A nurse is preparing to administer gentamicin 2 mg/kg IM to a client who has pelvic inflammatory disease and weighs 132 lb. Available is gentamicin injection 40 mg/mL. How many mL should the nurse administer?

(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Magnesium sulfate is a medication that is used to prevent seizures in women with preeclampsia, a condition that causes high blood pressure and organ damage during pregnancy. It is given intravenously (through a vein) and can also help lower blood pressure and relax the uterus¹.

Magnesium sulfate can cause various side effects and complications, such as
- Nausea, vomiting, or diarrhea
- Headache, drowsiness, or confusion
- Flushing, sweating, or feeling hot
- Weakness, muscle twitching, or paralysis
- Low blood pressure or slow heart rate
- Difficulty breathing or respiratory depression
- Allergic reaction or anaphylaxis
One of the serious complications of magnesium sulfate is magnesium toxicity, which occurs when the level of magnesium in the blood becomes too high. Magnesium toxicity can affect the nervous system, the muscles, the heart, and the lungs. It can cause severe symptoms, such as:
- Loss of reflexes
- Slurred speech or blurred vision
- Chest pain or cardiac arrest
- Coma or death
Magnesium toxicity can be caused by several factors, such as:
- Overdose of magnesium sulfate
- Impaired kidney function or renal failure
- Dehydration or fluid loss
- Interaction with other medications, such as calcium channel blockers or neuromuscular blockers
One of the signs of magnesium toxicity is decreased urine output. Urine output is a measure of how much urine the kidneys produce and excrete. It reflects the kidney function and hydration status. Normal urine output for adults is about 0.5 to 1 mL/kg/hour. For a 70 kg adult, this would be about 35 to 70 mL/hour².
Decreased urine output can indicate that the kidneys are not working properly and are unable to filter and remove excess magnesium from the blood. This can lead to a buildup of magnesium in the blood and cause magnesium toxicity. Decreased urine output can also indicate that the body is dehydrated and has low blood volume. This can reduce the blood flow to the kidneys and impair their function².
Therefore, the nurse should recognize urine output 20 mL/hr. as an adverse reaction to magnesium sulfate and report it to the provider immediately. The nurse should also monitor the client's vital signs, reflexes, respiratory status, and magnesium level closely and be prepared to administer calcium gluconate as an antidote if needed¹²³.

The other options are not manifestations that the nurse should recognize as adverse reactions to
magnesium sulfate:
- a) Hypertension is not an adverse reaction to magnesium sulfate, but a symptom of preeclampsia. Magnesium sulfate can help lower blood pressure in women with preeclampsia by relaxing the blood vessels and reducing vascular resistance¹³.

- c) Hyperglycemia is not an adverse reaction to magnesium sulfate, but a condition that causes high blood sugar levels. It can be caused by diabetes mellitus, pregnancy-induced diabetes (gestational diabetes), infection, stress, or certain medications. Magnesium sulfate does not affect blood sugar levels directly.
- d) Respiratory rate 16/min is not an adverse reaction to magnesium sulfate, but a normal finding for
respiratory rate in adults. The normal range for respiratory rate in adults is 12 to 20 breaths per minute. The respiratory rate may vary depending on age, activity level, health status, and environmental factors.

Among the given options, the client who has hyperemesis gravidarum and a sodium level of 110 mEq/L should be assessed first. Hyperemesis gravidarum is a condition characterized by severe and persistent vomiting during pregnancy, leading to dehydration and electrolyte imbalances. A sodium level of 110 mEq/L indicates hyponatremia, which is an abnormally low level of sodium in the blood.

Hyponatremia can lead to serious complications, including neurological symptoms such as confusion, seizures, and coma. Prompt assessment and intervention are necessary to correct the electrolyte imbalance and prevent further complications.

Option a) A client with preeclampsia and a creatinine level of 1.1 mg/dL should be monitored closely, as elevated creatinine levels can indicate impaired kidney function. However, in this scenario, the client with hyperemesis gravidarum and severe hyponatremia requires more immediate attention due to the potential for neurological complications.

Option c) A client with diabetes mellitus and an HbA1C of 5.8% may require further management and monitoring, but it does not present an immediate risk or urgency compared to the client with hyperemesis gravidarum and severe hyponatremia.

Option d) A client with placenta previa and a hematocrit of 35% may need close monitoring for potential bleeding, but it does not pose an immediate threat compared to the client with hyperemesis gravidarum and severe hyponatremia.

Therefore, the nurse should assess the client who has hyperemesis gravidarum and a sodium level of 110 mEq/L as the first priority due to the risk of complications associated with severe hyponatremia.