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?

Choice A rationale

Combination oral contraceptives are contraindicated for smokers over 35 due to an increased risk of cardiovascular events such as thromboembolism and myocardial infarction. While the client is younger, her smoking habit is still a significant risk factor, and oral contraceptives do not protect against sexually transmitted infections given her multiple partners.

Choice B rationale

Depo-Provera, an injectable progestin, can cause irregular bleeding and potential weight gain, which might not be ideal given the client's existing irregular menstrual cycles and menorrhagia. Furthermore, it does not offer protection against sexually transmitted infections.

Choice C rationale

Barrier methods such as female condoms, when used consistently and correctly, provide protection against both pregnancy and sexually transmitted infections, which is crucial given the client's multiple partners. While they require proper education and may have a higher failure rate than hormonal methods, they address the STI risk directly.

Choice D rationale

A contraceptive implant is a highly effective long-acting reversible contraceptive. However, it does not protect against sexually transmitted infections. Given the client's multiple partners, STI protection is a primary concern that the implant does not address. .

Choice A rationale

Monitoring vital signs (blood pressure, heart rate, respiratory rate, temperature) is a crucial immediate intervention to assess the client's hemodynamic stability in the presence of vaginal bleeding. Bright red bleeding may indicate active bleeding that could compromise maternal and fetal well-being.

Choice B rationale

While oxygen administration might be considered if there are signs of fetal distress or maternal hypoxemia, applying oxygen at 10L via non-rebreather face mask is not the immediate first-line intervention for painless bright red vaginal bleeding at 32 weeks gestation without further assessment. The need for oxygen depends on the overall clinical picture.

Choice C rationale

A digital vaginal examination is contraindicated in the presence of unexplained vaginal bleeding in the third trimester, especially if placenta previa is suspected. Palpation of the placenta could cause severe hemorrhage. An ultrasound should be performed first to determine the cause of the bleeding.

Choice D rationale

Initiating intravenous (IV) Lactated Ringers for fluid replacement is an important immediate intervention to maintain intravascular volume and prevent hypovolemia, especially if the vaginal bleeding is significant. This helps to support maternal circulation and fetal perfusion.

Choice E rationale

While assessing for domestic violence is important for the overall well-being of the pregnant client, it is not an immediate intervention in the acute presentation of painless bright red vaginal bleeding at 32 weeks gestation. The immediate focus should be on assessing and managing the bleeding and maternal-fetal status.