A nurse in a mental health clinic is assessing a client who was recently diagnosed with anorexia nervosa. Which of the following findings should the nurse identify as an indication of laxative misuse?

A. Administer calcium gluconate for urine output less than 50 mL/hr: Calcium gluconate is given to treat magnesium sulfate toxicity, which is indicated by absent deep tendon reflexes, respiratory depression, or high serum magnesium levels. Low urine output requires monitoring but does not automatically warrant calcium gluconate administration.

B. Check deep tendon reflexes every 8 hr: Deep tendon reflexes should be assessed frequently during magnesium sulfate therapy, usually every 1–2 hours, to detect early signs of toxicity. Checking only every 8 hours is insufficient for safe monitoring.

C. Administer one dose of betamethasone now and repeat in 24 hr: Betamethasone is given to accelerate fetal lung maturity in preterm gestation, which is critical at 31 weeks. Administering the two-dose course as prescribed helps reduce neonatal respiratory complications, making this a priority intervention alongside magnesium sulfate therapy.

D. Limit IV intake to no more than 200 mL/hr: Monitoring and limiting IV fluids helps prevent fluid overload and pulmonary edema in preeclamptic clients, but ensuring fetal lung maturity with betamethasone takes priority at this gestational age in case of an early delivery.

A. "You should increase your daily fluid intake.": Adequate hydration is important during early pregnancy to support maternal blood volume expansion, amniotic fluid production, and overall health. Increasing fluid intake can also help alleviate common symptoms such as constipation and mild nausea.

B. "Headaches are expected throughout pregnancy.": While mild headaches can occur, persistent or severe headaches are not considered normal and may indicate complications such as hypertension. Clients should be advised to report significant or recurrent headaches to their provider.

C. "You will feel your baby moving within the next month.": Fetal movement, or “quickening,” typically occurs between 16–20 weeks of gestation for primigravid clients, not at 9–10 weeks. Early reassurance should focus on expected developmental milestones for this stage.

D. "Hormone shifts often cause severe vomiting.": Mild nausea and vomiting are common in early pregnancy due to hormonal changes, but severe vomiting (hyperemesis gravidarum) is not expected and requires medical evaluation for hydration and nutritional management.