A woman in her second trimester of pregnancy presents to the perinatal clinic with complaints of scant vaginal bleeding,abdominal pain,and shoulder pain.What action should the nurse perform first?

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This woman is displaying symptoms of a possible ruptured ectopic pregnancy (vaginal bleeding,abdominal pain,shoulder pain).Shoulder pain can occur from nerve irritation due to the presence of blood in the pelvic cavity.A b-hCG test finding will be lower than expected for the gestational age.The woman will most likely need a pelvic exam.However,to facilitate a rapid diagnosis,the nurse should first obtain and send a blood sample for b-hCG test.The nurse can then assess the woman for risk factors for ectopic pregnancy.However,preterm labor is not a risk factor.Methotrexate is used for uncomplicated,non-life-threatening ectopic pregnancies.It would not be indicated in this patient because she has manifestations of rupture.

A Woman in Her Second Trimester of Pregnancy Presents to the Perinatal