A nurse is assessing a client who received magnesium sulfate to treat preterm labor. Which of the following clinical findings should the nurse identify as an indication of toxicity of magnesium sulfate therapy and report to the provider?

Explanation:

A. Preparation for cesarean birth:

This is the correct choice. Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to vaginal bleeding. In cases of suspected placenta previa with significant bleeding, cesarean birth is the safest delivery option to minimize the risk of complications such as hemorrhage. Therefore, immediate preparation for cesarean birth is indicated to ensure the safety of both the mother and the baby.

B. Initiation of pushing:

Pushing or active pushing efforts are contraindicated in cases of suspected placenta previa with significant vaginal bleeding. Pushing can increase the risk of further placental detachment and exacerbate bleeding. It is crucial to avoid any actions that could worsen the bleeding or harm the mother and baby. Therefore, initiation of pushing is not appropriate in this situation.

C. Examination to determine cervical status:

While cervical examinations are important during labor to assess progress and determine readiness for delivery, they are not appropriate in cases of suspected placenta previa with active vaginal bleeding. Cervical examinations can potentially increase bleeding and should be avoided until the placental location and stability are assessed through ultrasound or other diagnostic methods. Therefore, examination to determine cervical status is not appropriate in this situation.

D. A magnesium sulfate infusion:

Magnesium sulfate infusion is not indicated for suspected placenta previa with significant vaginal bleeding. Magnesium sulfate is commonly used to prevent or manage preterm labor and certain hypertensive disorders during pregnancy but is not a treatment for placenta previa or its associated bleeding. Immediate preparation for cesarean birth is the priority in this situation to ensure the safety of the mother and baby. Therefore, a magnesium sulfate infusion is not appropriate in this situation.

Explanation:

A. A client who is at 28 weeks of gestation and receiving terbutaline reports fine tremors:

Fine tremors are a known side effect of terbutaline, which is often used to delay preterm labor by relaxing the uterus. While tremors are a common and expected side effect of terbutaline, they are not typically considered an urgent concern unless they are severe or accompanied by other concerning symptoms.

B. A client who has a diagnosis of preeclampsia has 2+ proteinuria and 2+ patellar reflexes:

Proteinuria (2+) and increased deep tendon reflexes (2+) are significant findings in a client with preeclampsia, indicating worsening of the condition and potential organ involvement. However, they may not require immediate reporting unless accompanied by other severe symptoms such as severe hypertension, severe headache, visual disturbances, or epigastric pain.

C. A client who has a diagnosis of preeclampsia reports epigastric pain and unresolved headache:

This is the correct answer. Epigastric pain and unresolved headache are concerning symptoms in a client with preeclampsia and can indicate worsening of the condition or complications such as HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). These symptoms may suggest liver involvement, which is a serious complication of preeclampsia and requires immediate evaluation and management by the provider.

D. A tearful client who is at 32 weeks of gestation and is experiencing irregular, frequent contractions:

While tearfulness and irregular, frequent contractions may indicate emotional distress or early labor, they are not typically considered urgent findings unless accompanied by other signs of impending preterm labor such as cervical changes or regular, painful contractions. Immediate reporting is important if there are signs of active labor or cervical changes, but based on the information provided, this finding is not as urgent as the epigastric pain and unresolved headache in a client with preeclampsia.