Maternity Nursing A client at 34 weeks gestation has constipation. The client has been taking 325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks ago. Which instructions should the nurse recommend for this client? Select all that apply. Unordered Options Ordered Response 1. Dec...
Maternity Nursing
Antepartum
34 Week Gestation Client With Constipation
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A client at 34 weeks gestation has constipation. The client has been taking 325 mg
ferrous sulfate tid for anemia since the last appointment 4 weeks ago. Which
instructions should the nurse recommend for this client? Select all that apply.
Unordered Options Ordered Response
1. Decrease total daily dairy intake
2. Increase intake of fruits and vegetables
3. Moderate-intensity regular exercise
4. One cup of hot coffee each morning
5. One laxative twice daily for a week
You answered this question incorrectly. Correct answer is: 2,3
Time Spent: 93 Seconds
40% of people answered this question correctly.
Last Updated: 8/19/2015
Explanation
Constipation is a common complication of pregnancy due to an increase in the
hormone progesterone, which causes the smooth muscles of the gastrointestinal tract
to relax. This leads to constipation from slowing of stool movement. Ferrous sulfate
(iron) may also cause constipation.
,Interventions to prevent and treat constipation include:
1. High-fiber diet – increase fruits and vegetables and add breakfast cereals and
whole-grain bread; prunes also help constipation
2. Increased fluid intake – drink at least 10-12 cups of fluid daily. In combination
with a high-fiber diet, fluids help the most to treat constipation.
3. Regular exercise – moderate-intensity exercise (eg, walking, swimming,
aerobics) is recommended throughout pregnancy
4. Bulk-forming fiber supplements – bulk-forming agents such as psyllium (eg,
Metamucil), methylcellulose (eg, Citrucel), and wheat dextran (eg, Benefiber) are
natural synthetic fiber products. These agents absorb water and create bulk to
the stool. They have very few adverse effects.
(Option 1) Dairy is a great source of calcium, which is essential for fetal bone
development.
(Option 4) Coffee may contain caffeine and should be avoided during
pregnancy. Coffee can also lead to heartburn.
(Option 5) Laxatives are not recommended during pregnancy due to the risk of
dehydration and electrolyte imbalance. Dehydration can lead to preterm labor. The
client should contact the health care provider (HCP) regarding any over-the-counter
drugs, including stool softeners and laxatives.
Educational objective:
Constipation in pregnancy may be caused by increased progesterone levels and from
ferrous sulfate. It is best treated with 10-12 cups of fluid daily, a high-fiber diet, and
regular exercise. Clients should not take laxatives without first discussing these with the
primary HCP.
Antepartum
Pre-Eclampsia/Eclampsia
Test Id: 51538826
Question Id: 30515 (729561)
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A 28-year-old client is admitted to the labor and delivery unit for severe
preeclampsia. She is started on IV magnesium sulfate infusion. Which signs indicate
that the client has developed magnesium sulfate toxicity? Select all that apply.
Unordered Options Ordered Response
1. 0/4 patellar reflex
2. Blood pressure is 156/84 mm Hg
3. Client voided 600 mL in 8 hours
4. Respirations are 10/min
5. Serum magnesium level is 6 mg/dL
You answered this question incorrectly. Correct answer is: 1,4
Time Spent: 105 Seconds
12% of people answered this question correctly.
Last Updated: 1/12/2016
Explanation
Although the normal blood level of magnesium is 1.5-2.5 mEq/L, a therapeutic
magnesium level of 5-8 mg/dL is necessary to prevent seizures in a preeclamptic client
(Option 5). Magnesium that exceeds the therapeutic level causes toxicity by acting as
a central nervous system depressant and by blocking neuromuscular
transmission. Loss of deep-tendon reflexes (DTRs) is the earliest sign of magnesium
sulfate toxicity (9.6-12 mg/dL). If not recognized at this level, clients progress to
respiratory depression (12-18 mg/dL), followed by cardiac arrest (24-30
mg/dL). Urine output is also reduced. The treatment for magnesium sulfate toxicity is
immediate discontinuation of the infusion. Administration of calcium gluconate
(antidote) is recommended only for cardiorespiratory compromise (not for loss of
DTRs).
, (Option 1) DTRs are scored on a scale of 0-4; normal findings are 2+. DTRs should be
assessed every 2 hours during magnesium administration. Decreased reflexes could
be a sign of pending respiratory depression.
(Option 2) Hypertension is a sign of preeclampsia. Hydralazine (Apresoline),
methyldopa (Aldomet), or labetalol (beta blockers) is used to lower blood pressure if
needed (usually considered when >160/110 mm Hg).
(Option 3) Urine output below the obligatory amount of 30 mL/hr is a sign of
magnesium toxicity. The client can always void more and would be expected to do so
with additional fluid administration.
(Option 4) Respiratory depression (rate <12/min) is an assessment finding indicating
magnesium toxicity. Assessments (including vital signs) should initially be performed
every 5-15 minutes during the loading dose and then every 30-60 minutes until the
client stabilizes.
Educational objective:
The therapeutic level of magnesium for preeclampsia-eclampsia treatment is 5-8
mg/dL. Signs of magnesium toxicity are decreased/loss of DTRs, respiratory
depression (<12/min), decreased urine output (<30 mL/hr), and cardiac arrest if these
are not recognized. Calcium gluconate (antidote) should be readily available for
cardiorespiratory compromise.
Antepartum
Pre-Eclampsia/Eclampsia
Test Id: 51538826
Question Id: 30616 (729561)
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