Final answer:
"A nurse is developing a plan of care for a client who has preeclampsia and is receiving magnesium sulfate. Then the nurse should report the Absent deep tendon reflexes.
The answer is option ⇒C
Step-by-step explanation:
When developing a plan of care for a client with preeclampsia receiving magnesium sulfate, the nurse should report any signs or symptoms that may indicate adverse effects or complications. In this case, the nurse should report the following: c) Absent deep tendon reflexes.
The presence of absent deep tendon reflexes may indicate magnesium toxicity. Magnesium sulfate is a medication used to prevent seizures in preeclampsia, but it can also affect neuromuscular function. Absent deep tendon reflexes suggest an excessive effect of magnesium on the central nervous system and can be a sign of toxicity. Prompt reporting is essential to prevent further complications and ensure appropriate management.
a) Decreased respiratory rate, while it should be monitored, can be expected as a side effect of magnesium sulfate. It is not an immediate concern unless it becomes significantly low.
b) Increased urine output is a positive sign in a client with preeclampsia, as it indicates improved kidney function and elimination of excess fluid. However, it is not a cause for immediate concern.
d) Elevated blood pressure is a characteristic symptom of preeclampsia and is expected to be present in the client. It is important to monitor blood pressure regularly, but it does not warrant immediate reporting unless it reaches dangerous levels.
In summary, when developing a plan of care for a client with preeclampsia receiving magnesium sulfate, the nurse should promptly report the presence of absent deep tendon reflexes, as it may indicate magnesium toxicity.
The answer is option ⇒C