A nurse is assisting with the care of a client who has a prescription for magnesium sulfate. Which of the following adverse effects should the nurse report to the provider?
Respiratory rate 10/min.
Urine output 160 mL in 4 hr.
Diaphoresis.
Nausea.
The Correct Answer is A
Choice A rationale
Respiratory rate of 10/min is a critical adverse effect, indicating potential respiratory depression due to magnesium sulfate, a serious and life-threatening condition requiring immediate intervention.
Choice B rationale
Urine output of 160 mL in 4 hours is lower than expected but not immediately life-threatening. It needs monitoring but is not as critical as respiratory rate.
Choice C rationale
Diaphoresis, or excessive sweating, can be a side effect of magnesium sulfate but is not life-threatening. It warrants attention but does not require immediate reporting.
Choice D rationale
Nausea is a common, less severe side effect of magnesium sulfate that does not indicate an urgent situation.
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Correct Answer is D
Explanation
Choice A rationale
Lecithin/sphingomyelin (L/S) ratio does not indicate genetic disorders; it's used to assess fetal lung maturity.
Choice B rationale
The test does not determine placental function. It specifically evaluates fetal lung maturity through the ratio of lecithin to sphingomyelin in amniotic fluid.
Choice C rationale
The test is not used to assess the risk of Rh incompatibility. The L/S ratio focuses on lung development rather than blood compatibility issues.
Choice D rationale
The L/S ratio assesses the baby's lung maturity, indicating if the lungs produce enough surfactant for proper function after birth.
Correct Answer is B
Explanation
Choice A rationale
Wearing a loose-fitting bra does not help in managing mastitis. Proper breast support and continuing breastfeeding are important to keep the milk flowing and reduce inflammation.
Choice B rationale
Continuing to breastfeed helps to clear the infection and maintain milk supply. It ensures that the ducts are cleared, reducing inflammation and aiding recovery from mastitis.
Choice C rationale
Limiting fluid intake is not recommended. Adequate hydration is crucial to help with milk production and overall recovery, especially during an infection.
Choice D rationale
An abdominal sonogram is not relevant to the management of mastitis. Treatment focuses on antibiotics, pain relief, and continued breastfeeding. .