Patient is receiving magnesium sulfate therapy

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1. A patient is receiving magnesium sulfate therapy for severe preeclampsia. What initial sign of toxicity should alert the nurse to intervene?

Hyperactive sensorium
Increase in respiratory rate
Lack of knee-jerk reflex
Development of cardiac dysrhythmia

2. A nurse is monitoring a patient with severe preeclampsia who is receiving an infusion of magnesium sulfate. Assessment reveals a pulse rate of 55/minute, respirations of 12/minute, and a flushed face. What is the next nursing action?

Continue the infusion and notify the health care provider.
Stop the infusion and start an infusion of dextrose and water.
Continue the infusion and document the finding on the clinical record
Decrease the rate of infusion and obtain blood for a magnesium level.

3. A patient admitted with preeclampsia is receiving magnesium sulfate. Which assessment indicates that a therapeutic level of the medication has been reached?

Respiratory rate of 12
Increased fetal activity
Decreased urine output
Deep tendon reflexes of +2

4. Which woman should the nurse identify is at risk for developing a hypertensive disorder of pregnancy?

Primigravida who is obese
Multipara who is 31 years old
Multipara who had more than six previous pregnancy
Primigravida who took oral contraceptives within 3 months of conception

5. A patient in the prenatal clinic is diagnosed with preeclampsia. What clinical findings support this diagnosis?

Elevated blood pressure of 150/100 mmHg
Elevated blood pressure that is accompanied by a headache
Blood pressure above the baseline while fluctuating at each reading
Blood pressure more than 140mmHg systolic accompanied by proteinuria

6. A patient is admitted to the birthing suite with a blood pressure of 150/90 mmHg, 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis?

Headache
Constipation
Abdominal pain
Vaginal bleeding
Visual disturbances

7. A nurse is monitoring a patient with severe preeclampsia for the onset of eclampsia. What clinical finding indicates an impending seizure?

Persistent headache with blurred vision

Epigastric pain with nausea and vomiting
Spots with flashes of light before the eyes
Rolling of the eyes to one side with a fixed stare

8. A patient with the diagnosis of severe preeclampsia is admitted to the hospital from the emergency department. What precaution should the nurse initiate?

Pad the side rails on the bed
Place the call button next to the patient
Have oxygen with face mask available
Assign a nursing assistant to stay with the patient

9. When does a nurse caring for a patient with eclampsia determine that the risk for another seizure has subsided?

After birth occurs
After labor begins
48 hours postpartum
24 hours postpartum.

Reference no: EM133845259

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