A nurse is collecting data from a client who is at 18 weeks of gestation and tells the nurse that she felt light flutering in her stomach the previous day. The nurse should use which of the following terms to document this finding?

The nurse should expect the client to have pelvic pain, as this is the most common symptom of an ectopic pregnancy, which occurs when the fertilized ovum implants outside the uterine cavity, usually in the fallopian tube. Pelvic pain can range from mild to severe, and can be unilateral or bilateral, depending on the location and extent of the ectopic pregnancy. Pelvic pain can be caused by tubal distension, rupture, or bleeding.

The other findings are not typical of an ectopic pregnancy and may indicate other conditions.

1. Severe nausea and vomiting are not common signs of an ectopic pregnancy, but they may occur in any pregnancy due to hormonal changes or other factors. Severe nausea and vomiting may also indicate hyperemesis gravidarum, which is a condition where nausea and vomiting are so severe that they cause dehydration, electrolyte imbalance, and weight loss.
2. Copious vaginal bleeding is not a usual sign of an ectopic pregnancy, but it may occur if the ectopic pregnancy ruptures and causes hemorrhage. However, copious vaginal bleeding may also indicate other complications such as placenta previa, placental abruption, or spontaneous abortion.
3. Uterine enlargement greater than expected for gestational age is not a sign of an ectopic pregnancy, but it may indicate a multiple gestation, hydatidiform mole, polyhydramnios, or a large fetus. An ectopic pregnancy usually causes uterine enlargement less than expected for gestational age, as the uterus does not contain a viable pregnancy.

The nurse's first action should be to massage the client's fundus, as this can help stimulate uterine contraction and prevent hemorrhage. The fundus is the upper part of the uterus that contracts and involutes after delivery to compress the blood vessels and stop bleeding. The nurse should palpate the fundus for firmness, height, and position, and massage it gently if it is boggy or displaced.

The other actions are not the first priority and may be done after massaging the fundus.

The nurse should observe for the pooling of blood under the buttocks, as this can indicate a large amount of blood loss that may not be visible on the perineal pad. However, this is not the first action to take, as it does not address the cause of the bleeding or stop it from continuing.

The nurse should assess the client's blood pressure, as this can indicate the severity of blood loss and the presence of shock. However, blood pressure may not change significantly until a large amount of blood is lost, and it is not specific to the cause of bleeding. Therefore, blood pressure is not the first action to take.

The nurse should prepare to administer a prescribed oxytocic preparation, such as oxytocin or methylergonovine, as this can enhance uterine contraction and reduce bleeding. However, this requires a provider's order and may take time to obtain and administer. Therefore, an oxytocic preparation is not the first action to take.