A woman is being treated for preterm labor with magnesium sulfate. The nurse is concerned that the patient is experiencing early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity?
1. Patellar reflexes are weak or absent.
2. Complaints by the patient of feeling flushed and warm
3. Respiratory rate of 16
4. Fetal heart rate of 120
1
Rationale 1: Early signs of magnesium sulfate toxicity are related to a decrease in deep tendon reflexes.
Rationale 2: The peripheral vasodilation will cause flushing and a feeling of warmth; this is a side effect, not a toxic effect.
Rationale 3: Late signs of toxicity are a respiratory rate less than 12, urine output less than 30 cc/hour, and confusion.
Rationale 4: Magnesium typically has no effect on fetal heart rate.
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