A nurse caring for a client with preeclampsia prepares for the administration

A nurse caring for a client with preeclampsia

This preview shows page 44 - 46 out of 265 pages.

46.A nurse caring for a client with preeclampsia prepares for the administration of an intravenous infusion of magnesium sulfate. Which of the following substances does the nurse ensure is available at the client's bedside? A) Vitamin KB) Protamine sulfateC) Potassium chlorideD) Calcium gluconateANS: DFeedback: CORRECTRationale: Magnesium sulfate, which has anticonvulsant properties, is used for a client with preeclampsia to help prevent seizures (eclampsia). It also causes central nervous system depression, however, so toxicity is a concern. Calcium gluconate should be available at the bedside of a client receiving an intravenous infusion of magnesium sulfate to reverse magnesium toxicity and prevent respiratory arrest if the serum magnesium level becomes too high. Vitamin K is the antidote for warfarin sodium (Coumadin). Protamine sulfate is the antidote for heparin. Potassium chloride is used to treat potassium deficiency. Test-Taking Strategy: Knowledge regarding the antidotes to various medications is needed to answer this question. Use the process of elimination and remember that calcium gluconate is the antidote to magnesium sulfate. Review care of the client receiving magnesium sulfate if you had difficulty with this question. Reference: Lowdermilk, D., Perry, S., & Cashion, K., (2010). Maternity nursing (8th ed., p. 685). St. Louis: Mosby.
Image of page 44
Cognitive Ability: Applying Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Maternity/Intrapartum Points Earned: 1.0/1.0 Correct Answer(s): D 47.A nurse is monitoring a client receiving terbutaline (Brethine) by intravenous infusion to stop pretermlabor. The nurse notes that the client's heart rate is 120 beats/min and that the fetal heart rate is 170beats/min. The appropriate action by the nurse is: sympathetic nervous system, resulting in bronchodilation and inhibition of uterine muscle activity. The nurse monitors the client for adverse effects and notifies the physician if the maternal heart rate is faster than 110 beats/min, respiration is faster than 24 breaths/min, systolic blood pressure is less than 90 mm Hg, the fetal heart rate is faster than 160 beats/min, or the client complains of chest pain or dyspnea. Increasing the rate of infusion and continuing to monitor the client and are inappropriate and delay necessary interventions. Although the nurse would document the findings, the most appropriate action in this scenario is to contact the physician. Test-Taking Strategy: Use the process of elimination. Focusing on the data in the question and recalling the normal maternal heart rate and normal fetal heart rate will direct you to the correct option. Review care of the client receiving terbutaline if you had difficulty with this question.
Image of page 45
Image of page 46

You've reached the end of your free preview.

Want to read all 265 pages?

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture