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 late menses, right lower quadrant abdominal pain, and scant dark red vaginal spotting in the setting of a positive reproductive history and prior pelvic inflammatory disease. These findings raise concern for a possible ectopic pregnancy, which is a life-threatening condition if the fallopian tube ruptures. Early signs often include amenorrhea, abdominal pain, and abnormal vaginal bleeding with initially stable vital signs. Immediate follow-up focuses on identifying potential pregnancy complications and preventing hemorrhagic shock. Rationale: A. Bowel sounds are hyperactive, which may reflect mild gastrointestinal irritation or nonspecific GI activity. Abnormal bowel sounds can occur in various conditions, they are not the most urgent concern in this clinical presentation. They do not directly indicate an immediate life-threatening reproductive emergency. B. Oxygen saturation of 97% on room air is within normal limits and indicates adequate oxygenation. There is no evidence of respiratory compromise at this time. Therefore, this finding does not require immediate follow-up. C. Vaginal spotting in a client with delayed menses and abdominal pain is concerning for possible ectopic pregnancy or early pregnancy complication. Dark red spotting suggests abnormal uterine bleeding rather than normal menstruation. This requires urgent evaluation because it may indicate early pregnancy loss or tubal implantation. D. Heart rate of 90/min is within normal adult limits and does not indicate hemodynamic instability at this time. Although tachycardia can be an early sign of internal bleeding, this value alone is not currently abnormal. Continuous monitoring is important, but it is not the priority finding requiring immediate intervention. E. Temperature of 37.3°C (99.1°F) is within normal range and does not indicate infection or systemic inflammatory response. There is no evidence of fever or sepsis contributing to the client’s symptoms. Therefore, this finding does not require urgent follow-up. F. Abdominal findings of right lower quadrant tenderness are highly concerning in this clinical context and may indicate ectopic pregnancy or other acute abdominal pathology. Given the reproductive history and missed period, this finding could suggest tubal implantation or impending rupture. Immediate evaluation is required to rule out life-threatening complications. G. Respiratory findings of slight inspiratory wheezes are consistent with the client’s history of asthma and are not currently severe. Oxygenation remains stable, and there is no evidence of acute respiratory distress. This is not the priority concern compared to possible gynecologic emergency. H. Menstrual period being 2 weeks late with last period 6 weeks ago is significant because it suggests possible early pregnancy. In combination with abdominal pain and spotting, this raises concern for ectopic pregnancy. This finding requires urgent follow-up to confirm pregnancy status and rule out complications.