Which of the following lifestyle factors indicates an increased risk for high-risk pregnancy?

Choice A reason: A change in deep tendon reflexes from 4+ (hyperreflexic) to 2+ (normal) indicates magnesium sulfate’s therapeutic effect in preeclampsia, as it reduces neuronal excitability, preventing seizures. Magnesium stabilizes nerve membranes, lowering seizure risk by modulating calcium channels, aligning with its anticonvulsant role in preeclampsia management.

Choice B reason: A fetal heart rate increase from 150/min to 166/min is not a direct indicator of magnesium sulfate’s effectiveness. Magnesium primarily prevents maternal seizures, not fetal heart rate changes. This increase may reflect fetal stress or normal variation, unrelated to magnesium’s neurological stabilization in preeclampsia treatment.

Choice C reason: Minimal fetal heart rate variability suggests fetal compromise, not magnesium sulfate’s desired effect. Magnesium aims to prevent maternal seizures without significantly altering fetal heart patterns. Reduced variability may indicate hypoxia, requiring separate intervention, as it does not reflect the drug’s therapeutic goal of maternal neurological stabilization.

Choice D reason: Urinary output of 20 mL/hr indicates potential magnesium toxicity or renal impairment, not therapeutic effectiveness. Magnesium sulfate requires adequate renal excretion to avoid toxicity, and output below 30 mL/hr suggests accumulation, risking respiratory depression or cardiac effects, contrary to the drug’s intended anticonvulsant action in preeclampsia.

Choice A reason: Weight changes of 4.5 kg do not necessitate a new vaginal contraceptive ring, as its efficacy relies on local hormone release, not body weight. The ring delivers consistent estrogen and progestin doses, preventing ovulation and altering cervical mucus, unaffected by minor weight fluctuations, per contraceptive pharmacology.

Choice B reason: Leaving the ring inserted for 3 weeks followed by a 1-week removal is the correct regimen, allowing hormonal contraception to prevent ovulation and maintain endometrial stability. This cycle mimics the menstrual cycle, ensuring continuous protection while permitting withdrawal bleeding, aligning with the ring’s pharmacokinetic design for effective contraception.

Choice C reason: Washing the ring with soap and water after use is incorrect, as it may degrade the device or reduce efficacy. The ring is disposable or reusable per cycle, and cleaning disrupts its hormonal matrix. Proper hygiene involves handwashing before insertion, not cleaning the ring itself, per manufacturer guidelines.

Choice D reason: Inserting the ring 6 hours before intercourse is incorrect, as the vaginal ring provides continuous contraception, not on-demand use. It requires insertion for 3 weeks to deliver steady hormones, preventing ovulation and altering cervical mucus, unlike barrier methods, making this timing irrelevant to its contraceptive mechanism.