A nurse at a provider's office is caring for a client.

Select the 3 findings that require immediate follow-up.

The client presents with delayed menses, abdominal pain, vaginal spotting, a positive pregnancy test, rising but abnormal hCG patterns, low progesterone, and right lower quadrant tenderness, along with a history of pelvic inflammatory disease, which is a major risk factor for tubal implantation. Ectopic pregnancy is a potentially life-threatening condition requiring prompt diagnosis, confirmation of location, and stabilization planning. Nursing priorities include confirming diagnosis, monitoring hormonal trends, preparing for medical management, and ensuring readiness for possible hemorrhage.

Rationale:

• Cervical cerclage: Cervical cerclage is used to treat cervical insufficiency in cases of threatened miscarriage where the cervix is incompetent but the pregnancy is intrauterine. In this case, the findings suggest an ectopic pregnancy, where the gestation is located outside the uterus. Performing a cerclage would not address the underlying pathology and would expose the client to unnecessary risk. Therefore, it is not appropriate and is contraindicated.

• Transvaginal ultrasound: Transvaginal ultrasound is the gold standard diagnostic tool for confirming the location of pregnancy in early gestation. In suspected ectopic pregnancy, it is essential to determine whether the gestational sac is within the uterus or implanted outside, such as in the fallopian tube. The client’s symptoms, elevated but inconsistent hCG levels, and unilateral pain strongly indicate the need for imaging. Early identification helps guide urgent medical or surgical management and prevent rupture.

• Methotrexate IM: Methotrexate is a folic acid antagonist used to medically treat unruptured ectopic pregnancy by inhibiting rapidly dividing trophoblastic cells. The client is hemodynamically stable with no signs of rupture, making medical management appropriate at this stage. Low progesterone levels and abnormal hCG trends further support nonviable extrauterine pregnancy. Methotrexate helps avoid surgery by allowing reabsorption of the ectopic tissue.

• Repeat quantitative β-hCG level: Serial β-hCG monitoring is essential in suspected ectopic pregnancy to evaluate whether hormone levels are rising appropriately or abnormally. In a normal pregnancy, hCG levels should double approximately every 48–72 hours; abnormal trends suggest ectopic or failing pregnancy. The client’s current values already show concerning patterns, so continued monitoring guides treatment effectiveness and detects deterioration. Trending levels is critical for clinical decision-making.

• Blood typing: Blood typing is necessary in all suspected ectopic pregnancies because there is a risk of sudden hemorrhage if rupture occurs. Determining the client’s blood type and Rh status ensures readiness for transfusion and administration of Rh immunoglobulin if needed. Although the client is currently stable, ectopic pregnancies can deteriorate rapidly. This is a standard precautionary measure in any early pregnancy with bleeding and abdominal pain.

Furosemide is a loop diuretic commonly used in clients with heart failure to reduce fluid overload by promoting the excretion of sodium and water in the kidneys. While effective in decreasing edema and pulmonary congestion, it also increases the loss of key electrolytes. Nursing care involves monitoring fluid status, electrolytes, and renal function to prevent complications. Understanding expected adverse effects is essential for safe medication management.

Rationale:
A. Hypernatremia is not a typical adverse effect of Furosemide. Instead, furosemide promotes sodium loss through the kidneys, which more commonly leads to hyponatremia rather than elevated sodium levels. Therefore, this finding is not expected.

B. Hyperchloremia is also not associated with furosemide use because the medication promotes chloride excretion along with sodium and water. This typically results in decreased chloride levels rather than an increase. Electrolyte loss is a hallmark effect of loop diuretics.

C. Hypokalemia is a common and clinically significant adverse effect of furosemide. Increased urinary excretion of potassium can lead to dangerous potassium depletion, which may result in muscle weakness and cardiac dysrhythmias. Clients with conditions such as Heart failure are particularly vulnerable and require close electrolyte monitoring.

D. Hypoglycemia is not a typical adverse effect of furosemide. While some diuretics may have mild effects on glucose metabolism, loop diuretics are not primarily associated with significant blood glucose reduction. The main concerns remain fluid and electrolyte imbalances.