Magnesium Sulfate is being administered intravenously to a client for pregnancy-induced hypertension.
Which assessment finding should the nurse identify as a complication of this treatment?
Respiratory rate of 10 bpm.
Blood pressure of 148/94.
Deep tendon reflexes of +2.
Urine output of 70ml/hour.
The Correct Answer is A
Choice A rationale:
A respiratory rate of 10 bpm is significantly lower than the normal range for adults, which is typically 12-20 breaths per minute. This finding suggests respiratory depression, a potential complication of magnesium sulfate administration. Magnesium sulfate, when given intravenously, can lead to respiratory depression, hypotension, and loss of deep tendon reflexes. Monitoring respiratory rate is crucial to detect early signs of respiratory depression, allowing prompt intervention to prevent respiratory failure.
Choice B rationale:
A blood pressure of 148/94 mmHg is elevated and indicates hypertension. While hypertension is a known side effect of magnesium sulfate, a blood pressure reading alone is not specific enough to indicate a complication of treatment. It is essential to consider other vital signs and symptoms for a comprehensive assessment.
Choice C rationale:
Deep tendon reflexes of +2 are within the normal range and do not indicate a complication of magnesium sulfate administration. Hyperreflexia (exaggerated reflexes) is a sign of magnesium toxicity, but +2 reflexes are normal. Monitoring deep tendon reflexes is crucial, but the given value is within the normal range.
Choice D rationale:
An urine output of 70 ml/hour is within the normal range of urine output (30-60 ml/hour) for adults. While monitoring urine output is essential to assess renal function, this value does not indicate a complication of magnesium sulfate administration. Decreased urine output could suggest kidney injury, which is a potential complication of magnesium sulfate, but 70 ml/hour is within the normal range.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Adjusting the insulin dosage without proper medical guidance can be dangerous for a child with diabetes. Giving half the regular morning dose without considering the child's current blood glucose levels can lead to hypoglycemia, a potentially life-threatening condition. This choice is unsafe and incorrect.
Choice B rationale:
Substituting simple carbohydrates or calorie-containing liquids for solid foods might help maintain the child's blood glucose levels to some extent. However, it's crucial to ensure that the child's overall nutritional needs are met. In cases of illness, monitoring blood glucose levels and consulting with a healthcare provider are essential. This choice, while not the best option, could be a temporary measure if the child is not eating solid foods due to illness.
Choice C rationale:
Giving the child plenty of unsweetened, clear liquids is the most appropriate choice. This helps prevent dehydration, a common concern when a child is not eating or drinking adequately due to illness. Clear liquids, such as water, clear broths, or oral rehydration solutions, can help maintain hydration and provide some electrolytes. It's essential for parents to monitor the child's condition closely and seek medical advice if the child's condition worsens.
Choice D rationale:
Taking the child directly to the emergency department is not necessary if the child is only experiencing a minor illness and is not eating. However, if the child shows signs of severe dehydration, persistent vomiting, or other concerning symptoms, seeking medical attention promptly is crucial. In the absence of these severe symptoms, choice C is the most appropriate course of action.
Correct Answer is B
Explanation
Choice A rationale:
Kimberly and Amanda sharing clay to each make things represents cooperative play, not parallel play. Cooperative play involves interaction and collaboration between children, whereas parallel play involves children playing side by side without interacting.
Choice B rationale:
Brian playing with his truck next to Kristina playing with her truck demonstrates parallel play. In parallel play, children play independently but alongside others, showing interest in what others are doing but without direct interaction.
Choice C rationale:
Adam playing a board game with Kyle, Steven, and Erich represents cooperative play, not parallel play. Cooperative play involves shared activities and collaboration, while parallel play involves independent activities in proximity to others.
Choice D rationale:
Danielle playing with a music box on her mother's lap is an example of solitary play, where a child plays alone without regard to others. Solitary play is common in younger children and is different from parallel play.
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