A nurse is caring for a client who is receiving magnesium sulfate for pre-term labor.

Which of the following assessments should the nurse perform to evaluate the therapeutic effect of the medication?

Measure urine output

Check deep tendon reflexes

Assess uterine activity

Monitor blood pressure

Answer and Explanation

The Correct Answer is C

The therapeutic effect of magnesium sulfate is to inhibit uterine contractions and prevent or delay preterm labor.

By assessing uterine activity, the nurse can evaluate if the medication is working or not.

Choice A is wrong because measuring urine output is not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for toxicity and renal function.

Choice B is wrong because checking deep tendon reflexes is also not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for neuromuscular effects and toxicity.

Choice D is wrong because monitoring blood pressure is not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for cardiovascular effects and toxicity.

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Correct Answer is B

Explanation

Tachycardia.

Terbutaline is a medication that can be used to stop or delay preterm labor by relaxing the uterine muscles.However, it can also cause serious side effects for both the mother and the baby.One of the most common side effects of terbutaline is tachycardia, which means a fast or irregular heartbeat.This can lead to chest pain, palpitations, shortness of breath, and even cardiac arrhythmias or ischemia.

Therefore, the nurse should monitor the mother’s heart rate and rhythm closely when administering terbutaline.

Choice A is wrong because terbutaline does not cause hypotension, which means low blood pressure.In fact, terbutaline can increase blood pressure by constricting blood vessels.

Choice C is wrong because terbutaline does not cause hyperglycemia, which means high blood sugar.However, terbutaline can interfere with insulin secretion and glucose metabolism in some cases, especially in diabetic mothers.

Therefore, the nurse should monitor the mother’s blood sugar levels when administering terbutaline.

Choice D is wrong because terbutaline does not cause hypokalemia, which means low potassium levels in the blood.However, terbutaline can cause a temporary increase in potassium levels in the baby, which can affect the baby’s heart function.

Therefore, the nurse should monitor the baby’s heart rate and rhythm when administering terbutaline.

Normal ranges for heart rate are 60 to 100 beats per minute for adults and 120 to 160 beats per minute for fetuses.

Normal ranges for blood pressure aretypically between 90/60 mmHg and 120/80 mmHg.

A. Administer IV fluids B. Obtain a urine specimen C. Assess fetal heart rate D. Insert an indwelling urinary catheter

Correct Answer is C

Explanation

This is because assessing fetal heart rate is the most important action to take first when a client has prelabor rupture of membranes (PROM) at 34 weeks of gestation and oligohydramnios.Fetal heart rate can indicate fetal well-being, distress, or infection.Oligohydramnios can increase the risk of umbilical cord compression and fetal hypoxia.

Choice A is wrong because administering IV fluids is not the first priority in this situation.IV fluids may be given to prevent dehydration, enhance uterine blood flow, or augment labor, but they are not as urgent as assessing fetal heart rate.

Choice B is wrong because obtaining a urine specimen is not the first priority in this situation.A urine specimen may be obtained to check for infection, proteinuria, or glucose levels, but they are not as urgent as assessing fetal heart rate.

Choice D is wrong because inserting an indwelling urinary catheter is not the first priority in this situation.An indwelling urinary catheter may be inserted to monitor fluid balance, prevent bladder distension, or reduce the risk of infection, but they are not as urgent as assessing fetal heart rate.

Normal ranges for fetal heart rate are 110 to 160 beats per minute.Oligohydramnios is defined as an amniotic fluid index of less than 5 cm.

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A nurse is caring for a client who is receiving magnesium sulfate for pre-term labor. Which of the following assessments should the nurse perform to evaluate the therapeutic effect of the medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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A nurse is caring for a client who is receiving magnesium sulfate for pre-term labor.

Which of the following assessments should the nurse perform to evaluate the therapeutic effect of the medication?