A nurse is preparing to administer an IV loading dose of magnesium sulfate to a client who has preeclampsia with severe features.
Which of the following actions should the nurse take?
Administer the medication over 30 min using an infusion pump
Place the client in a supine position with a wedge under the right hip
Monitor the client’s blood pressure every 15 min during the infusion
Have calcium gluconate available at the bedside as an antidote.
The Correct Answer is D
The correct answer is choice D. Have calcium gluconate available at the bedside as an antidote. Magnesium sulfate is used to prevent and treat seizures in women with severe preeclampsia or eclampsia. However, it can also cause toxicity and respiratory depression if the serum level is too high. Calcium gluconate is the antidote for magnesium sulfate toxicity and should be readily available at the bedside.
Choice A is wrong because the medication should be administered over 20-30 minutes using an infusion pump.
A shorter infusion time may increase the risk of adverse effects.
Choice B is wrong because the client should be placed in a lateral position to improve uteroplacental perfusion and reduce the risk of aspiration.
Choice C is wrong because the client’s blood pressure should be monitored every 5 minutes during the infusion, not every 15 minutes.
Blood pressure is an indicator of the severity of preeclampsia and the effectiveness of magnesium sulfate therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
The correct answer ischoice A, B, D and E.These are all signs and symptoms that may indicate worsening condition or preeclampsia in a client with gestational hypertension.Preeclampsia is a complication of pregnancy that is marked by high blood pressure and presence of proteins in urine.
Choice C is wrong because chest pain or shortness of breath are not typical symptoms of preeclampsia, but they may indicate other serious conditions such as heart problems or pulmonary edema.
If a client with gestational hypertension experiences these symptoms, they should seek immediate medical attention.
Normal ranges for blood pressure and proteinuria are:
• Blood pressure: less than 140/90 mm Hg.
• Proteinuria: less than 300 mg in a 24-hour urine collection or less than 30 mg/dL in a random urine sample.
Correct Answer is ["A","B","D","E"]
Explanation
The correct answer is choice C. Choice C is wrong because breastfeeding is not contraindicated for women with gestational hypertension.Breastfeeding has many benefits for both the mother and the baby, and it does not affect blood pressure.
Choice A is correct because blood pressure medication should be continued as prescribed until the next check-up.Stopping medication abruptly can cause a rebound increase in blood pressure and increase the risk of complications.
Choice B is correct because headache, blurred vision, or abdominal pain are signs of severe preeclampsia, a serious complication of gestational hypertension that can affect the brain, liver, and kidneys.These symptoms should be reported to the provider immediately.
Choice D is correct because limiting salt intake and drinking plenty of fluids can help lower blood pressure and prevent fluid retention.
Salt can cause the body to hold on to excess water, which increases blood volume and blood pressure.Fluids can help flush out excess salt and keep the body hydrated.
Choice E is correct because weighing oneself daily and reporting any sudden weight gain to the provider can help monitor fluid balance and detect signs of preeclampsia.A weight gain of more than 2 pounds in a week or 5 pounds in a month may indicate fluid accumulation and increased blood pressure.
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