A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate.
Which of the following clinical findings should the nurse instruct the client to report?
Increased muscle weakness.
Increased fetal movement.
Increased respiratory rate.
Increased urinary output.
Increased urinary output.
The Correct Answer is A
Magnesium sulfate is used to prevent seizures in women with preeclampsia.
However, taking too much magnesium can be life-threatening to both mother and child.
In women, one of the most common symptoms of magnesium toxicity is muscle weakness12.
Choice B is not an answer because increased fetal movement is not a symptom of magnesium toxicity.
Choice C is not an answer because increased respiratory rate is not a symptom of magnesium toxicity.
Choice D is not an answer because increased urinary output is not a symptom of magnesium toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1227"]
Explanation
Naegele’s rule is a method for estimating the due date of a baby based on the woman’s last menstrual period (LMP).
It involves adding seven days and subtracting three months from the first day of the LMP.
It assumes a 28-day menstrual cycle and a 280-day gestation period, which may vary for different women 1.
Using this rule, if the client’s last menstrual period was March 20, then adding seven days would give March 27.
Subtracting three months would give December 27 of the previous year.
Adding one year would give December 27 of the current year, which is the estimated date of delivery in MMDD format: 1227.
Correct Answer is A
Explanation
This client should be reassessed by the RN prior to transfer, as worsening perineal pain may indicate a hematoma, infection, or inadequate pain management. The RN should inspect the perineum, check the vital signs, and evaluate the effectiveness of the medication.
The other options are not correct because:
B .A multigravida whose peri-pad is 1/4 saturated with lochia rubra after one hour does not need to be reassessed by the RN, as this is a normal finding for a client two hours post-birth. Lochia rubra is the red-colored vaginal discharge that contains blood and debris from the placental site, and it usually lasts for 3 to 4 days after delivery. A peri-pad that is 1/4 saturated after one hour is within the expected range of blood loss.
C. A multigravida complaining of strong afterbirth pains when breastfeeding does not need to be reassessed by the RN, as this is a normal finding for a client two hours post-birth. Afterbirth pains are cramps caused by uterine contractions that help shrink the uterus and prevent bleeding. They are more common and intense in multiparous women and during breastfeeding, as oxytocin is released and stimulates the contractions.
D. A primigravida who passed a small clot when she sat up on the edge of the bed does not need to be reassessed by the RN, as this is a normal finding for a client two hours post-birth. Small clots may form in the uterus or vagina due to pooling of blood during rest or anesthesia, and they are usually expelled when changing position or ambulating. As long as the clot is smaller than a plum and there is no excessive bleeding or pain, it is not a cause for concern.
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