What findings may indicate a ruptured ectopic pregnancy when assessing the client?

A finding of shoulder pain in the context of a ruptured ectopic pregnancy is indicative of referred pain due to diaphragmatic irritation. When an ectopic pregnancy ruptures, it can lead to blood accumulation in the abdominal cavity, which can irritate the diaphragm. This irritation stimulates the phrenic nerve, which refers pain to the shoulder area, specifically the tip of the shoulder. This phenomenon is known as Kehr's sign and is a classic symptom that can indicate internal bleeding related to ectopic pregnancy.

While other symptoms such as hypotension (low blood pressure), tachycardia (increased pulse rate), and distended neck veins may also suggest significant blood loss or hemorrhaging, shoulder pain is more specifically linked to the ectopic pregnancy's complications and points to the pathophysiology involved with diaphragmatic irritation. Therefore, shoulder pain stands out as a specific indicator of potential ruptured ectopic pregnancy in the clinical assessment.