Physiological Integrity
84. A client, who is a 17-year-old gravida 1, para 0, is at 35 weeks' gestation with a blood pressure of 164/116 mm Hg on her left side, 4+ deep tendon reflexes, and 3+ proteinuria. Her physician orders a 4-gram loading dose of magnesium sulfate over 30 minutes, followed by 2 gm/hr. After administration of the bolus, the client complains of chest heaviness. A nurse assesses the client's deep tendon reflexes, which are now absent. The nurse should anticipate that the physician will most likely order:
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Test-Taking Tip
The key is to recognize that the client is experiencing magnesium toxicity. Do not get distracted by other possible drugs used in treating preeclampsia. Remember that the antidote for magnesium is another electrolyte, calcium.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Analysis; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Medication Administration
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Physiological Integrity
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Answer 1 is incorrect because butorphanol tartrate is a pain medication, and does not treat the client's condition of magnesium toxicity. Answer 2 is incorrect because furosemide works by blocking the absorption of salt and fluid in the kidney tubules, causing a profound increase in urine output (diuresis). The diuretic effect of furosemide can cause body water and electrolyte depletion and is not used to treat pregnancy-induced hypertension, and does not treat magnesium toxicity. Answer 3 is incorrect because diazepam is used to treat seizures related to eclampsia. Diazepam is not used to reverse magnesium toxicity. Answer 4 is correct because this client most likely is experiencing magnesium toxicity. Calcium gluconate is the antidote for magnesium overdose.
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