Main Answer:
Discontinue magnesium sulfate IV to address decreased reflexes promptly, preventing potential toxicity. D. Discontinue the IV infusion.
Therefore, the correct answer is D. Discontinue the IV infusion.
Step-by-step explanation:
The priority action for the nurse in this scenario is to discontinue the IV infusion of magnesium sulfate. Decreased deep tendon reflexes may indicate magnesium sulfate toxicity, and prompt intervention is crucial to prevent further complications. Discontinuing the IV infusion is the most immediate and direct action to address the potential overdose of magnesium sulfate.
Magnesium sulfate is commonly used in medical settings to prevent seizures in conditions like preeclampsia. However, it has a narrow therapeutic range, and excessive levels can lead to respiratory depression and decreased reflexes. Monitoring for signs of toxicity, such as diminished deep tendon reflexes, is essential in providing safe and effective care to the client.
The nurse should not only discontinue the IV infusion but also closely monitor the client's respiratory status, vital signs, and other symptoms of magnesium toxicity. Additionally, informing the healthcare provider about the findings and actions taken is essential for further guidance and possible adjustments to the treatment plan.
In summary, recognizing and promptly addressing the decreased deep tendon reflexes by discontinuing the IV infusion is critical in preventing complications associated with magnesium sulfate toxicity.
Therefore, the correct answer is D. Discontinue the IV infusion.