A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

"We will monitor your blood pressure to see if it decreases."

"We will check for a reduction in swelling and fluid retention."

"We will assess for a decrease in seizure activity and improved reflexes."

"You should feel less pain and have fewer headaches."

Answer and Explanation

The Correct Answer is C

A. "We will monitor your blood pressure to see if it decreases."
While magnesium sulfate may have a mild antihypertensive effect, it is not primarily given to lower blood pressure; antihypertensives are used for that purpose.

B. "We will check for a reduction in swelling and fluid retention."
Edema in preeclampsia is due to capillary leakage and kidney dysfunction, not directly affected by magnesium sulfate.

C. "We will assess for a decrease in seizure activity and improved reflexes."
Magnesium sulfate is used primarily as a seizure prophylaxis in preeclampsia by stabilizing the central nervous system and reducing hyperreflexia and clonus, which are signs of worsening preeclampsia.

D. "You should feel less pain and have fewer headaches."
While magnesium sulfate can improve symptoms, it is not an analgesic and does not directly relieve pain.

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Correct Answer is ["B","C","E"]

Explanation

A. Penicillin
Penicillin is an antibiotic used for bacterial infections, not viral infections like HSV-2. Herpes simplex virus requires antiviral medications such as acyclovir, valacyclovir, or famciclovir for symptom management.

B. Perineal care of genital lesions
Proper perineal care helps prevent secondary infections and promotes healing. The client should be advised to keep the area clean and dry, avoid irritating soaps, and wear loose-fitting clothing.

C. Use of barrier protection
Consistent use of barrier protection (e.g., condoms) reduces the risk of transmitting HSV-2 to sexual partners. The client should be educated that HSV-2 can be transmitted even when lesions are not visible due to asymptomatic viral shedding.

D. Gardasil injection
Gardasil is a vaccine that protects against certain strains of Human Papillomavirus (HPV), not HSV-2. While both HSV-2 and HPV are sexually transmitted infections, they are caused by different viruses and require different preventive measures.

E. Hand washing
Proper hand hygiene prevents the spread of HSV-2 from touching lesions and transferring the virus to other body areas or individuals. Clients should be advised to wash hands thoroughly after touching affected areas.

A. During the next attempt to get pregnant B. Immediately after delivery C. During the third trimester of pregnancy D. During the first trimester of pregnancy

Correct Answer is B

Explanation

A. During the next attempt to get pregnant
This is incorrect because waiting until the next pregnancy increases the risk of congenital rubella syndrome in future pregnancies. The vaccine should be given immediately postpartum to provide immunity.

B. Immediately after delivery
This is correct because the rubella vaccine (MMR) is a live vaccine and is contraindicated during pregnancy due to teratogenic effects. It should be given postpartum before hospital discharge to prevent future rubella infections.

C. During the third trimester of pregnancy
This is incorrect because live vaccines are contraindicated in pregnancy due to the risk of fetal infection.

D. During the first trimester of pregnancy
This is incorrect because administering a live vaccine early in pregnancy is dangerous and could cause fetal harm or congenital anomalies.

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A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A teenager presents to the clinic with complaints of painful lesions, fever, headache, and vaginal discharge. After testing she is diagnosed with Herpes simplex virus type 2. What education should the nurse include in a teaching plan? (Select All that Apply.)

Correct Answer is ["B","C","E"]

Explanation

A nurse is caring for a client in the first trimester of pregnancy and discovers that the client lacks immunity to rubella based on her blood work. When is the recommended time for administering rubella immunization?

Correct Answer is B

Explanation

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