A laboring client receiving IV magnesium sulfate for severe … | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A laboring client receiving IV magnesium sulfate for severe preeclampsia becomes confused, with deep tendon reflexes absent and respirations of 10/min. Which is the priority nursing action?
1Stop the magnesium infusion immediately, administer calcium gluconate IV, and notify the provider✓ Correct answer
2Begin continuous oxytocin infusion
3Administer naloxone for the respiratory depression
4Increase the magnesium infusion to deepen sedation
Explanation
Correct (2): Absent DTRs, RR 7-10 mEq/L). Priority: STOP the infusion, administer calcium gluconate 1 g IV over 3 minutes as the antidote, support airway/breathing, notify provider. Continue to monitor reflexes, RR, urine output, and serum magnesium. (1) More magnesium worsens toxicity. (3) Naloxone reverses opioids. (4) Oxytocin worsens BP and is contraindicated in severe preeclampsia management without specific indication.
Scenario 32-year-old G2P1 at 36 weeks with severe preeclampsia on magnesium sulfate 2 g/hr IV. New findings: confusion, absent DTRs, RR 10/min, SpO2 92%.
Key concepts
Magnesium toxicity — Loss of DTRs, respiratory depression, confusion, and ultimately cardiac arrest from elevated serum magnesium.
Calcium gluconate antidote — IV calcium reverses neuromuscular blockade caused by magnesium toxicity.
Preeclampsia magnesium target — Therapeutic serum magnesium 4-7 mEq/L for seizure prophylaxis in severe preeclampsia/eclampsia.