nclex pharm 6th edition
The nurse is monitoring a preterm labor client who is receiving magnesium sulfate intravenously. The nurse should monitor for which adverse effects of this medication? Select all that apply. 1.Flushing 2.Hypertension 3.Increased urine output 4.Depressed respirations 5.Extreme muscle weakness 6.Hyperactive deep tendon reflexes
1, 4, 5 Rationale: Magnesium sulfate is a central nervous system depressant, and it relaxes smooth muscle, including the uterus. It is used to stop preterm labor contractions, and it is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels. Test-Taking Strategy: Focus on the subject, adverse effects of magnesium sulfate. Recalling that this medication is a central nervous system depressant will assist you with answering correctly.
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which is noted on data collection? 1.Proteinuria of 3+ 2.Presence of deep tendon reflexes 3.Serum magnesium level of 6 mEq/L 4.Respirations of 10 breaths per minute
Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression (respiratory rate less than 12 breaths per minute), a loss of deep tendon reflexes, and a sudden drop in the fetal heart rate, maternal heart rate, and blood pressure. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L or 5 to 8 mg/dL. Proteinuria of 3+ is likely to be noted in a client with preeclampsia. Test-Taking Strategy: Focus on the subject, signs of toxicity from magnesium sulfate. Eliminate option 2 first because it is a normal finding. Next, eliminate option 3, knowing that the therapeutic serum level of magnesium is between 4 and 7.5 mEq/L. From the remaining options, recalling that proteinuria of 3+ would be noted in a client with preeclampsia will direct you to the correct option.
Epidural analgesia is administered to a woman for pain relief after a cesarean birth. The nurse assigned to care for the woman ensures that which medication is readily available if respiratory depression occurs? 1.Betamethasone 2.Morphine sulfate 3.Naloxone (Narcan) 4.Meperidine hydrochloride (Demerol)
Rationale: Opioids are used for epidural analgesia. An adverse effect of epidural analgesia is a delayed respiratory depression. Naloxone (Narcan) is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and meperidine hydrochloride are opioid analgesics. Betamethasone is a corticosteroid that is administered to enhance fetal lung maturity. Test-Taking Strategy: Focus on the subject, the antidote for respiratory depression. Eliminate options 2 and 4 first, knowing that these medications are opioid analgesics. Next, eliminate option 1, knowing that this medication is a corticosteroid.
Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before the administration of methylergonovine, the nurse should check which priority item? 1.Uterine tone 2.Blood pressure 3.Amount of lochia 4.Deep tendon reflexes
Rationale: Methylergonovine, which is an ergot alkaloid, is an agent that is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority before the administration of the medication is to check the blood pressure. The health care provider should be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum data collection procedures, option 2 is related specifically to the administration of this medication. Test-Taking Strategy: Note the strategic word, priority. Eliminate options 1 and 3 first, because they are comparable or alike and related to one another. From the remaining options, use the ABCs—airway, breathing, and circulation. Obtaining the blood pressure is a method of checking circulation.
Rho(D) immune globulin (RhoGAM) is prescribed for a woman after the delivery of a newborn infant, and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which condition? 1.Having Rh-positive blood 2.Developing a rubella infection 3.Developing physiological jaundice 4.Being affected by Rh incompatibility
Rationale: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus that is Rh positive. During pregnancy and at delivery, some of the baby's Rh-positive blood can enter the maternal circulation, thus causing the woman's immune system to form antibodies against the Rh-positive blood. The administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen. Test-Taking Strategy: Focus on the subject, the purpose of Rho(D) immune globulin. Note the relationship between the name of the medication, Rho(D) immune globulin, and the word incompatibility in the correct option.
