Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 2==
A client with preeclampsia with severe features is receiving IV magnesium sulfate. Assessment reveals a respiratory rate of 10 breaths per minute, absent deep tendon reflexes, and a urine output of 20 mL over the past hour. Which action should the nurse take '''first'''?
# Notify the health care provider.
# Administer calcium gluconate IV.
# Stop the magnesium sulfate infusion.
# Obtain a serum magnesium level.

'''Answer:''' 3 (C). Stop the magnesium sulfate infusion.

''Rationale:'' This client has magnesium toxicity. The first action is to stop the drug that is causing the harm, which halts further accumulation immediately and can be done in seconds. Calcium gluconate (option 2) is the antidote and is given next, but administering it while the infusion continues is illogical. Notifying the provider (option 1) and drawing a level (option 4) are both appropriate but do not stop the ongoing injury. Note the progression of toxicity: loss of deep tendon reflexes appears first, then respiratory depression, then decreased level of consciousness and cardiac arrest. Oliguria worsens toxicity because magnesium is cleared by the kidneys.