The nurse who suspects that a client has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.)
a. Pelvic pain
b. Missed period
c. Abdominal pain
d. Unanticipated heavy bleeding
e. Vaginal spotting or light bleeding
ANS: A, B, C, E
A missed period or spotting can easily be mistaken by the client as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the client often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about 50% of women, shoulder and neck pain occurs because of irritation of the diaphragm from the hemorrhage.
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