A nurse is caring for a client who has severe preeclampsia and is receiving hydralazine IV bolus for blood pressure management.

Which of the following adverse effects should the nurse monitor for? (Select all that apply.)

The correct answer is choice B. The client’s urine output is at least 30 mL/hr.This indicates that the therapy is effective because magnesium sulfate can cause renal impairment and fluid retention, which can worsen the condition of preeclampsia.

A normal urine output is a sign that the kidneys are functioning well and that the fluid balance is maintained.

Choice A is wrong because the client’s blood pressure may not normalize even with magnesium sulfate therapy.

Magnesium sulfate is mainly used to prevent seizures, not to lower blood pressure.Other antihypertensive medications may be needed to control blood pressure in severe preeclampsia.

Choice C is wrong because the client’s deep tendon reflexes are expected to decrease with magnesium sulfate therapy, as it is a central nervous system depressant.

A normal reflex response is 2+, but a lower response (1+ or 0) may indicate magnesium toxicity, which can cause respiratory depression, cardiac arrest, and coma.

Choice D is wrong because the client’s respiratory rate should be monitored closely with magnesium sulfate therapy, as it can also cause respiratory depression.

A normal respiratory rate is 12 to 20 breaths per minute, but a lower rate (less than 12) may indicate magnesium toxicity, which requires immediate treatment with calcium gluconate.

The correct answer is choice D. All of the above.All of these factors increase a woman’s risk for developing gestational hypertension.

Choice A is wrong because nulliparity (having no previous pregnancies) is a risk factor for gestational hypertension.Rates in nulliparous women range from 6% to 17% while rates in multiparous women range from 2% to 4%.

Choice B is wrong because age younger than 20 years is a risk factor for gestational hypertension.Pregnant women more than 40 years or less than 18 years are at risk of gestational hypertension.

Choice C is wrong because history of chronic renal disease is a risk factor for gestational hypertension.High blood pressure can also cause problems during and after delivery, such as preeclampsia, eclampsia, stroke, and placental abruption.

Gestational hypertension is blood pressure greater than or equal to 140/90 that begins during the latter half of pregnancy (typically after 20 weeks) and goes away after childbirth.It can put the mother and her baby at risk for problems during the pregnancy, such as preterm delivery and low birth weight.