptococcal pharyngitis, reflecting bacterial colonization and immune response. This finding is not typically seen in viral causes like RSV or in epiglottitis.
• Drooling: Drooling is classic for epiglottitis due to pain and difficulty swallowing. The inflamed, swollen epiglottis causes discomfort and obstruction, preventing normal handling of oral secretions. It's a red flag for impending airway compromise.
• Wheezing upon auscultation: RSV causes bronchiolitis, which leads to wheezing due to lower airway obstruction by mucus and inflammation. Wheezing is not a feature of epiglottitis (which affects the upper airway) or streptococcal pharyngitis (which affects the oropharynx).