A nurse is caring for a client who is at 35 weeks of gestation and is receiving magnesium sulfate for treatment of preeclampsia.
Which of the following findings indicates that the medication is having the desired effect?

Choice A rationale

Premature newborns have immature respiratory and neurological systems, making them vulnerable to respiratory compromise and apnea in a car seat. A car seat test prior to discharge assesses their ability to maintain adequate oxygenation and heart rate while positioned in the car seat for a prolonged period, ensuring safety.

Choice B rationale

The retainer clip should be positioned at the level of the newborn's armpits, not the abdomen. Proper placement at the armpit level ensures that the harness straps are snug over the shoulders and chest, effectively restraining the infant and preventing ejection in the event of a collision, optimizing crash protection.

Choice C rationale

Newborns, especially premature ones, must always be placed in a rear-facing car seat in the back seat of the vehicle. Rear-facing provides optimal support for the newborn's fragile head, neck, and spine, distributing crash forces over the entire back and significantly reducing the risk of severe injuries in a collision.

Choice D rationale

The recommended angle for a rear-facing car seat is typically between 30 to 45 degrees, depending on the specific car seat model, not 60 degrees. This recline angle is crucial to prevent the newborn's head from falling forward and compromising their airway, which is particularly critical for a premature infant with underdeveloped neck control. .

Choice A rationale

A client at 12 weeks of gestation not feeling fetal movement is expected. Fetal movement, or quickening, typically begins between 16 and 20 weeks of gestation for primigravidas and earlier for multigravidas. At 12 weeks, the fetus is still small and movements are not usually strong enough to be consistently perceived by the mother, thus this finding is not immediately concerning.

Choice B rationale

A fetal heart rate (FHR) of 160/min at 28 weeks of gestation is within the normal range, which is typically 110-160 beats/min. A normal FHR indicates adequate fetal oxygenation and well-being. Therefore, this finding does not suggest an emergent situation requiring immediate provider assessment.

Choice C rationale

Deep tendon reflexes (DTRs) graded as 2+ are considered normal. This grading indicates an average, brisk reflex response. Abnormal DTRs, such as hyperreflexia (3+ or 4+), can be indicative of preeclampsia, but a 2+ finding is physiological and does not warrant immediate concern.

Choice D rationale

Blurred vision in a client at 36 weeks of gestation can be a symptom of preeclampsia, a serious hypertensive disorder of pregnancy. This condition can lead to severe complications such as eclampsia, placental abruption, or HELLP syndrome, requiring immediate medical evaluation and intervention to prevent adverse maternal and fetal outcomes.