The nurse is caring for a pregnant client with preeclampsia who is receiving IV magnesium sulfate. The nurses assess the following symptoms: -Respiratory rate of 10 breaths/min

Urine output 25ml during the last hour

Absent deep tendon reflexes

What medication should the nurse prepare to administer?

A. Pancreatic enzyme replacement therapy (PERT) is not tied to the development of diabetes. While CF-related diabetes can occur due to progressive pancreatic damage, enzyme therapy is required much earlier to address malabsorption caused by blocked pancreatic ducts. Waiting for diabetes to develop would allow continued nutrient deficiencies, poor weight gain, and fat-soluble vitamin deficiencies (A, D, E, K).

B. Children with CF do not digest fats more efficiently than carbohydrates. In fact, fat digestion is particularly impaired because pancreatic lipase is insufficient due to duct obstruction. Proteins and carbohydrates are also affected to a lesser extent. PERT provides a mix of lipase, amylase, and protease to compensate for this deficiency and ensure adequate nutrient absorption.

C. CF does not cause an overproduction of digestive enzymes. On the contrary, thick mucus blocks pancreatic ducts, preventing enzymes from reaching the intestines. This blockage leads to enzyme deficiency in the gastrointestinal tract, resulting in malabsorption, steatorrhea (fatty stools), abdominal bloating, and poor growth.

D. In CF, mutations in the CFTR gene lead to thick, sticky mucus production in multiple organs, including the pancreas. This mucus obstructs the pancreatic ducts, preventing digestive enzymes such as lipase, amylase, and protease from reaching the small intestine. Without these enzymes, fats, proteins, and carbohydrates are incompletely digested, causing nutrient malabsorption, fatty stools, and poor weight gain. PERT replaces the missing enzymes, allowing proper digestion and absorption of nutrients, improving growth, and reducing gastrointestinal symptoms. Regular dosing with meals and snacks is essential to optimize nutrient absorption and support normal growth and development in children with CF.

A. A threatened miscarriage is characterized by vaginal bleeding, mild cramping, and a closed cervix, but the fetus is still viable with a detectable heartbeat. In this case, the fetal heartbeat is absent, making a threatened miscarriage unlikely.

B. An incomplete miscarriage occurs when some products of conception have been expelled while others remain in the uterus. It is usually accompanied by heavy bleeding, cramping, and an open cervix. This client has a closed cervix and no bleeding, ruling out an incomplete miscarriage.

C. A missed miscarriage occurs when the fetus has died in utero but has not been expelled. The client may have no symptoms—no bleeding or cramping—and the cervix remains closed. Ultrasound confirms the absence of fetal cardiac activity, which matches this presentation. Missed miscarriages often require medical or surgical management to prevent complications such as infection or coagulopathy.

D. An inevitable miscarriage is indicated by vaginal bleeding, cramping, and cervical dilation, suggesting that miscarriage is in progress and cannot be prevented. Since this client has a closed cervix and no active bleeding, an inevitable miscarriage is unlikely.