A nurse is caring for a client who has heart failure and is taking furosemide which of the following findings should the nurse recognize as an adverse effect of this medication?

The client underwent surgical intervention (right salpingostomy), which carries risks such as hemorrhage, hypovolemic shock, infection, and adverse anesthetic effects. Postoperative assessment findings must be carefully evaluated for early signs of deterioration. Hypotension combined with bradycardia, hypothermia, and cool clammy skin suggests potential shock or significant hemodynamic instability, which requires urgent intervention to prevent cardiovascular collapse.

Rationale for correct choices:

• Blood pressure 90/60 mm Hg: A blood pressure of 90/60 mm Hg indicates hypotension, which is a major postoperative warning sign for possible hemorrhage or shock following ectopic pregnancy surgery. Given the vascular nature of reproductive structures and recent surgical intervention, internal bleeding is a significant concern. This drop in perfusion pressure can rapidly progress to organ hypoperfusion and cardiovascular collapse if not addressed immediately. It is the most urgent abnormal finding requiring immediate follow-up.

• Heart rate 60/min: Bradycardia in the postoperative setting may indicate worsening hemodynamic instability, especially when combined with hypotension. While opioids or anesthesia may contribute, the presence of low blood pressure makes this finding more concerning for circulatory compromise. It may represent a late or atypical response in shock states where compensatory mechanisms are failing. Continuous is essential.

• Temperature 35.3° C (95.5° F): Hypothermia after surgery may result from anesthesia effects, environmental exposure in the operating room, or impaired thermoregulation. However, in combination with hypotension and bradycardia, it may indicate poor perfusion and early shock. Reduced core temperature can impair coagulation, increasing the risk of postoperative bleeding. This finding supports the concern for systemic instability rather than isolated temperature variation.

• Skin cool and moist to touch: Cool, moist skin is a classic sign of peripheral vasoconstriction and sympathetic activation seen in shock states. It reflects the body’s attempt to preserve blood flow to vital organs at the expense of peripheral circulation. When combined with hypotension, it strongly suggests decreased tissue perfusion. This finding supports the likelihood of postoperative hemorrhage or circulatory compromise requiring immediate intervention.

Rationale for incorrect findings:

• Pain rating 1/10: A pain score of 1/10 is an expected and reassuring postoperative finding following laparoscopic surgery. It indicates effective pain control and no evidence of acute complications such as severe internal bleeding or peritoneal irritation. In postoperative monitoring, significant worsening pain would be more concerning for complications. Therefore, a low pain score is a normal and non-alarming finding in this scenario.

• Neurological status: drowsy but easy to arouse: Mild drowsiness is common after anesthesia and opioid administration in the postoperative period. The client is easily arousable and responsive. This suggests intact airway protection and no immediate neurological emergency. In the absence of worsening confusion or unresponsiveness, this finding is expected and not the priority concern.

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.