A nurse in a community clinic is caring for a client who requests assistance with smoking cessation. The nurse should expect a prescription for which of the following medications?

Rationale for correct choices:

• Apply oxygen via nasal cannula: The client is experiencing signs of decreased oxygenation (SpO₂ 92%), shallow respirations, and lethargy, which may indicate central nervous system depression from magnesium sulfate. Administering oxygen improves tissue perfusion and is a priority for maternal and fetal well-being.
• Calcium gluconate: Magnesium sulfate toxicity presents with depressed deep tendon reflexes, lethargy, and respiratory depression. Since the client's DTRs have decreased from 3+ to 1+ and respirations are now shallow, calcium gluconate should be prepared as the antidote to reverse toxicity promptly.

Rationale for incorrect choices:

• Reduce fluid intake: Although the client has reduced urine output and elevated creatinine and BUN levels, there is no indication of fluid overload. Reducing fluids does not address the immediate concern of hypoxia or magnesium toxicity, which are more urgent.
• Discontinue IV infusion: The IV is essential for delivering antihypertensive medications and magnesium sulfate. Discontinuing it would delay critical treatment and worsen the client’s condition. Adjustments, if needed, should follow provider orders after assessment, not be the nurse's initial independent action.
• Hydralazine: Hydralazine is appropriate for severe hypertension but is not the most urgent need when magnesium toxicity is suspected. Managing respiratory compromise and preparing the antidote takes precedence over blood pressure control in this case.
• Nifedipine: Nifedipine was already prescribed and may be administered for ongoing hypertension management. However, it is not used to treat magnesium sulfate toxicity and does not reverse respiratory depression. Thus, while important, it is not the immediate medication to prepare in this scenario.

Rationale:

A. Wear a dosimeter film badge to measure exposure: A dosimeter badge tracks the cumulative radiation exposure for healthcare workers. It is essential for staff safety when caring for clients with internal radiation therapy.

B. Discard bed linens from the client's room at the end of each day: Linens should not be discarded unless contaminated. They are usually kept in the room until radiation is removed to avoid unnecessary exposure to other staff or areas.

C. Instruct visitors to remain 61 cm (2 feet) away from the client: Visitors should maintain a greater distance typically at least 6 feet (about 2 meters) and limit their visit time (usually to 30 minutes or less). Two feet is insufficient to minimize radiation exposure.

D. Place a caution sign on the client's door: Posting a radiation warning sign helps alert all personnel and visitors about radiation precautions, promoting safety and compliance with guidelines.

E. Don a lead apron when providing care: A lead apron protects the nurse from radiation exposure, especially when prolonged or close contact is necessary. It is a critical part of personal protective equipment in this setting.