A woman in labor is being treated with magnesium sulfate intravenously and is beginning to show signs and symptoms of hypermagnesemia. The infusion has been discontinued, and the nurse should anticipate administration of what drug?

Correct Answer: B

Rationale: Hypermagnesemia is an electrolyte imbalance characterized by high levels of magnesium in the blood. In this scenario, the woman in labor is showing signs of hypermagnesemia due to the intravenous administration of magnesium sulfate. The first step in managing hypermagnesemia is to discontinue the source of excess magnesium, which in this case is the magnesium sulfate infusion. Calcium gluconate is the correct choice for the nurse to anticipate administering in this situation. Calcium gluconate is a calcium supplement that can help counteract the effects of hypermagnesemia. Calcium and magnesium have an inverse relationship in the body, so administering calcium can help lower magnesium levels and alleviate symptoms of hypermagnesemia. Metoprolol (Lopressor) is a beta-blocker used to treat high blood pressure and heart conditions. It is not indicated for the treatment of hypermagnesemia and would not address the underlying cause of the woman's symptoms. Potassium chloride is a supplement used to treat or prevent low potassium levels in the blood. It is unrelated to the treatment of hypermagnesemia and would not be appropriate in this situation. Furosemide (Lasix) is a loop diuretic used to treat fluid retention and high blood pressure. While diuretics can help eliminate excess magnesium in the body, they are not the first-line treatment for hypermagnesemia. Calcium gluconate is the more appropriate choice in this scenario to quickly counteract the effects of excess magnesium and alleviate symptoms.

Correct Answer: A

Rationale: A bulk-producing agent, such as Metamucil, is most physiologic for the mother and safe for the fetus. Mineral oil is not recommended because of the lack of absorption of fat-soluble vitamins. Saline cathartics are not recommended because of hypernatremia. Stimulant cathartics are not recommended for the pregnant woman.

Correct Answer: C

Rationale: Choice A is incorrect because discontinuing HAART during pregnancy can actually increase the risk of HIV transmission from mother to child. HAART is crucial in reducing the viral load in pregnant women with HIV, therefore discontinuation would be detrimental. Choice B is incorrect because increasing the dosage of HAART during pregnancy is not a standard practice. The goal is to maintain the viral load at a low level to reduce the risk of transmission to the baby, but this can usually be achieved with the standard regimen without the need for dosage adjustments. Choice D is incorrect because not all components of HAART are contraindicated during pregnancy. While some drugs may need to be switched due to potential teratogenic effects, many of the medications used in HAART are safe to use during pregnancy and can be continued without any changes. The correct answer, choice C, is supported by guidelines from organizations such as the World Health Organization and the Centers for Disease Control and Prevention, which recommend that pregnant women with HIV continue their HAART regimen unchanged if it is effective and well-tolerated. This helps to control the viral load, reduce the risk of transmission to the baby, and maintain the health of the mother.

Correct Answer: B

Rationale: Hypertension (choice B) is the correct answer as a maternal adverse effect of Pitocin. Pitocin, a synthetic form of oxytocin, is commonly used to induce labor or augment contractions. It can lead to hypertension in some patients due to its vasoconstrictive effects. This can result in increased blood pressure, which can be harmful to both the mother and the baby. Acute confusion (choice A) is not typically associated with Pitocin administration. Confusion may be a sign of other underlying conditions or complications, but it is not a direct adverse effect of Pitocin. Edema (choice C) is also not a common adverse effect of Pitocin. Edema refers to swelling caused by excess fluid trapped in the body's tissues, and it is not typically caused by Pitocin administration. Inverted T wave (choice D) on an electrocardiogram (ECG) is not a known adverse effect of Pitocin. Inverted T waves can be indicative of cardiac issues such as ischemia or electrolyte imbalances, but they are not directly linked to Pitocin administration. Overall, hypertension is the correct maternal adverse effect of Pitocin due to its vasoconstrictive properties, while acute confusion, edema, and inverted T waves are not typically associated with Pitocin administration.

Correct Answer: D

Rationale: Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels; oral doses can be given as maintenance therapy. Magnesium sulfate is administered intravenously and not administered at home. Oxytocin induces labor. Nifedipine is a calcium channel blocker that decreases uterine contractions.