A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority?

Choice A Reason: This is correct because recurrent pelvic infections, such as pelvic inflammatory disease (PID), can cause scarring and inflammation of the fallopian tubes, which can impair the normal movement of the fertilized egg to the uterus. This can increase the risk of ectopic pregnancy, which is a life-threatening condition where the fertilized egg implants outside the uterine cavity, usually in the fallopian tube.

Choice B Reason: This is incorrect because ovarian cysts are fluid-filled sacs that develop in or on the ovaries. They are usually benign and do not affect fertility or pregnancy. However, some types of ovarian cysts, such as endometriomas or dermoid cysts, may require surgery to remove them, which can cause damage to the ovaries or fallopian tubes and increase the risk of ectopic pregnancy.

Choice C Reason: This is incorrect because use of oral contraceptives for 8 years is not a risk factor for ectopic pregnancy. In fact, oral contraceptives can reduce the risk of ectopic pregnancy by preventing ovulation and fertilization. However, if a woman becomes pregnant while taking oral contraceptives, she should stop taking them and consult her doctor, as they may have adverse effects on the developing fetus.

Choice D Reason: This is incorrect because heavy, irregular periods are not a risk factor for ectopic pregnancy. They may indicate other conditions such as hormonal imbalance, uterine fibroids, polycystic ovary syndrome (PCOS), or endometriosis, which can affect fertility or pregnancy, but not necessarily cause ectopic pregnancy.

Choice A Reason: Homelessness is a risk factor for high-risk pregnancy because it exposes the woman to various challenges and stressors that can affect her health and well-being. Homeless women may face difficulties in accessing adequate nutrition, hygiene, safety, shelter, transportation, and health care. They may also experience higher levels of violence, substance abuse, mental illness, and social isolation. These factors can increase the risk of infections, complications, preterm birth, low birth weight, and infant mortality.

Choice B Reason: Age is not a risk factor for high-risk pregnancy in this case because the woman is 22 years old, which is within the optimal age range for childbearing. The optimal age range is considered to be between 20 and 35 years old, as women in this age group tend to have fewer complications and better outcomes than women who are younger or older. Women who are younger than 20 or older than 35 are considered to have advanced maternal age or adolescent pregnancy, respectively, which are risk factors for high-risk pregnancy.

Choice C Reason: BP 110/70 is not a risk factor for high-risk pregnancy because it is within the normal range for blood pressure. The normal range for blood pressure is considered to be between 90/60 and 120/80 mmHg. Blood pressure that is too high or too low can indicate problems such as preeclampsia, eclampsia, or hypotension, which are risk factors for high-risk pregnancy.

Choice D Reason: BMI 17.5 is a risk factor for high-risk pregnancy because it indicates that the woman is underweight. BMI stands for body mass index, which is a measure of body fat based on height and weight. The normal range for BMI is considered to be between 18.5 and 24.9 kg/m2. BMI that is too low or too high can indicate problems such as malnutrition, obesity, or gestational diabetes, which are risk factors for high-risk pregnancy.

Choice E Reason: Prenatal care is a risk factor for high-risk pregnancy because it indicates that the woman has not received adequate medical attention and support during her pregnancy. Prenatal care is essential for ensuring the health and well-being of both the mother and the baby. Prenatal care involves regular visits to a health care provider who can monitor the progress of the pregnancy, screen for any complications or infections, provide education and counseling, and prescribe any necessary medications or interventions. Lack of prenatal care can increase the risk of maternal mortality, morbidity, preterm birth, low birth weight, congenital anomalies, and infant mortality.

Choice F Reason: Prenatal history is a risk factor for high-risk pregnancy because it indicates that the woman has had previous pregnancies that ended in miscarriage or stillbirth. Prenatal history can provide important information about the woman's reproductive health and potential complications that may recur or affect her current pregnancy. Previous pregnancy losses can indicate problems such as genetic abnormalities, chromosomal disorders, infections, immunological factors, hormonal imbalances, uterine abnormalities, or placental issues. These factors can increase the risk of spontaneous abortion, fetal demise, preterm birth, intrauterine growth restriction (IUGR), or placenta previa.