A woman in her second trimester of pregnancy presents to the ...

[panfilo]

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).

Question 2

A 22-year-old woman presents to the emergency department with abdominal pain and vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and she complains of dizziness.
 
  Which action by the nurse takes priority?
  A.
  Assess the woman for sexually transmitted infections.
  B.
  Collect a urine sample for pregnancy testing.
  C.
  Obtain informed consent for a salpingectomy.
  D.
  Start two large-bore IVs for fluid replacement.

[macagn]

Answer to Question 1

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 -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 -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.

Answer to Question 2

ANS: D
This patient has both signs (hypotension, tachycardia) and symptoms (complaints of dizziness) of acute volume loss. The nurse should consider a ruptured ectopic pregnancy as a possible problem in this patient and assess her for other manifestations and risk factors. However, the priority is starting large-bore IV lines for fluid resuscitation. The nurse may need to obtain informed consent for an operative procedure once a definitive diagnosis is made.