A client with severe preeclampsia receiving magnesium sulfate has absent patellar reflexes and a respiratory rate of 9/min. Which action should the nurse take first?
1Begin an oxytocin infusion and reassess the respiratory rate after delivery.
2Increase the magnesium infusion because absent reflexes indicate inadequate seizure prevention.
3Stop magnesium, support ventilation, notify the provider, and prepare prescribed IV calcium.✓ Correct answer
4Administer naloxone because it specifically reverses magnesium-related neuromuscular blockade.
Explanation
Absent deep-tendon reflexes and respiratory depression indicate magnesium toxicity. The nurse should stop the magnesium infusion immediately, support airway and ventilation, notify the provider, and prepare an injectable calcium salt such as calcium gluconate as prescribed to antagonize magnesium effects. Increasing magnesium, delaying care, or giving naloxone does not treat this toxicity.
Clinical reasoning Rising magnesium first diminishes neuromuscular reflexes and can progress to respiratory paralysis. Renal impairment or low urine output increases accumulation risk.
Decision rule Loss of patellar reflexes plus respiratory depression requires immediate cessation of magnesium, ventilatory support, and readiness to administer IV calcium under the emergency treatment plan.
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%.