A nurse explains why preterm labor treatment focuses on delaying birth. Which statement is correct?

Hyperemesis gravidarum is a severe complication characterized by intractable vomiting leading to fluid-electrolyte imbalance, ketonuria, and weight loss exceeding 5% of pre-pregnancy mass. The pathophysiology involves high serum hCG levels and potential hyperthyroidism. Patients exhibit signs of intravascular dehydration and metabolic alkalosis.

A. Iron deficiency: While anemia is common in pregnancy, it typically presents with fatigue and pallor rather than acute, persistent emesis and significant weight loss. Iron supplements can actually exacerbate gastric irritation and nausea. It is not the primary cause of the severe hemodynamic instability described here.

B. Hyperemesis gravidarum: The combination of 6-pound weight loss, persistent inability to retain nutrients, and orthostatic dizziness indicates a pathological state beyond normal morning sickness. This condition requires aggressive intravenous rehydration and electrolyte replacement. Dark urine and dizziness are clinical hallmarks of severe volume depletion.

C. Gastroenteritis: An acute infection of the digestive tract usually presents with diarrhea, fever, and abdominal cramping alongside vomiting. While it causes temporary dehydration, the 10-week gestational timing and lack of lower gastrointestinal symptoms point toward a pregnancy-induced etiology. It is typically a self-limiting viral or bacterial event.

D. Normal morning sickness: Physiological nausea of pregnancy usually peaks in the morning and does not result in significant weight loss or clinical dehydration. Clients can typically maintain some oral intake and do not experience dizziness upon standing. It lacks the severe metabolic consequences seen in hyperemesis.

Magnesium sulfate is a neuromuscular blocking agent used for seizure prophylaxis in preeclampsia. It acts by decreasing acetylcholine release at the motor endplate, potentially leading to iatrogenic toxicity. Management requires monitoring for hyporeflexia and respiratory depression to ensure therapeutic safety.

A. Encourage ambulation: Patients receiving intravenous magnesium are at high risk for falls due to muscular weakness and potential dizziness. Bed rest is typically mandated to ensure patient safety and facilitate continuous monitoring. Ambulation could lead to significant physical injury during the infusion period.

B. Check reflexes: The loss of deep tendon reflexes is an early clinical indicator of magnesium toxicity. Frequent assessment of the patellar or brachioradialis reflex allows for the detection of supratherapeutic levels before respiratory arrest occurs. This is a priority assessment for patient safety.

C. Restrict fluids: While monitoring intake and output is essential to ensure renal clearance of magnesium, strict restriction is not standard unless pulmonary edema is present. Dehydration can actually impair the excretion of the drug, increasing the risk of systemic accumulation. Maintenance of adequate hydration is generally preferred.

D. Provide ice chips: Ice chips are a comfort measure for dry mouth but do not address the physiological risks associated with high-dose magnesium therapy. While helpful for patient satisfaction, they do not provide data regarding the patient’s neuromuscular or cardiac status. This is a non-priority intervention.