A nurse is monitoring a client with severe pre-eclampsia who is receiving magnesium sulfate intravenously.

Which of the following signs indicates magnesium toxicity and requires immediate intervention?

“This medication will help my baby’s lungs develop faster.” Corticosteroid therapy is given to pregnant clients with eclampsia to accelerate fetal lung maturity and reduce the risk of respiratory distress syndrome in the newborn.

Some possible explanations for the other choices are:

• Choice A is wrong because corticosteroids do not lower blood pressure.Antihypertensive drugs such as hydralazine or labetalol are used to treat hypertension in eclampsia.

• Choice B is wrong because corticosteroids do not prevent seizures.Magnesium sulfate is the drug of choice for seizure prophylaxis and treatment in eclampsia.

• Choice D is wrong because corticosteroids do not reduce inflammation in the body.They may have anti-inflammatory effects in some conditions, but their main purpose in eclampsia is to enhance fetal lung development.

Normal ranges for blood pressure and proteinuria in pregnancy are:

• Blood pressure: less than 140/90 mm Hg

• Proteinuria: less than 300 mg/24 hours or less than 1+ on dipstick

The correct answer is choice A, B, C and E.The nurse should monitor the client’s deep tendon reflexes hourly because magnesium sulfate can cause neuromuscular blockade and decreased reflexes.The nurse should keep calcium gluconate readily available because it is the antidote for magnesium toxicity.The nurse should maintain a urine output of at least 40 mL/hr because magnesium is excreted by the kidneys and low urine output can indicate renal impairment or fluid overload.The nurse should check the client’s blood pressure every 15 minutes because magnesium sulfate can cause hypotension and preeclampsia can cause hypertension.

Choice D is wrong because the medication should not be infused via a peripheral IV line, but rather through a central line or a large-bore IV catheter to prevent tissue damage.