The nurse is calculating the estimated date of confinement (EDC) using Nagele's rule for a client whose last menstrual period started on December 1. Which date is most accurate?

Choice A rationale:

A stat magnesium sulfate level (Choice A) is unnecessary in this situation. The symptoms described - increased temperature, pulse rate, and blood pressure, along with absent deep tendon reflexes - indicate magnesium sulfate toxicity. Discontinuing the infusion and managing the symptoms take precedence over checking the magnesium sulfate level.

Choice B rationale:

Administering oxygen (Choice B) is important for maintaining the patient's oxygenation levels, but it does not address the magnesium sulfate toxicity. The primary intervention should be to discontinue the infusion and manage the symptoms.

Choice C rationale:

Discontinuing the magnesium sulfate infusion (Choice C) is the correct action in this situation. The symptoms, including absent deep tendon reflexes and the patient's complaint of thirst and warmth, indicate magnesium sulfate toxicity. Stopping the infusion is crucial to prevent further complications.

Choice D rationale:

Hydralazine (Choice D) is an antihypertensive medication and is not the appropriate intervention for magnesium sulfate toxicity. Managing magnesium sulfate toxicity involves discontinuing the infusion and providing supportive care.

Choice A rationale:
Correction of acidosis is not the primary intervention for vaso-occlusive sickle cell crisis. The crisis primarily involves pain due to the obstruction of blood flow by sickled cells. Correcting acidosis is not a direct treatment for this condition.
Choice B rationale:
Adequate hydration is essential in managing vaso-occlusive sickle cell crisis. Proper hydration helps prevent dehydration, which can worsen the crisis and lead to complications. Hydration helps maintain blood flow and prevent further sickling of red blood cells.
Choice C rationale:
Pain management is a crucial intervention for a child with vaso-occlusive sickle cell crisis. Pain results from tissue ischemia caused by sickled red blood cells. Effective pain management, often with analgesics, helps improve the child's comfort and quality of life during the crisis.
Choice D rationale:
Administration of heparin is not indicated for vaso-occlusive sickle cell crisis. Heparin is an anticoagulant that prevents blood clot formation. In sickle cell crisis, the primary issue is the obstruction of blood flow by sickled cells, not the formation of clots. Administering heparin may not address the underlying problem and can lead to potential complications.
Choice E rationale:
Replacement of factor VIII is not relevant to vaso-occlusive sickle cell crisis. Factor VIII is a protein involved in blood clotting and is primarily used in the treatment of hemophilia, a different condition unrelated to sickle cell crisis.