A client is on magnesium sulfate for pre-eclampsia with severe features.
The nurse must notify the attending physician regarding which of the following findings?
Patellar and biceps reflexes of 3+.
Urinary output of 30 mL/hr.
Respiratory rate of 16 rpm.
Serum magnesium level of 10 mg/dL. .
The Correct Answer is D
Choice A rationale
Reflexes of 3+ indicate hyperreflexia, common in pre-eclampsia, but not necessarily critical. Monitoring is essential but not an emergency.
Choice B rationale
Urinary output of 30 mL/hr is within the acceptable range but requires monitoring for any changes. It's not a critical alert.
Choice C rationale
A respiratory rate of 16 rpm is normal and does not indicate immediate risk requiring physician notification.
Choice D rationale
Serum magnesium level of 10 mg/dL is significantly high, indicating potential toxicity. Immediate physician notification is critical to adjust magnesium sulfate administration.
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View Related questions
Correct Answer is A
Explanation
Choice A rationale
History of preterm birth is the principal risk factor for predicting preterm birth. Previous preterm births significantly increase the likelihood of subsequent preterm deliveries due to
underlying etiological factors.
Choice B rationale
Low prepregnancy weight is a risk factor but not as significant as a history of preterm birth. It can contribute to complications in pregnancy but does not have the same predictive value.
Choice C rationale
Smoking during pregnancy increases the risk of preterm birth but is not the principal risk factor. It is a modifiable behavior that contributes to poor pregnancy outcomes.
Choice D rationale
Obesity can impact pregnancy outcomes but is not the principal risk factor for preterm birth. It is associated with other complications rather than directly predicting preterm delivery.
Correct Answer is C
Explanation
Choice A rationale
Decreased pain level can be an effect of addressing the cause of pain, but it doesn't indicate improved uterine tone or resolution of atony.
Choice B rationale
Stable blood pressure is important, but it is not the direct outcome of improved uterine tone or the resolution of uterine atony.
Choice C rationale
A firm fundus at or below the umbilicus indicates successful contraction of the uterus, resolving uterine atony and reducing bleeding.
Choice D rationale
Reduced lochial flow can indicate decreased bleeding, but it does not directly indicate improved uterine tone or resolution of uterine atony.