A nurse is assisting with the admission of a client who is at 10 weeks of gestation and reports abdominal pain and moderate vaginal bleeding.

Incomplete abortion is the initial diagnosis.

Which of the following actions should the nurse contribute to the client’s plan of care?

The correct answer is choice b. Placenta previa.

Choice A rationale:

Threatened abortion typically occurs in the first trimester and involves vaginal bleeding with or without abdominal pain. It is not associated with late pregnancy bleeding.

Choice B rationale:

Placenta previa is characterized by painless, bright red vaginal bleeding in the third trimester. It occurs when the placenta covers the cervix, leading to bleeding as the cervix begins to dilate.

Choice C rationale:

Preterm labor involves uterine contractions leading to cervical changes before 37 weeks of gestation. While it can cause bleeding, it is usually accompanied by regular contractions and not typically described as bright red bleeding.

Choice D rationale:

Abruptio placentae involves the premature separation of the placenta from the uterine wall, leading to painful, dark red vaginal bleeding. It is often associated with abdominal pain and uterine tenderness, which differentiates it from placenta previa.

Choice A: Severe nausea and vomiting

While nausea and vomiting can be common in early pregnancy, including ectopic pregnancies, they are not specific indicators of an ectopic pregnancy.

Approximately 70-80% of pregnant women experience nausea and vomiting, regardless of the location of the pregnancy. Hence, the presence of severe nausea and vomiting alone would not definitively point towards an ectopic pregnancy.

Choice B: Uterine enlargement greater than expected for gestational age

In an ectopic pregnancy, the fertilized egg implants outside the uterus, typically in the fallopian tube. This means the uterus would not be expected to enlarge as it would in a normal intrauterine pregnancy. In fact, uterine size might be smaller than expected for gestational age in cases of ectopic pregnancy.

Choice C: Copious vaginal bleeding

While vaginal bleeding can occur in ectopic pregnancies, it's not always present and is not the most common initial symptom. When bleeding does occur, it's often lighter than a normal menstrual period and may be brown or dark in color.

Copious vaginal bleeding is more likely to occur in cases of miscarriage or other pregnancy complications.

Choice D: Pelvic pain

Pelvic pain is the most common and characteristic symptom of an ectopic pregnancy.

The pain is often described as sharp, stabbing, or cramping, and it may be localized to one side of the abdomen. The pain can be intermittent or constant, and it may worsen with activity or movement.

The pain is caused by the stretching of the fallopian tube as the ectopic pregnancy grows. In some cases, the pain can be severe enough to cause nausea and vomiting.

Therefore, pelvic pain is the most reliable finding that the nurse should expect in a client with a possible ectopic pregnancy at 8 weeks of gestation.