The nurse continues to care for the client who is at 30 weeks of gestation.

Exhibits

Complete the following sentence by using the lists of options.

The client is at highest risk for developing

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as evidenced by the client's

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.

A. Bradypnea: Magnesium sulfate toxicity depresses the central nervous system, leading to respiratory depression such as bradypnea. This is a critical sign requiring immediate intervention, as respiratory rates below 12 breaths per minute can be life-threatening.
B. Tremors: Tremors are typically associated with hypomagnesemia or withdrawal states, not magnesium toxicity. Magnesium toxicity causes muscle weakness and diminished reflexes rather than increased neuromuscular activity.
C. Insomnia: Insomnia is not a recognized symptom of magnesium toxicity. In contrast, elevated magnesium levels tend to cause sedation, lethargy, and decreased mental alertness.
D. Hypertension: Magnesium sulfate can actually lower blood pressure due to its vasodilatory effects. Hypertension would be inconsistent with toxicity and more commonly seen in preeclampsia before magnesium is administered.

Rationale for Correct Options:

• Placental abruption: This condition involves the premature detachment of the placenta from the uterine wall, often triggered by hypertensive disorders. The client’s elevated blood pressure (148/94 mm Hg), facial edema, and hyperreflexia point toward preeclampsia, a leading risk factor for placental abruption.
• Hypertension: Hypertension during pregnancy compromises uteroplacental blood flow, potentially causing vascular damage and leading to placental separation. The client’s reading reflects stage 1 hypertension, which, along with other signs, raises concern for placental complications such as abruption.

Rationale for Incorrect Options:

• Spontaneous abortion: Typically occurs before 20 weeks gestation, making it irrelevant for a client at 30 weeks. There are no signs of fetal loss or cervical dilation in this case.
• Placenta previa: Presents with painless vaginal bleeding in the second or third trimester. This client has no vaginal bleeding or placental misplacement.
• Chorioamnionitis: This infection would present with fever, uterine tenderness, and fetal tachycardia. The client is afebrile, has clear lung sounds, and shows no evidence of intrauterine infection.
• Oligohydramnios: Usually detected via ultrasound or significantly low fundal height. The client's fundal measurement (29 cm at 30 weeks) is appropriate, and there’s no mention of decreased amniotic fluid.
• Hyperreflexia: Although suggestive of preeclampsia, it is a secondary symptom that indicates neurologic involvement and seizure risk rather than directly causing placental abruption.
• Vomiting: While it may be associated with preeclampsia, it is non-specific and does not independently increase the risk of placental abruption without supporting findings like hypertension or abdominal pain.