The nurse is caring for a 30-week gestation client who was loaded on a magnesium sulfate infusion one hour ago for preterm labor. Which of the following assessment findings would warrant the infusion to be discontinued immediately?

Blood pressure of 138/88.

Urinary output of 40 ml/hr.

Respiratory rate of 10 breaths/minute.

Patellar reflex of +2.

Answer and Explanation

The Correct Answer is C

This is because magnesium sulfate can cause respiratory depression, and a respiratory rate of 10 breaths/minute is significantly lower than the normal range of 12-20 breaths/minute. Other factors such as blood pressure of 138/88, the urinary output of 40 ml/hr, and patellar reflex of +2 should also be monitored, but they would not necessarily warrant immediate discontinuation of the magnesium sulfate infusion.

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Correct Answer is A

Explanation

A history of cesarean section for fetal distress is an indication for a repeat cesarean section in subsequent pregnancies, as the risk of recurrence of fetal distress is higher. A trial of labor after cesarean (TOLAC) may be attempted in some cases, but a planned cesarean section is often recommended.
Option B is incorrect because fear of natural childbirth is not a medical indication for a cesarean section.
Option C is incorrect because gestational diabetes does not typically require a cesarean section unless other complications arise, such as fetal macrosomia or failed induction of labor.
Option D is incorrect because a history of cephalopelvic disproportion with the first pregnancy may not necessarily require a cesarean section in subsequent pregnancies. A trial of labor may be attempted, depending on the circumstances.

A. Continue routine prenatal care. B. Be referred to an endocrinologist. C. Be diagnosed with Type II diabetes. D. Be referred to a dietician.

Correct Answer is B

Explanation

In some cases, an endocrinologist may also be involved in the management of gestational diabetes. The nurse can anticipate that the client will be diagnosed with gestational diabetes and will be referred to a dietician for dietary modifications and glucose monitoring during the remainder of her pregnancy. Regular prenatal care will also continue, and the healthcare provider may adjust the treatment plan based on the client's individual needs.

However, a diagnosis of Type II diabetes would not be made solely based on a failed GTT during pregnancy, as gestational diabetes is a temporary condition that usually resolves after delivery.

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The nurse is caring for a 30-week gestation client who was loaded on a magnesium sulfate infusion one hour ago for preterm labor. Which of the following assessment findings would warrant the infusion to be discontinued immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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The nurse is caring for a 30-week gestation client who was loaded on a magnesium sulfate infusion one hour ago for preterm labor. Which of the following assessment findings would warrant the infusion to be discontinued immediately?

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