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. Prepare the abdominal and perineal areas: While preparing the abdominal and perineal areas may be necessary for potential interventions, such as a cesarean section or vaginal examination, it is not the priority at this moment.

B. Witness the signature for informed consent for surgery: Obtaining informed consent for surgery is important, especially if surgical intervention is anticipated. However, the priority in this case is to stabilize the client's condition and address the potential causes of painless, bright red vaginal bleeding.

C. Insert an indwelling urinary catheter: Inserting an indwelling urinary catheter may be beneficial for monitoring urinary output and assessing fluid status. However, it is not the immediate priority compared to addressing the client's vital signs and managing potential causes of bleeding.

D. Initiate IV access: This is the correct answer. Given the client's large amount of painless, bright red vaginal bleeding, the priority is to establish IV access to administer fluids and possibly blood products if there is evidence of hypovolemia or hemorrhage. IV access will also allow for the administration of medications or other interventions as needed.

Explanation:

A. "I know I am at increased risk to develop type 2 diabetes."

This statement indicates an understanding of the increased risk for developing type 2 diabetes after experiencing gestational diabetes. It shows awareness of the long-term implications and the importance of ongoing monitoring and lifestyle management.

B. "I will reduce my exercise schedule to 3 days a week."

This statement is concerning because regular exercise is an essential component of managing gestational diabetes. Exercise helps control blood sugar levels, improves insulin sensitivity, and promotes overall health during pregnancy. The client should not reduce their exercise schedule unless advised by their healthcare provider for specific reasons.

C. "I will take my glyburide daily with breakfast."

Glyburide is an oral medication used to help control blood sugar levels in some cases of gestational diabetes. Taking it with breakfast can help optimize its effectiveness. This statement indicates an understanding of medication management.

D. "I should limit my carbohydrates to 50% of caloric intake."

Limiting carbohydrates is often a key part of managing gestational diabetes, as it can help control blood sugar levels. However, the specific percentage of carbohydrate intake may vary based on individual factors and should be determined in consultation with a healthcare provider or registered dietitian.