امرأة حامل ٧ أسابيع عندها ألم حاد بجهة واحدة من البطن وألم بالكتف، وضغطها ٨٦/٥٠. الصورة توضح الحالة. ما الإجراء الأولوية؟

A client 7 weeks pregnant has sharp one-sided abdominal pain, shoulder pain and BP 86/50. The image shows her condition. What is the priority?

1. Give methotrexate and follow up in clinic
2. Repeat hCG in 48 hours
3. Apply a warm pack to the abdomen
4. Prepare for emergency surgery with fluid resuscitation

Answer: D) Prepare for emergency surgery with fluid resuscitation. Shoulder pain with hypotension means a ruptured ectopic with internal bleeding, a surgical emergency. Methotrexate is only for stable clients.