A nurse is preparing to administer magnesium sulfate intravenously to a client who has preeclampsia. Which of the following actions should the nurse take?

Choice A reason:

Sodium is the most likely electrolyte to be elevated in a client who has fluid volume excess. This is because fluid volume excess, or hypervolemia, is caused by an increase in total body sodium content and an increase in total body water. Sodium is the main electrolyte that regulates fluid balance in the body. When sodium levels are high, the body retains water to dilute it. This leads to fluid overload and edema. Therefore, a client with fluid volume excess would have high sodium levels in their blood.

Choice B reason:

Potassium is not likely to be elevated in a client who has fluid volume excess. Potassium is mainly found inside the cells, and its levels are regulated by the kidneys. Potassium levels can be affected by acid-base balance, insulin, aldosterone, and cell damage. A client with fluid volume excess may have low potassium levels due to dilution or increased excretion by the kidneys.

Choice C reason:

Calcium is not likely to be elevated in a client who has fluid volume excess. Calcium is mostly bound to albumin, a protein in the blood. Calcium levels can be affected by parathyroid hormone, vitamin D, phosphate, and albumin levels. A client with fluid volume excess may have low calcium levels due to dilution or low albumin levels.

Choice D reason:

Magnesium is not likely to be elevated in a client who has fluid volume excess. Magnesium is mainly found inside the cells and bones, and its levels are regulated by the kidneys. Magnesium levels can be affected by renal function, intestinal absorption, hormonal factors, and medications. A client with fluid volume excess may have low magnesium levels due to dilution or increased excretion by the kidneys.

• Choice A reason: Dilute the medication in normal saline solution. This is incorrect because magnesium sulfate should be diluted in lactated Ringer's solution, not normal saline solution.

• Choice B reason:

• Infuse the medication over 10 minutes. This is incorrect because magnesium sulfate should be infused over 20 to 30 minutes.

• Choice C reason:

• Monitor the client's blood pressure every 15 minutes. This is incorrect because monitoring the client's blood pressure every 15 minutes is not enough to prevent or detect complications of preeclampsia or magnesium sulfate therapy. The nurse should also monitor the client's respiratory rate, deep tendon reflexes, urine output, and serum magnesium levels.

• Choice D reason:

• Have calcium gluconate available as an antidote. This is correct because calcium gluconate is the antidote for magnesium toxicity, which can cause respiratory depression, cardiac arrest, and coma. Magnesium toxicity can occur if the client has renal impairment, receives too high a dose, or has a low urine output. The nurse should have calcium gluconate readily available and administer it intravenously if signs of magnesium toxicity occur.