A pregnant client uses illicit drugs. What is the most severe fetal risk?

Magnesium sulfate is a neuromuscular blocking agent used for seizure prophylaxis in preeclampsia. It acts by decreasing acetylcholine release at the motor endplate, potentially leading to iatrogenic toxicity. Management requires monitoring for hyporeflexia and respiratory depression to ensure therapeutic safety.

A. Encourage ambulation: Patients receiving intravenous magnesium are at high risk for falls due to muscular weakness and potential dizziness. Bed rest is typically mandated to ensure patient safety and facilitate continuous monitoring. Ambulation could lead to significant physical injury during the infusion period.

B. Check reflexes: The loss of deep tendon reflexes is an early clinical indicator of magnesium toxicity. Frequent assessment of the patellar or brachioradialis reflex allows for the detection of supratherapeutic levels before respiratory arrest occurs. This is a priority assessment for patient safety.

C. Restrict fluids: While monitoring intake and output is essential to ensure renal clearance of magnesium, strict restriction is not standard unless pulmonary edema is present. Dehydration can actually impair the excretion of the drug, increasing the risk of systemic accumulation. Maintenance of adequate hydration is generally preferred.

D. Provide ice chips: Ice chips are a comfort measure for dry mouth but do not address the physiological risks associated with high-dose magnesium therapy. While helpful for patient satisfaction, they do not provide data regarding the patient’s neuromuscular or cardiac status. This is a non-priority intervention.

Emergency contraception aims to prevent pregnancy after unprotected coitus by delaying or inhibiting ovulation. These medications are most effective when administered within 72 to 120 hours, depending on the pharmacological agent used. They do not interrupt an established pregnancy and are not abortifacients.

A. Start birth control pills next month: Waiting until the next menstrual cycle offers no protection for the current exposure and allows for potential fertilization to occur. Standard oral contraceptives are meant for long-term prophylaxis rather than acute post-coital intervention. This advice would be ineffective in this scenario.

B. Tubal ligation: This is a permanent surgical sterilization procedure that does not provide any immediate post-coital protection. It requires an invasive operation and is not an appropriate response to a single acute exposure. It is a contraceptive choice for those desiring no future children.

C. Emergency contraception: High-dose progestin or selective progesterone receptor modulators can effectively prevent pregnancy if taken within the appropriate window. This intervention acts rapidly to prevent the release of an egg before fertilization can take place. It is the primary recommendation for recent unprotected contact.

D. Do nothing: Taking no action carries a significant risk of unplanned pregnancy if the encounter occurred near the patient's fertile window. There are safe, effective medical options available to significantly reduce this risk. Recommending no intervention ignores the patient's stated goal of prevention.