A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem?

A. Jaundice:

Jaundice refers to the yellowing of the skin and whites of the eyes due to elevated levels of bilirubin in the blood. While jaundice can be a sign of liver dysfunction or obstruction of the bile ducts, it is not typically associated with a ruptured ectopic pregnancy. Therefore, assessing for jaundice would not be the priority in this situation.

B. Hemorrhage:

Hemorrhage, or excessive bleeding, is the priority assessment in a suspected case of a ruptured ectopic pregnancy. A ruptured ectopic pregnancy can lead to significant internal bleeding, which can quickly become life-threatening. Signs and symptoms of hemorrhage may include hypotension, tachycardia, abdominal pain, dizziness, fainting, and signs of shock. Prompt recognition and management of hemorrhage are crucial to stabilize the client's condition and prevent further complications.

C. Edema:

Edema refers to the abnormal accumulation of fluid in the body tissues, resulting in swelling. While edema can occur in various conditions, such as heart failure or kidney disease, it is not typically associated with a ruptured ectopic pregnancy. Assessing for edema would not be the priority in this situation.

D. Infection:

Infection can occur as a complication of a ruptured ectopic pregnancy, particularly if there is contamination of the abdominal cavity by blood and tissue from the ruptured fallopian tube. However, the immediate concern in a suspected case of a ruptured ectopic pregnancy is hemorrhage, as it poses an immediate threat to the client's life. While infection is a concern, it is secondary to hemorrhage in terms of priority assessment and management.

A. Alcohol:

Alcohol consumption during pregnancy can lead to a range of adverse effects on the fetus, collectively known as fetal alcohol spectrum disorders (FASDs). However, the symptoms described in the scenario—tachycardia, hypertension, and evidence suggesting vasoconstriction—are not typical of alcohol use. While alcohol can lead to hypertension in chronic heavy drinkers, it is not commonly associated with tachycardia and vasoconstriction in the same way that stimulant drugs like cocaine are.

B. Heroin:

Heroin is an opioid drug that depresses the central nervous system, leading to effects such as respiratory depression, sedation, and decreased heart rate. While heroin use during pregnancy can have serious consequences for both the mother and the fetus, including neonatal withdrawal syndrome (neonatal abstinence syndrome), it is not typically associated with tachycardia, hypertension, and vasoconstriction. Therefore, heroin is less likely to be the substance causing the symptoms described in the scenario.

C. Marijuana:

Marijuana use during pregnancy has been associated with various adverse outcomes, including low birth weight and neurodevelopmental issues in children. However, the symptoms described—tachycardia, hypertension, and evidence suggesting vasoconstriction—are not typical of marijuana use. Marijuana is more commonly associated with effects such as relaxation, increased heart rate (tachycardia), and vasodilation (not vasoconstriction). Therefore, marijuana is less likely to be the substance causing the symptoms described in the scenario.

D. Cocaine:

Cocaine is a potent stimulant drug that acts on the central nervous system and cardiovascular system, leading to effects such as tachycardia, hypertension, and vasoconstriction. These symptoms are consistent with acute cocaine intoxication. Cocaine use during pregnancy can have serious adverse effects on both the mother and the fetus, including increased risk of miscarriage, preterm labor, placental abruption, and fetal growth restriction. Therefore, given the symptoms described in the scenario, cocaine is the substance that the nurse would question the woman about.