A client receiving IV magnesium sulfate for preterm labor develops slow respirations and absent deep tendon reflexes. What is the next nursing action?

A client receiving IV magnesium sulfate for preterm labor develops slow respirations and absent deep tendon reflexes. What is the next nursing action?

• A. Prepare to administer calcium gluconate as an antidote for magnesium toxicity
• B. Institute seizure precautions
• C. Increase the rate of magnesium sulfate
• D. Prepare for precipitous delivery

Answer: (A)

Magnesium sulfate toxicity presents as CNS and neuromuscular depression, with signs like slow respirations and absent deep tendon reflexes, so the immediate priority is reversal of the magnesium effects. Administering calcium gluconate IV is the antidote that reverses magnesium’s effects by counteracting its neuromuscular blockade, so preparing to give calcium gluconate is the best next action. In practice, you would stop the magnesium infusion and notify the provider while you administer the antidote and monitor the patient’s respiratory status, reflexes, and progressing signs of improvement. Seizure precautions are important in preeclampsia risk but do not address the toxicity itself. Increasing the magnesium rate would worsen the situation, and preparing for precipitous delivery does not resolve the immediate toxicity.

Magnesium sulfate toxicity presents as CNS and neuromuscular depression, with signs like slow respirations and absent deep tendon reflexes, so the immediate priority is reversal of the magnesium effects. Administering calcium gluconate IV is the antidote that reverses magnesium’s effects by counteracting its neuromuscular blockade, so preparing to give calcium gluconate is the best next action. In practice, you would stop the magnesium infusion and notify the provider while you administer the antidote and monitor the patient’s respiratory status, reflexes, and progressing signs of improvement. Seizure precautions are important in preeclampsia risk but do not address the toxicity itself. Increasing the magnesium rate would worsen the situation, and preparing for precipitous delivery does not resolve the immediate toxicity.