# 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?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391764&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 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?

## Option

1. Stop the magnesium infusion immediately, administer calcium gluconate IV, and notify the provider **✔ Correct answer**
2. Begin continuous oxytocin infusion
3. Administer naloxone for the respiratory depression
4. Increase the magnesium infusion to deepen sedation

**Correct answer: 1**

## 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.

## In-depth explanation

Memory Tip Magnesium toxicity progression: DTRs lost (8-10) → RR depressed → cardiac arrest. Antidote = calcium gluconate. CPG Therapeutic level for preeclampsia: 4-7 mEq/L (4.8-9.6 mg/dL); monitor q1-2h DTRs, RR, urine output ≥30 mL/hr.

## Clinical scenario

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.

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