HESI: Ectopic Pregnancy and Rationale Questions
and Verified Answers
The client has no significant medical history and no obstetric history. She states that she has some
vaginal bleeding, but she thinks it is her menses. Her surgical history includes tubes in her ears at 3 years
old. She is a social drinker but does not smoke tobacco or use illicit drugs. One parent has hypertension,
and the other had gallbladder disease, but the rest of her family has a benign medical history. Correct
Answer: The client presents to the Emergency Department (ED) at 0615. She reports that she was
awakened in the middle of the night with serious pain in her lower right abdomen accompanied by
nausea and an episode of vomiting. Admission assessment by the nurse reveals the following:
temperature 98.4° F (36.9° C), heart rate 80 beats/minute, respirations 20 breaths/minute, blood pressure
126/68 mmHg, pain 9/10 on the pain scale, and her last menstrual period (LMP) was about a month ago.
Her heart rate is regular, and lung auscultation reveals good air entry bilaterally with no adventitious
sounds. Palpation of the abdomen elicits pain in the right lower quadrant. The client's spouse is at her
bedside.
1.
What diagnostic tests does the nurse anticipate the healthcare provider (HCP) will request after
considering the client's history and symptoms? (Select all that apply. One, some or all responses may be
correct.)
-Serum quantitative β-hCG level.
-Transvaginal ultrasound.
-Complete Blood Count (CBC).
-Progesterone serum level.
-Abdominal x-ray and CT scan.
-Assess client for Cullen sign. Correct Answer: -Serum quantitative β-hCG level.
(The most important screening tools for ectopic pregnancy are quantitative β-hCG levels and
transvaginal ultrasound examinations. When β-hCG levels are greater than 1500 to 2000 milli-
International Units/mL, for example, a normal intrauterine pregnancy should be visible on transvaginal
ultrasound. Therefore, if β-hCG levels are greater than 1,500 mIU/mL (1,500 IU/L) but no intrauterine
pregnancy is seen on transvaginal ultrasound, an ectopic pregnancy is very likely. β-hCG levels will
probably be redrawn every 48 hours to determine if the pregnancy is viable.)
, -Transvaginal ultrasound.
(The term discriminatory zone addresses the concept that there is a β-hCG level above which a normal
intrauterine pregnancy should be visible on ultrasound. If β-hCG levels are greater than 1,500 mIU/mL
(1,500 IU/L) but no intrauterine pregnancy is seen on transvaginal ultrasound, an ectopic pregnancy is
very likely.)
-Complete Blood Count (CBC).
(An increased white blood cell (WBC) count can indicate an infection. Hemoglobin (Hgb) and
hematocrit (Hct) may indicate loss of blood.)
-Progesterone serum level.
(A progesterone level greater than 25 ng/mL (79.5 nmol/L) almost always rules out the presence of an
ectopic pregnancy. However, a progesterone level less than 5 ng/mL (15.9 nmol/L) suggests either an
ectopic pregnancy or an abnormal intrauterine pregnancy.)
-Assess client for Cullen sign.
(An ecchymotic blueness around the umbilicus (Cullen sign), indicating hematoperitoneum (blood in the
peritoneal cavity), may also develop in an undiagnosed ruptured intraabdominal ectopic pregnancy.)
2.
The client's hCG level is 2,550 mU/mL and positive for pregnancy. Progesterone level is 4 ng/mL (12.72
nmol/L). The client is negative for Cullen Sign. No intrauterine pregnancy is seen on transvaginal
ultrasound. The client states her last menstrual period was about a month ago.
Based on the provided results, the nurse can infer which of the following?
-The client has a urinary tract infection and is pregnant.
-The client has appendicitis and may require surgery.
-The client is pregnant but no fetal sac noted in uterus.
-The client's vaginal bleeding indicates she is menstruating. Correct Answer: -The client is pregnant but
no fetal sac noted in uterus.
and Verified Answers
The client has no significant medical history and no obstetric history. She states that she has some
vaginal bleeding, but she thinks it is her menses. Her surgical history includes tubes in her ears at 3 years
old. She is a social drinker but does not smoke tobacco or use illicit drugs. One parent has hypertension,
and the other had gallbladder disease, but the rest of her family has a benign medical history. Correct
Answer: The client presents to the Emergency Department (ED) at 0615. She reports that she was
awakened in the middle of the night with serious pain in her lower right abdomen accompanied by
nausea and an episode of vomiting. Admission assessment by the nurse reveals the following:
temperature 98.4° F (36.9° C), heart rate 80 beats/minute, respirations 20 breaths/minute, blood pressure
126/68 mmHg, pain 9/10 on the pain scale, and her last menstrual period (LMP) was about a month ago.
Her heart rate is regular, and lung auscultation reveals good air entry bilaterally with no adventitious
sounds. Palpation of the abdomen elicits pain in the right lower quadrant. The client's spouse is at her
bedside.
1.
What diagnostic tests does the nurse anticipate the healthcare provider (HCP) will request after
considering the client's history and symptoms? (Select all that apply. One, some or all responses may be
correct.)
-Serum quantitative β-hCG level.
-Transvaginal ultrasound.
-Complete Blood Count (CBC).
-Progesterone serum level.
-Abdominal x-ray and CT scan.
-Assess client for Cullen sign. Correct Answer: -Serum quantitative β-hCG level.
(The most important screening tools for ectopic pregnancy are quantitative β-hCG levels and
transvaginal ultrasound examinations. When β-hCG levels are greater than 1500 to 2000 milli-
International Units/mL, for example, a normal intrauterine pregnancy should be visible on transvaginal
ultrasound. Therefore, if β-hCG levels are greater than 1,500 mIU/mL (1,500 IU/L) but no intrauterine
pregnancy is seen on transvaginal ultrasound, an ectopic pregnancy is very likely. β-hCG levels will
probably be redrawn every 48 hours to determine if the pregnancy is viable.)
, -Transvaginal ultrasound.
(The term discriminatory zone addresses the concept that there is a β-hCG level above which a normal
intrauterine pregnancy should be visible on ultrasound. If β-hCG levels are greater than 1,500 mIU/mL
(1,500 IU/L) but no intrauterine pregnancy is seen on transvaginal ultrasound, an ectopic pregnancy is
very likely.)
-Complete Blood Count (CBC).
(An increased white blood cell (WBC) count can indicate an infection. Hemoglobin (Hgb) and
hematocrit (Hct) may indicate loss of blood.)
-Progesterone serum level.
(A progesterone level greater than 25 ng/mL (79.5 nmol/L) almost always rules out the presence of an
ectopic pregnancy. However, a progesterone level less than 5 ng/mL (15.9 nmol/L) suggests either an
ectopic pregnancy or an abnormal intrauterine pregnancy.)
-Assess client for Cullen sign.
(An ecchymotic blueness around the umbilicus (Cullen sign), indicating hematoperitoneum (blood in the
peritoneal cavity), may also develop in an undiagnosed ruptured intraabdominal ectopic pregnancy.)
2.
The client's hCG level is 2,550 mU/mL and positive for pregnancy. Progesterone level is 4 ng/mL (12.72
nmol/L). The client is negative for Cullen Sign. No intrauterine pregnancy is seen on transvaginal
ultrasound. The client states her last menstrual period was about a month ago.
Based on the provided results, the nurse can infer which of the following?
-The client has a urinary tract infection and is pregnant.
-The client has appendicitis and may require surgery.
-The client is pregnant but no fetal sac noted in uterus.
-The client's vaginal bleeding indicates she is menstruating. Correct Answer: -The client is pregnant but
no fetal sac noted in uterus.
