a nurse is caring for a client who is receiving magnesium sulfate for preeclampsia which finding indicates magnesium toxicity
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment Form A

1. A client is receiving magnesium sulfate for preeclampsia. Which finding indicates magnesium toxicity?

Correct answer: B

Rationale: Diminished deep tendon reflexes are a sign of magnesium toxicity. Magnesium sulfate can depress the central nervous system, leading to decreased reflexes. Respiratory rate of 12/min, urine output 40 mL/hr, and systolic blood pressure of 140 mm Hg are not specific findings of magnesium toxicity. Respiratory depression, oliguria, and hypotension are more concerning signs that require immediate attention.

2. A nurse is caring for a client prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about?

Correct answer: A

Rationale: The correct answer is A: Potassium supplements. Lisinopril, an ACE inhibitor, can increase potassium levels in the body. Therefore, the nurse should instruct the client to avoid potassium supplements to prevent hyperkalemia, a potentially dangerous condition. Choices B, C, and D are incorrect because they do not have significant interactions with lisinopril that would lead to adverse effects like hyperkalemia.

3. A nurse is providing discharge instructions about breast engorgement to a client who has decided not to breastfeed. Which of the following statements by the client indicates a need for further instruction?

Correct answer: C

Rationale: The correct answer is C. Manually expressing breast milk will stimulate more milk production, which contradicts the goal of reducing milk supply in clients who choose not to breastfeed. Choices A, B, and D are correct statements that can help relieve breast engorgement without promoting further milk production.

4. A client with burn injuries covering their upper body is concerned about their altered appearance. Which of the following statements should the nurse make?

Correct answer: D

Rationale: The nurse should encourage the client to attend a support group for individuals with burn injuries. Support groups can provide emotional support, promote acceptance of altered appearance, and help the client cope with the changes. Choice A is incorrect because it may not address the client's emotional needs. Choice B is incorrect as suggesting a timeline for cosmetic surgery may not be appropriate without considering the client's physical and emotional readiness. Choice C is incorrect as reconstructive surgery may not completely restore the client's previous appearance and may set unrealistic expectations.

5. A healthcare professional is preparing to administer a dose of potassium chloride. Which of the following should the professional do?

Correct answer: B

Rationale: Correct Answer: Dilute the medication. Potassium chloride should always be diluted before administration to avoid irritation and complications. Choice A is incorrect because administering it as a bolus can lead to adverse effects. Choice C is incorrect as giving it rapidly can be dangerous. Choice D is incorrect as monitoring the respiratory rate is not directly related to administering potassium chloride.

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