The nurse is caring for a client who reports severe abdominal pain and vaginal spotting. The client had a positive urine pregnancy test at home, and her last menstrual period was 8 weeks ago. Which client report to the nurse is most concerning?

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11ecbb05_cbf8_9890_b433_b79f2ca50f5d_MD0009_00 Symptoms of ectopic pregnancy may include lower abdominal and pelvic pain; amenorrhea, possibly followed by vaginal spotting or bleeding; and a palpable adnexal mass on pelvic examination. An ectopic pregnancy may implant in one of many locations outside the uterine cavity, including the fallopian tubes, ovaries, or abdominal cavity. As the ectopic pregnancy outgrows its environment, it may rupture, causing life-threatening maternal hemorrhage. Symptoms indicative of a ruptured ectopic pregnancy include hypotension, tachycardia, dizziness, and referred shoulder pain (Option D). Shoulder pain results from irritation of the diaphragm by intraabdominal blood. A ruptured ectopic pregnancy is a surgical emergency and requires immediate intervention. (Option A) Abdominal pain with an ectopic pregnancy may start out as mild, dull, and one-sided, and progress to severe and generalized as the pregnancy grows. However, a ruptured ectopic pregnancy is more dangerous than an unruptured ectopic pregnancy. (Option B) Pelvic inflammatory disease increases the risk for ectopic pregnancies. Although this important piece of the client's history raises suspicion for a diagnosis of ectopic pregnancy, it is not the most concerning finding. (Option C) Initially, a client with an ectopic pregnancy may report typical early pregnancy symptoms, such as morning sickness. Nausea and vomiting are not uncommon in ectopic pregnancies, and gastrointestinal distress may worsen after rupture. Educational objective: An ectopic pregnancy may rupture prior to diagnosis, causing life-threatening maternal hemorrhage. Symptoms of a ruptured ectopic pregnancy include hypotension, tachycardia, dizziness, and referred shoulder pain. Ruptured ectopic pregnancy is a surgical emergency requiring immediate intervention.

The Nurse Is Caring for a Client Who Reports Severe