Which of the following findings indicates that magnesium sulfate is having the desired effect for a client who is at 35 weeks of gestation and receiving it for treatment of preeclampsia?

Choice A reason: Immediately bathing a newborn with herpes simplex virus (HSV) is not recommended, as it may spread lesions or increase infection risk. HSV, a viral infection, requires antiviral therapy, not bathing, to manage cutaneous lesions. Bathing could disrupt skin integrity, potentially exacerbating viral spread or secondary bacterial infections in a compromised neonate.

Choice B reason: Administering ampicillin, a bacterial antibiotic, is ineffective against HSV, a viral infection. Neonatal HSV requires antiviral drugs like acyclovir to target viral replication. Ampicillin addresses bacterial infections, such as group B streptococcus, but lacks efficacy against herpesviruses, making it an inappropriate treatment choice for this condition based on microbiological principles.

Choice C reason: Withholding breastfeeding is unnecessary unless active HSV lesions are present on the breast. HSV transmission via breast milk is rare, and breastfeeding supports neonatal immunity. If the mother has no active lesions, breastfeeding is safe with proper hygiene, as the virus primarily spreads through direct contact with lesions, not milk.

Choice D reason: Initiating contact precautions is critical for neonatal HSV, as the virus spreads through direct contact with lesions or secretions. Precautions, including gloves and gowns, prevent transmission to healthcare workers and other patients. HSV’s high infectivity in neonates, due to immature immunity, necessitates strict isolation to control viral spread in clinical settings.

Choice A reason: Palpation of the fetal presenting part in the cervical os indicates labor progression or malpresentation, not uterine rupture. Uterine rupture involves uterine wall tearing, causing hemorrhage or fetal extrusion, not cervical findings. This finding is unrelated to the catastrophic internal bleeding or placental disruption characteristic of rupture.

Choice B reason: Severe bradypnea (respiratory rate of 10/min) is not a primary sign of uterine rupture. Rupture causes hemorrhage, leading to hypovolemic shock with symptoms like hypotension or tachycardia. Respiratory changes may occur secondary to shock but are not specific. Uterine rupture primarily affects cardiovascular stability, not respiratory rate.

Choice C reason: A sudden gush of amniotic fluid indicates membrane rupture, a normal labor event, not uterine rupture. Uterine rupture involves uterine wall tearing, causing bleeding or fetal distress, not fluid release. Amniotic fluid loss is unrelated to the structural failure or hemorrhagic shock associated with uterine rupture in VBAC.

Choice D reason: Hypotension (85/40 mm Hg) indicates uterine rupture, as it suggests hypovolemic shock from internal hemorrhage due to uterine wall tearing. Blood loss reduces intravascular volume, impairing cardiac output and placental perfusion. This life-threatening sign in VBAC requires immediate intervention to address maternal and fetal compromise, aligning with rupture’s pathophysiology.