A patient who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age
An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The patient is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include? 1. "You're feeling dizzy because the pregnancy is compressing your vena cava."
2. "The pain is due to the baby putting pressure on nerves internally."
3. "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding."
4. "This is a minor problem. The doctor will be right back to explain it to you."
3
Rationale 1: Dizziness from vena cava compression occurs in the third trimester when women are supine.
Rationale 2: The fetus is too small to be putting pressure on the nerves.
Rationale 3: Dizziness and abdominal pain with shoulder pain are symptoms of internal bleeding. A lower-than-expected beta-hCG indicates either an ectopic pregnancy or a pregnancy that is miscarrying; in this case, it is an ectopic pregnancy.
Rationale 4: Therapeutic communication requires giving the patient an answer rather than referring the patient to someone else.
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