# A 28-year-old at 7 weeks gestation by LMP presents with sudden right lower quadrant pain, syncope, BP 88/56, HR 124, and a serum hCG of 4200 with no intrauterine pregnancy on bedside US. Which interventions should the nurse anticipate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375099&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

A 28-year-old at 7 weeks gestation by LMP presents with sudden right lower quadrant pain, syncope, BP 88/56, HR 124, and a serum hCG of 4200 with no intrauterine pregnancy on bedside US. Which interventions should the nurse anticipate? Select all that apply.

1

Insert a urinary catheter to monitor output and resuscitation response

2

Type and cross for blood products and anticipate possible transfusion

3

Establish two large-bore IVs and prepare for emergent surgery

4

Begin methotrexate for medical management of ruptured ectopic

5

Administer Rho(D) immune globulin (RhoGAM) if the client is Rh-negative

## Explanation

Ruptured ectopic with hemodynamic instability requires SURGICAL management (laparoscopic salpingostomy or salpingectomy) with two large-bore IVs, blood products on standby, urinary catheter for resuscitation monitoring. Rh-negative clients receive anti-D immunoglobulin. Methotrexate is for STABLE unruptured ectopic with hCG under 5000, no fetal cardiac activity, mass under 3.5 cm — NOT for ruptured/unstable. Time to surgical control is the most important determinant of survival.

## In-depth explanation

Risk factors: prior PID, prior ectopic, IUD in place at conception, tubal surgery, IVF. Consider ectopic in any reproductive-age female with abdominal pain plus positive hCG.

## Clinical scenario

Free fluid on FAST. History of PID and prior tubal surgery. Hb 9.4.

## Key concepts

- **ectopic pregnancy** — Pregnancy implanting outside the uterine cavity; tubal most common.
- **methotrexate** — Folate antagonist used for medical management of stable, unruptured ectopic.
- **Rho(D) immune globulin** — Prevents Rh isoimmunization in Rh-negative pregnant clients exposed to Rh-positive blood.

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