A nurse is caring for a client who has a fractured leg and rates their pain as 7 on a scale of 0 to 10. Which of the following medications should the nurse expect to administer?

Rationale for correct choices

• Stop the magnesium sulfate infusion: The client exhibits signs of magnesium sulfate toxicity, including lethargy, shallow respirations, hyporeflexia (DTR 1+), and oliguria (urine output 20 mL/hr). Immediate cessation of the infusion is the priority to prevent progression to respiratory depression, coma, or cardiac arrest. Stopping the infusion reduces further magnesium accumulation and stabilizes the client.

• Calcium gluconate: Calcium gluconate is the antidote for magnesium sulfate toxicity. It counteracts the neuromuscular and cardiac effects of magnesium, reversing hyporeflexia and respiratory depression. The nurse should prepare calcium gluconate IV for rapid administration while monitoring vital signs and respiratory status closely.

Rationale for incorrect choices

• Apply oxygen via nasal cannula: Although supplemental oxygen can support the client’s respiratory function, it does not reverse the toxic effects of magnesium. Oxygen therapy alone is insufficient in managing magnesium toxicity and is secondary to stopping the infusion.

• Place the client in Trendelenburg position: Trendelenburg positioning is not indicated and may worsen respiratory compromise. Maintaining a side-lying or semi-Fowler’s position is safer for airway management and monitoring during magnesium toxicity.

• Magnesium sulfate: Continuing magnesium sulfate would worsen toxicity, potentially leading to respiratory failure, cardiac arrest, and further CNS depression. Administration is contraindicated once toxicity signs appear.

• IV antibiotics: There is no indication of infection or sepsis in the client’s current assessment. Antibiotics do not address magnesium toxicity and are not warranted at this stage.

A. "I can infuse the medication at a faster rate.": Infusing vancomycin faster than the recommended rate can cause adverse effects such as “red man syndrome,” hypotension, and cardiac arrhythmias. Rate adjustments must follow safe administration guidelines rather than client preference.

B. "I can adjust the time and schedule for when it's convenient for you.": Vancomycin dosing schedules are based on therapeutic drug levels and infection control, not convenience. Arbitrary adjustments could reduce efficacy or increase toxicity.

C. "I have up to 2 hours after the usual scheduled time to give you this medication.": Vancomycin can generally be administered within a 1–2 hour window of the scheduled time without compromising therapeutic effectiveness. This statement educates the client about safe timing while maintaining efficacy and adherence to clinical guidelines.

D. "I can start the medication 30 minutes earlier.": Administering vancomycin earlier than the recommended schedule may affect dosing intervals and drug serum levels. While minor adjustments may be permissible, starting early should follow provider orders and institutional protocols.