Author Question: A woman is being treated for preterm labor with magnesium sulfate. The nurse is concerned that the ... (Read 153 times)

SAVANNAHHOOPER23 · **on:** Jun 27, 2018

A woman is being treated for preterm labor with magnesium sulfate. The nurse is concerned that the patient is experiencing early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity?

1. Patellar reflexes are weak or absent.
2. Complaints by the patient of feeling flushed and warm
3. Respiratory rate of 16
4. Fetal heart rate of 120

Question 2

The nurse is caring for a 15-year-old who just delivered a 32-weeks'-gestation stillborn infant with numerous defects. In caring for this patient, the nurse knows that:

1. The patient will likely do no grieving, as she is so young and the pregnancy was probably a mistake in any case.
2. Adolescents have a sense of invulnerability, an It can't happen to me mentality.
3. The patient's mother will handle her daughter's grief, so the nurse doesn't need to be concerned.
4. The nurse will remove the baby before the patient sees it.

Viet Thy · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

1
Rationale 1: Early signs of magnesium sulfate toxicity are related to a decrease in deep tendon reflexes.
Rationale 2: The peripheral vasodilation will cause flushing and a feeling of warmth; this is a side effect, not a toxic effect.
Rationale 3: Late signs of toxicity are a respiratory rate less than 12, urine output less than 30 cc/hour, and confusion.
Rationale 4: Magnesium typically has no effect on fetal heart rate.

Answer to Question 2

2
Rationale 1: Adolescents often feel a high level of grief, as this is often the first loss they have experienced.
Rationale 2: Adolescents feel removed from death because they are so young. A perinatal death might be their first experience of death.
Rationale 3: The nurse needs to be there for the patient. It is not appropriate to depend on the mother to help with the grieving.
Rationale 4: The patient has the right to see the baby if she wishes.