Correct Answer: B

Rationale: Magnesium sulfate is used to prevent eclampsia, but it can lead to toxicity if levels become too high. One common sign of magnesium toxicity is increased deep tendon reflexes, also known as hyperreflexia. This occurs because magnesium is a muscle relaxant, and elevated levels can lead to over-relaxation of muscles, causing an exaggerated reflex response. Other signs of magnesium toxicity include respiratory depression, decreased urine output, and cardiac arrest. Therefore, in a woman receiving intravenous magnesium sulfate during labor, an increase in deep tendon reflexes would indicate potential toxicity and require immediate intervention.

Correct Answer: A

Rationale: Providing emotional support and empathy for the client's experience should be prioritized to address concerns of a postpartum client who experienced a traumatic birth. Emotional support can help the client feel validated and heard, which can be instrumental in starting the healing process. By acknowledging the client's emotions and experiences, the nurse can establish trust and create a safe space for the client to express their feelings. This can also help in building a therapeutic relationship that can positively impact the client's emotional well-being. Providing a supportive environment is essential for addressing breastfeeding difficulties and emotional distress in this situation.

Correct Answer: A

Rationale: Following total hip arthroplasty (THA), patients are at an increased risk of developing deep vein thrombosis (DVT) due to factors such as immobility, surgery-related vascular damage, and hypercoagulability. DVT refers to the formation of blood clots in the deep veins, typically in the lower extremities. These clots can break loose and travel to the lungs, causing a potentially life-threatening condition called pulmonary embolism (PE). Therefore, monitoring for signs and symptoms of DVT is crucial in the immediate postoperative period to promptly detect and prevent the development of complications such as PE. Common signs of DVT include leg swelling, pain, warmth, and redness. Additionally, healthcare providers may employ preventive measures such as early ambulation, compression stockings, and anticoagulant therapy to reduce the risk of DVT post-THA surgery.

Correct Answer: C

Rationale: Antipsychotic medications, especially first-generation antipsychotics, can cause extrapyramidal symptoms (EPS) as an adverse effect. EPS include symptoms such as muscle rigidity, tremors, akathisia (restlessness), and tardive dyskinesia (involuntary movements of the face and body). These symptoms are due to the medications' effects on the dopamine system in the brain. It is crucial for the nurse to monitor the patient closely for EPS because they can be uncomfortable, distressing, and may impact the patient's quality of life and medication adherence. Early recognition and management of EPS are essential to prevent further complications and improve the patient's overall well-being.

Correct Answer: D

Rationale: A subarachnoid hemorrhage is characterized by bleeding within the subarachnoid space, the area between the arachnoid mater and the pia mater surrounding the brain. Patients typically present with a sudden-onset severe headache, altered mental status, and focal neurological deficits due to the mass effect of the blood in the subarachnoid space. Imaging, such as a CT scan, can confirm the presence of the hemorrhagic lesion. Ischemic stroke results from a blockage in the blood vessels supplying the brain, leading to tissue infarction and neurological deficits. Subdural hematoma is a collection of blood between the dura mater and the arachnoid mater, commonly seen following head trauma. Intracerebral hemorrhage involves bleeding within the brain tissue itself, often leading to focal neurological deficits.