Question

"A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: A.Hydralazine.

B. Magnesium sulfate bolus.
C. Diazepam.
D. Calcium gluconate."

Answer 1

In the case of a preeclamptic woman with high blood pressure, the nurse expects the doctor to prescribe Hydralazine, an antihypertensive agent, as no signs of magnesium toxicity or seizures are present.

Step-by-step explanation:

A woman with severe preeclampsia who has been receiving magnesium sulfate by IV infusion likely requires further intervention due to her high blood pressure readings (155/112 mm Hg). Given that she has 3+ deep tendon reflexes and no ankle clonus, her reflexes are brisk but there is no evidence of magnesium toxicity. The absence of ankle clonus indicates that her nervous system is not overly depressed, a side effect that could occur with too much magnesium. In this case, the nurse calls the physician, anticipating an order for Hydralazine (A). Hydralazine is an antihypertensive medication that works by dilating blood vessels and is commonly used to manage high blood pressure during preeclampsia. Administration of a magnesium sulfate bolus (B) would not be anticipated since there is no evidence of seizure activity and there may be a concern for potential magnesium toxicity with additional dosing. Diazepam (C) is used for seizures, which are not currently present. Calcium gluconate (D) is an antagonist to magnesium and is used in cases of magnesium overdose; this is not indicated as the patient does not show signs of magnesium toxicity.