A nurse is assessing a client who has severe preeclampsia and is receiving magnesium sulfate via continuous IV infusion.
Which of the following findings should alert the nurse to suspect magnesium toxicity?
Respiratory rate 10/min
Urine output 40 mL/hr
Patellar reflex 2+
Serum magnesium level 4.5 mEq/L
The Correct Answer is A
Respiratory rate 10/min. This indicates muscle weakness and difficulty breathing, which are symptoms of magnesium toxicity. Magnesium sulfate is a medication that can cause magnesium overdose if given in excess or if the patient has impaired kidney function.
Choice B. Urine output 40 mL/hr is wrong because this is within the normal range for urine output, which is 30 to 50 mL/hr. Urine output may decrease in severe cases of magnesium toxicity due to urine retention.
Choice C. Patellar reflex 2+ is wrong because this is a normal finding for the knee-jerk reflex. A low or absent patellar reflex may indicate magnesium toxicity, as it reflects muscle weakness and nerve dysfunction.
Choice D. Serum magnesium level 4.5 mEq/L is wrong because this is within the normal range for serum magnesium, which is 1.7 to 2.3 mEq/L. Serum magnesium levels above 2.6 mEq/L can indicate hypermagnesemia or magnesium overdose.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Labetalol is an antihypertensive drug that can lower blood pressure in pregnant women with preeclampsia.Preeclampsia is a condition that causes high blood pressure and proteinuria after 20 weeks of gestation.
Choice A is wrong because hydralazine is not recommended as a first-line treatment for preeclampsia due to its potential adverse effects on maternal and fetal outcomes.
Choice B is wrong because nifedipine is not licensed for use in pregnancy and may interact with magnesium sulfate, which is an anticonvulsant medication used to prevent or treat seizures in severe preeclampsia.
Choice D is wrong because methyldopa is not effective for acute blood pressure control and may cause adverse effects such as depression, sedation, and hemolytic anemia.
Correct Answer is A
Explanation
Absence of seizures indicates a therapeutic response to magnesium sulfate therapy for a client with eclampsia.Magnesium sulfate is used to prevent seizures in women with preeclampsia, a complication of pregnancy characterized by high blood pressure and organ dysfunction.Magnesium sulfate may act as a vasodilator, an anticonvulsant, and a protector of the blood-brain barrier.
Choice B is wrong because a decrease in urine output may indicate renal impairment, which is a complication of preeclampsia and eclampsia.
Choice C is wrong because an increase in deep tendon reflexes may indicate hyperreflexia, which is a sign of increased neuromuscular irritability and a risk factor for seizures.
Choice D is wrong because an increase in respiratory rate may indicate respiratory distress, which can be caused by pulmonary edema, another complication of preeclampsia and eclampsia.
Normal ranges for urine output are 0.5 to 1 mL/kg/hour, for deep tendon reflexes are 1+ to 2+, and for respiratory rate are 12 to 20 breaths per minute.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.