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?
A.
Assess her for a history of preterm labor.
B.
Obtain a blood sample for a ?-hCG test.
C.
Prepare the woman for a pelvic exam.
D.
Request an order for methotrexate (Rheumatrex).
ANS: B
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 β-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 β-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.
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