The nurse receives report on 4 first-trimester pregnant clients. Which client should the nurse assess first?

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11ecbb05_cbf7_600e_b433_89bf2e9aef18_MD0009_00 An ectopic pregnancy occurs when a fertilized egg implants and begins to grow outside the uterine cavity, frequently in the fallopian tubes. Clients with ectopic pregnancies may report a positive pregnancy test, vaginal spotting/bleeding, and/or abdominal pain. If untreated, continued growth can lead to fallopian tube rupture, resulting in hemorrhage and hemodynamic compromise. Intra-abdominal bleeding can lead to referred shoulder pain, a classic sign of diaphragm irritation. Ruptured ectopic pregnancy requires emergency surgical intervention and hemodynamic support (eg, IV fluids, blood transfusion) (Option C). (Option A) In clients with hydatidiform mole or "molar pregnancy," the fetus is replaced by edematous, cystic chorionic villi. Clients experiencing molar pregnancy should anticipate intermittent, dark brown vaginal discharge until the pregnancy is evacuated. (Option B) Clients with hyperemesis gravidarum have excessive nausea and vomiting and weight loss, often requiring fluid replacement and antiemetic therapy. The condition is not usually life-threatening and does not take priority over ruptured ectopic pregnancy. (Option D) Clients who are Jehovah's Witnesses do not allow blood transfusions due to religious beliefs. Clients with threatened miscarriage usually report spotting but have a closed cervical os. Heavier bleeding requiring a blood transfusion may be more common with inevitable or incomplete miscarriages. Educational objective: Ectopic pregnancy occurs when a fertilized egg implants and begins to grow outside the uterus, often in the fallopian tubes. Rupture of an ectopic pregnancy results in hemorrhage and requires emergency surgery. Shoulder pain in a client with ectopic pregnancy indicates intra-abdominal bleeding from a rupture.

The Nurse Receives Report on 4 First-Trimester Pregnant Clients