A nurse is collecting data from a client who has preeclampsia and is receiving magnesium sulfate via a continuous IV infusion. Which of the following findings should the nurse report to the provider?

2+ deep tendon reflex.

Facial flushing.

Respiratory rate 13/min.

Urine output 20 mL/hr.

Answer and Explanation

The Correct Answer is D

A.   2+ deep tendon reflexes are within the expected range and are not typically concerning in a client receiving magnesium sulfate for preeclampsia.
B.   Facial flushing can occur as a side effect of magnesium sulfate but is not typically a cause for immediate concern unless it is severe or accompanied by other symptoms.
C.   A respiratory rate of 13/min is within the expected range and is not typically a concerning finding in a client receiving magnesium sulfate.
D.   Urine output of 20 mL/hr is significantly decreased and may indicate reduced renal perfusion, which can be a serious complication of preeclampsia. Therefore, it should be reported to the provider for further evaluation and management.

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Correct Answer is C

Explanation

A. General anesthesia is not typically used for thoracentesis, which is a minimally invasive procedure performed under local anesthesia.
B. While it's important for the client to remain still during the procedure, lying flat for 6 hours following thoracentesis is unnecessary and may increase the risk of complications such as discomfort or respiratory compromise.
C. Having a chest x-ray following the procedure is essential to assess for any complications such as pneumothorax or hemothorax, and to ensure proper lung re-expansion.
D. During thoracentesis, the client is typically instructed to remain still and breathe normally.
Deep breathing through the nose is not specifically indicated during the procedure.

A. Massage areas around the edge of the client's cast with lotion. B. Avoid elevating the extremity when the client is resting in bed. C. Give the client a dull object to scratch the skin under the cast. D. Tell the client to report any numbness in their toes.

Correct Answer is D

Explanation

A. Massaging areas around the edge of the cast with lotion can introduce moisture and compromise the integrity of the cast, increasing the risk of skin breakdown and infection.
B. Elevating the extremity when the client is resting in bed helps reduce swelling and improve circulation, promoting healing. It is an appropriate action for a client with a cast.
C. Inserting objects under the cast can damage the skin, increase the risk of infection, or disrupt the integrity of the cast.

D. Numbness can indicate impaired circulation or nerve compression and warrants immediate assessment, making this the correct action.

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A nurse is collecting data from a client who has preeclampsia and is receiving magnesium sulfate via a continuous IV infusion. Which of the following findings should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who is about to undergo a thoracentesis. Which of the following statements by the client indicates an understanding of the information?

Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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