In a pregnant woman with eclamptic seizures, what will be the loading dose of MgSO4 administered by you?

Appeared in: NHM MP Staff Nurse-2019

Explanation

The correct option describes the complete loading dose for the Pritchard regimen, a standard protocol for managing eclamptic seizures.
This regimen involves an initial intravenous (IV) dose to quickly achieve therapeutic levels, followed by a deep intramuscular (IM) dose for sustained effect.
The dose is 4 gm of MgSO4 given slowly IV, followed immediately by 10 gm given as two separate 5 gm deep IM injections, one in each buttock.

Option B: This option is incorrect because it only describes the intramuscular (IM) portion of the Pritchard regimen's loading dose. It omits the crucial initial 4 gm intravenous (IV) dose required to rapidly control seizures.
Option C: This option is incorrect as it describes the maintenance dose (5 gm IM) of the Pritchard regimen, which is given every 4 hours after the initial loading dose. It is not the loading dose itself.
Option D: This option is incorrect because a correct and complete loading dose regimen is provided in the options.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological management of eclampsia using Magnesium Sulfate (MgSO4) in acute care settings.
MgSO4 is the drug of choice for preventing and treating seizures in eclampsia, significantly reducing maternal morbidity and mortality.
Nurses must meticulously monitor for signs of magnesium toxicity: respiratory rate less than 12/min, loss of patellar reflexes, and urine output less than 30 mL/hr. The antidote, calcium gluconate, must be readily available at the bedside.
What if? If the patient has renal impairment (e.g., serum creatinine greater than 1.0 mg/dL), the maintenance dose must be adjusted or withheld, and serum magnesium levels monitored closely, as the drug is cleared by the kidneys and toxicity risk increases.

How to Approach the Question

First, identify the core of the question: the 'loading dose' of 'MgSO4' for 'eclamptic seizures'.
Recall the standard treatment protocols for eclampsia, primarily the Pritchard and Zuspan regimens.
Evaluate each option against the known protocols. The Pritchard regimen is a combined IV and IM protocol.
Option A describes a 4 gm IV dose plus a 10 gm IM dose (5 gm in each buttock). This matches the Pritchard loading dose.
Option B is only the IM part. Option C is the maintenance dose. Therefore, Option A is the complete and correct answer.

Concept Tested & Keywords

Concept Tested: Pharmacological management of eclampsia using Magnesium Sulfate (MgSO4).
Stem keywords: eclamptic seizures, pregnant woman, loading dose, MgSO4
Lead-in keywords: what will be
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 36-44

E6 Obstetrics Williams p. 30-51

Practise the full NHM MP Staff Nurse-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.