A nurse is preparing to administer gentamicin 2 mg/kg IM to a client who has pelvic inflammatory disease and weighs 132 lb. Available is gentamicin injection 40 mg/mL. How many mL should the nurse administer?

(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Magnesium sulfate is a medication that is used to prevent seizures in women with preeclampsia, a condition that causes high blood pressure and organ damage during pregnancy. It is given intravenously (through a vein) and can also help lower blood pressure and relax the uterus¹.

Magnesium sulfate can cause various side effects and complications, such as
- Nausea, vomiting, or diarrhea
- Headache, drowsiness, or confusion
- Flushing, sweating, or feeling hot
- Weakness, muscle twitching, or paralysis
- Low blood pressure or slow heart rate
- Difficulty breathing or respiratory depression
- Allergic reaction or anaphylaxis
One of the serious complications of magnesium sulfate is magnesium toxicity, which occurs when the level of magnesium in the blood becomes too high. Magnesium toxicity can affect the nervous system, the muscles, the heart, and the lungs. It can cause severe symptoms, such as:
- Loss of reflexes
- Slurred speech or blurred vision
- Chest pain or cardiac arrest
- Coma or death
Magnesium toxicity can be caused by several factors, such as:
- Overdose of magnesium sulfate
- Impaired kidney function or renal failure
- Dehydration or fluid loss
- Interaction with other medications, such as calcium channel blockers or neuromuscular blockers
One of the signs of magnesium toxicity is decreased urine output. Urine output is a measure of how much urine the kidneys produce and excrete. It reflects the kidney function and hydration status. Normal urine output for adults is about 0.5 to 1 mL/kg/hour. For a 70 kg adult, this would be about 35 to 70 mL/hour².
Decreased urine output can indicate that the kidneys are not working properly and are unable to filter and remove excess magnesium from the blood. This can lead to a buildup of magnesium in the blood and cause magnesium toxicity. Decreased urine output can also indicate that the body is dehydrated and has low blood volume. This can reduce the blood flow to the kidneys and impair their function².
Therefore, the nurse should recognize urine output 20 mL/hr. as an adverse reaction to magnesium sulfate and report it to the provider immediately. The nurse should also monitor the client's vital signs, reflexes, respiratory status, and magnesium level closely and be prepared to administer calcium gluconate as an antidote if needed¹²³.

The other options are not manifestations that the nurse should recognize as adverse reactions to
magnesium sulfate:
- a) Hypertension is not an adverse reaction to magnesium sulfate, but a symptom of preeclampsia. Magnesium sulfate can help lower blood pressure in women with preeclampsia by relaxing the blood vessels and reducing vascular resistance¹³.

- c) Hyperglycemia is not an adverse reaction to magnesium sulfate, but a condition that causes high blood sugar levels. It can be caused by diabetes mellitus, pregnancy-induced diabetes (gestational diabetes), infection, stress, or certain medications. Magnesium sulfate does not affect blood sugar levels directly.
- d) Respiratory rate 16/min is not an adverse reaction to magnesium sulfate, but a normal finding for
respiratory rate in adults. The normal range for respiratory rate in adults is 12 to 20 breaths per minute. The respiratory rate may vary depending on age, activity level, health status, and environmental factors.

Breast development is a normal part of fetal and neonatal growth. It occurs in stages, starting before birth and continuing during puberty and adulthood. Breast development is influenced by hormones, such as estrogen and progesterone, that are produced by the ovaries or the placenta¹².
Breast development in newborns can vary depending on the gestational age, sex, weight, and exposure to maternal hormones. Some newborns may have palpable breast tissue at birth, while others may develop it later in the first weeks of life. Some newborns may also secrete milk from their breasts, which is called witch's milk or neonatal galactorrhea. This is a harmless and temporary phenomenon that usually resolves within a few weeks without treatment³⁴.
The degree of breast development in newborns can be assessed by using a scoring system that ranges from 0 to 5, based on the size of the areola (the dark area around the nipple) and the presence of a bud (a small lump of glandular tissue under the areola). The scoring system is as follows³:
- Score 0: No breast tissue; flat areola with no bud
- Score 1: Breast tissue < 5 mm; flat areola with no bud
- Score 2: Breast tissue 5 to 10 mm; flat areola with no bud
- Score 3: Breast tissue > 10 mm; raised areola with no bud
- Score 4: Breast tissue > 10 mm; raised areola with bud
- Score 5: Breast tissue > 10 mm; raised areola with large bud
The average score for term newborns is 2.5 for girls and 2.0 for boys. The score tends to be higher for heavier babies and lower for lighter babies. The score also tends to be higher for babies who were exposed to higher levels of maternal hormones during pregnancy, such as those whose mothers had diabetes, preeclampsia, or multiple gestation³⁴.
A score of 0 indicates that there is no breast tissue at all, and the areola is flat with no bud. This finding can indicate preterm gestational age, as breast development usually starts before birth and progresses with increasing gestational age. Preterm newborns may have delayed or incomplete breast development due to insufficient exposure to maternal hormones or immature development of their own hormonal system³⁵.
Therefore, the nurse should identify this finding as indicating preterm gestational age and monitor the newborn for any other signs of prematurity, such as low birth weight, small head size, thin skin, low body temperature, respiratory distress, or feeding difficulties. The nurse should also provide appropriate care and support to the newborn and the parents according to the hospital protocol³⁵.

- b) Ambiguous secondary sex characteristics are physical features that do not clearly match the typical male or female pattern, such as genitalia, hair distribution, or voice pitch. They can be caused by genetic disorders, hormonal imbalances, or environmental influences. Ambiguous secondary sex characteristics do not affect breast development in newborns, as breast tissue is present in both sexes and is influenced by maternal hormones rather than sex hormones¹ .
- c) Decreased maternal hormones during pregnancy can affect breast development in newborns, but not in the way described. Decreased maternal hormones during pregnancy can cause lower breast scores in newborns, as they may have less stimulation of their breast tissue from the placenta. However, this does not mean that they have no breast tissue at all or a flat areola with no bud. They may still have some degree of breast development depending on their gestational age, sex, weight, and exposure to their own hormones³⁴.
- d) Congenital anomaly is a term that refers to any structural or functional abnormality that is present at birth. Congenital anomalies can affect any part of the body and can have various causes, such as genetic mutations, chromosomal abnormalities, infections, drugs, or environmental factors. Congenital anomalies can affect breast development in newborns, but not in the way described. Congenital anomalies that affect breast development in newborns usually cause abnormal or absent nipples or breasts, such as nipple hypoplasia (underdeveloped nipples), athelia (absence of nipples), amastia (absence of breasts), or polymastia (extra breasts). These anomalies do not cause a flat areola with no bud .