A nurse is assessing a full-term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider?

Magnesium sulfate is a medication that is used to prevent seizures in women with preeclampsia, a condition that causes high blood pressure and organ damage during pregnancy. It is given intravenously (through a vein) and can also help lower blood pressure and relax the uterus¹.

Magnesium sulfate can cause various side effects and complications, such as
- Nausea, vomiting, or diarrhea
- Headache, drowsiness, or confusion
- Flushing, sweating, or feeling hot
- Weakness, muscle twitching, or paralysis
- Low blood pressure or slow heart rate
- Difficulty breathing or respiratory depression
- Allergic reaction or anaphylaxis
One of the serious complications of magnesium sulfate is magnesium toxicity, which occurs when the level of magnesium in the blood becomes too high. Magnesium toxicity can affect the nervous system, the muscles, the heart, and the lungs. It can cause severe symptoms, such as:
- Loss of reflexes
- Slurred speech or blurred vision
- Chest pain or cardiac arrest
- Coma or death
Magnesium toxicity can be caused by several factors, such as:
- Overdose of magnesium sulfate
- Impaired kidney function or renal failure
- Dehydration or fluid loss
- Interaction with other medications, such as calcium channel blockers or neuromuscular blockers
One of the signs of magnesium toxicity is decreased urine output. Urine output is a measure of how much urine the kidneys produce and excrete. It reflects the kidney function and hydration status. Normal urine output for adults is about 0.5 to 1 mL/kg/hour. For a 70 kg adult, this would be about 35 to 70 mL/hour².
Decreased urine output can indicate that the kidneys are not working properly and are unable to filter and remove excess magnesium from the blood. This can lead to a buildup of magnesium in the blood and cause magnesium toxicity. Decreased urine output can also indicate that the body is dehydrated and has low blood volume. This can reduce the blood flow to the kidneys and impair their function².
Therefore, the nurse should recognize urine output 20 mL/hr. as an adverse reaction to magnesium sulfate and report it to the provider immediately. The nurse should also monitor the client's vital signs, reflexes, respiratory status, and magnesium level closely and be prepared to administer calcium gluconate as an antidote if needed¹²³.

The other options are not manifestations that the nurse should recognize as adverse reactions to
magnesium sulfate:
- a) Hypertension is not an adverse reaction to magnesium sulfate, but a symptom of preeclampsia. Magnesium sulfate can help lower blood pressure in women with preeclampsia by relaxing the blood vessels and reducing vascular resistance¹³.

- c) Hyperglycemia is not an adverse reaction to magnesium sulfate, but a condition that causes high blood sugar levels. It can be caused by diabetes mellitus, pregnancy-induced diabetes (gestational diabetes), infection, stress, or certain medications. Magnesium sulfate does not affect blood sugar levels directly.
- d) Respiratory rate 16/min is not an adverse reaction to magnesium sulfate, but a normal finding for
respiratory rate in adults. The normal range for respiratory rate in adults is 12 to 20 breaths per minute. The respiratory rate may vary depending on age, activity level, health status, and environmental factors.

Group B Streptococcus β-hemolytic (GBS) is a type of bacteria that can cause serious infections in newborns, such as sepsis, pneumonia, and meningitis. GBS can be transmitted from the mother to the baby during labor and delivery if the mother is colonized with GBS in her vagina or rectum¹.
To prevent GBS infection in newborns, pregnant women who test positive for GBS or have risk factors for GBS should receive intravenous (IV) antibiotics during labor. The antibiotics can reduce the amount of GBS bacteria in the mother's body and lower the chance of passing them to the baby¹².
The recommended antibiotic for GBS prophylaxis is penicillin, which is safe and effective for most women. However, some women may be allergic to penicillin and need an alternative antibiotic. Ampicillin is one of the alternative antibiotics that can be used for GBS prophylaxis in women who have a mild allergy to penicillin (such as rash or itching). Ampicillin is also a type of penicillin, but it has a slightly different structure and may not cause an allergic reaction in some people²³.
Therefore, the nurse should plan to administer ampicillin to the client who tested positive for GBS and has a mild allergy to penicillin. The nurse should also monitor the client for any signs of anaphylaxis (a severe allergic reaction) and have epinephrine ready in case of emergency²³.

The other options are not medications that the nurse should administer to the client:
- a) Cefotetan is another alternative antibiotic that can be used for GBS prophylaxis in women who have a severe allergy to penicillin (such as anaphylaxis or angioedema). However, it is not indicated for women who have a mild allergy to penicillin, as it may still cause cross-reactivity and an allergic reaction²³.
- b) Fluconazole is an antifungal medication that is used to treat fungal infections, such as candidiasis (thrush) or cryptococcal meningitis. It is not effective against bacterial infections, such as GBS, and it is not indicated for GBS prophylaxis⁴.
- d) Doxycycline is an antibiotic that is used to treat bacterial infections, such as chlamydia, gonorrhea, or Lyme disease. It is not effective against GBS and it is not indicated for GBS prophylaxis. Moreover, doxycycline is contraindicated in pregnancy, as it can cause harm to the fetus, such as tooth discoloration or bone growth problems.