A 22-year-old woman visits the clinic requesting birth control. Her medical history includes dysmenorrhea, irregular menstrual cycles, and menorrhagia. She smokes half a pack of cigarettes daily and reports being sexually active with multiple partners. Which birth control method is most appropriate for this client?

A. "Depo-Provera."
Depo-Provera (medroxyprogesterone injection) is effective for contraception, but it may worsen menstrual irregularities and cause bone density loss with long-term use, making it less ideal.

B. "Contraceptive implant."
While progestin-only implants (e.g., Nexplanon) are effective, they do not protect against STIs. Additionally, irregular bleeding is a common side effect, which may not be ideal for someone with menorrhagia and irregular cycles.

C. "Combination oral contraceptives."
Estrogen-containing contraceptives (e.g., combined oral contraceptive pills) are contraindicated in women who smoke and are ≥35 years old due to the increased risk of venous thromboembolism (VTE). While this client is 22 years old, smoking still makes this option less preferable.

D. "Barrier methods such as female condoms."
Barrier methods reduce the risk of sexually transmitted infections (STIs), which is crucial for this client with multiple sexual partners. Additionally, they do not contain hormones, making them safer for smokers.

A. Observe an area of redness on the breast of a client who is 1 day postpartum.
Assessment is outside the scope of practice for an AP. The nurse must assess the redness, as it could indicate mastitis or engorgement requiring further evaluation.

B. Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.
Assisting with hygiene and comfort measures, such as a sitz bath, is within the AP’s scope of practice. The nurse should ensure that the client understands proper perineal care and has no contraindications.

C. Monitor vital signs during admission of a client who has gestational hypertension.
Clients with gestational hypertension require close monitoring, and initial admission assessments, including vital signs, must be performed by the nurse to identify signs of preeclampsia or worsening hypertension.

D. Change the initial perineal pad of a client who just transferred from labor and delivery.
The first perineal pad change is an assessment opportunity for the nurse, allowing them to evaluate bleeding amount, presence of clots, and signs of postpartum hemorrhage. The nurse should perform the initial assessment and pad change before delegating routine hygiene tasks to the AP.