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?

Choice A rationale: Magnesium sulfate acts as a central nervous system depressant. In HELLP syndrome and preeclampsia, its primary therapeutic purpose is to provide seizure prophylaxis by decreasing neuromuscular irritability and excitability.

Choice B rationale: While magnesium sulfate may cause slight vasodilation, it is not an antihypertensive agent. Elevated blood pressure in HELLP syndrome is managed with specific medications like hydralazine, labetalol, or nifedipine.

Choice C rationale: Magnesium sulfate does not function as a diuretic. In fact, adequate urine output is a critical assessment for magnesium toxicity, as the medication is primarily excreted by the kidneys.

Choice D rationale: Magnesium sulfate has no direct effect on bone marrow or platelet production. HELLP syndrome is characterized by low platelets; improvement usually only occurs following delivery or resolving the underlying condition.

Protein excretion of 450 mg indicates proteinuria.Proteinuria is the presence of excess protein in the urine, which can be a sign of kidney damage or disease.Normal protein excretion in a 24-hour urine collection is less than 150 mg.

Choice A is wrong because protein excretion of 150 mg is within the normal range.

Choice B is wrong because protein excretion of 250 mg is slightly above the normal range, but not enough to indicate proteinuria.

Choice C is wrong because protein excretion of 350 mg is also above the normal range, but not enough to indicate proteinuria.

Preeclampsia is a condition that affects some pregnant women, usually after 20 weeks of pregnancy.It causes high blood pressure and proteinuria, which can harm both the mother and the baby.A 24-hour urine collection is a simple lab test that measures what’s in the urine and checks kidney function.The test is done by collecting all the urine passed in a 24-hour period in a special container that must be kept cool until returned to the lab.