A nurse is caring for a client in the prenatal clinic who has a possible ectopic pregnancy at 8 weeks of gestation. Which of the following findings should the nurse expect?

Choice A rationale Severe nausea and vomiting are more commonly associated with a molar pregnancy (hydatidiform mole) or hyperemesis gravidarum rather than an ectopic pregnancy. In a molar pregnancy, extremely high levels of human chorionic gonadotropin (hCG) trigger intense gastrointestinal distress. While a woman with an ectopic pregnancy may feel some nausea, it is not the primary or defining clinical finding. The primary symptoms of ectopic pregnancy are related to the location of the embryo and potential tubal rupture. Choice B rationale Copious vaginal bleeding is usually a sign of a spontaneous abortion or a placenta previa later in pregnancy. In an ectopic pregnancy, bleeding is often described as spotting or light brown discharge rather than heavy flow. This occurs because the uterine lining begins to slough off as the hormonal support from the abnormally placed pregnancy falters. While internal hemorrhage can be massive if a tube ruptures, external vaginal bleeding is typically minimal or moderate, not copious. Choice C rationale Uterine enlargement greater than expected for gestational age is a classic sign of a gestational trophoblastic disease, such as a molar pregnancy. In an ectopic pregnancy, the uterus may be slightly enlarged due to hormonal changes, but it will be smaller than expected for the gestational date because the fetus is not growing inside the uterine cavity. The growth occurs elsewhere, most commonly in the fallopian tube, which cannot accommodate the size of a developing fetus for long. Choice D rationale Pelvic pain is the most characteristic finding of an ectopic pregnancy. As the embryo grows in a confined space like the fallopian tube, it causes stretching and inflammation, leading to sharp, stabbing, or dull pain on one side of the lower abdomen. If the tube ruptures, the pain becomes sudden and severe, often radiating to the shoulder due to peritoneal irritation from blood. This pain is a critical warning sign that requires immediate medical evaluation to prevent life-threatening hemorrhage.