PRAC 6552 FINAL EXAM PREP ADVANCED NURSE PRACTICE IN REPRODUCTIVE HEALTH CARE PRACTICUM AN, Exams of Nursing

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PRAC 65 52 FINAL EXAM PREP

Advanced Nurse Practice in

Reproductive Health Care Practicum

ANSWERED

2023/

1. What are the benefits and challenges of providing family planning services in primary care settings? Provide at least three examples of each and explain how they affect the quality of care and patient outcomes. Answer: Some benefits of providing family planning services in primary care settings are:

• Increased access and convenience for patients who may not have other sources of reproductive health care or who prefer to receive these services from their primary care provider.
• Improved continuity and coordination of care for patients who have multiple health needs or chronic conditions that may affect their reproductive choices or outcomes.
• Enhanced prevention and early detection of reproductive health problems, such as sexually transmitted infections, cervical cancer, or unintended pregnancy, through routine screening and counseling. Some challenges of providing family planning services in primary care settings are:
• Limited time and resources to address the complex and diverse needs of patients who seek reproductive health care, especially in busy or understaffed clinics.
• Lack of training and expertise in some aspects of reproductive health care, such as contraceptive methods, abortion care, or infertility treatment, among some primary care providers or staff.
• Potential barriers to patient confidentiality and autonomy, such as parental consent laws, insurance coverage, or religious or cultural beliefs, that may limit the availability or acceptability of some reproductive health services.

2. How would you assess the reproductive health needs and preferences of a transgender patient who is seeking hormone therapy? What are some key considerations and best practices for providing culturally competent and inclusive care to this population? Answer: To assess the reproductive health needs and preferences of a transgender patient who is seeking hormone therapy, I would:

• Use respectful and affirming language and pronouns that match the patient's gender identity and expression, and ask the patient how they prefer to be addressed and referred to.
• Ask the patient about their reproductive goals and desires, such as whether they want to preserve their fertility, have children in the future, or avoid pregnancy.
• Review the patient's medical history and current medications, including any previous or current use of hormones or other substances that may affect their reproductive health.
• Perform a comprehensive physical examination, including a genital exam if indicated and consented by the patient, to evaluate their anatomy, function, and potential risks or complications of hormone therapy.
• Discuss the benefits, risks, side effects, and alternatives of hormone therapy, as well as the impact of hormone therapy on their reproductive health and options, such as contraception, pregnancy, abortion, sterilization, or assisted reproduction.
• Provide information and referrals to other resources or specialists that may be relevant or helpful for the patient's reproductive health care, such as mental health providers, endocrinologists, gynecologists, urologists, or fertility clinics. Some key considerations and best practices for providing culturally competent and inclusive care to transgender patients are:

• Recognize the diversity and variability of transgender identities and experiences, and avoid making assumptions or generalizations based on the patient's appearance, name, voice, or documents.
• Respect the patient's autonomy and decision-making regarding their gender identity and expression, as well as their reproductive health choices and goals.
• Educate yourself and your staff on the specific needs and challenges of transgender patients, such as discrimination, stigma, violence, harassment, or lack of access to quality care.
• Create a welcoming and safe environment for transgender patients in your clinic, such as by displaying inclusive signs or posters, using gender-neutral bathrooms or forms, or offering options for gender identity and pronouns on registration or intake.

3. What are some common causes and symptoms of pelvic inflammatory disease (PID)? How would you diagnose and treat a patient who presents with suspected PID? What are some possible complications and long-term consequences of untreated or recurrent PID? Answer: Some common causes of pelvic inflammatory disease (PID) are:

• Bacterial infections that ascend from the lower genital tract to the upper genital tract, such as chlamydia or gonorrhea.
• Other factors that increase the risk of infection or inflammation in the pelvic organs, such as intrauterine devices (IUDs), sexual intercourse with multiple partners, douching, or pelvic surgery. Some common symptoms of pelvic inflammatory disease (PID) are:
• Lower abdominal pain or tenderness
• Fever
• Abnormal vaginal discharge
• Bleeding between periods
• Pain during sex
• Nausea or vomiting To diagnose a patient who presents with suspected PID, I would:
• Take a detailed history of the patient's sexual activity, contraceptive use, menstrual cycle, and previous infections or treatments.
• Perform a pelvic exam to check for signs of infection or inflammation, such as cervical motion tenderness, uterine tenderness, or adnexal tenderness or masses.
• Collect samples for laboratory tests, such as urine, vaginal swabs, or blood

1. What are the indications, contraindications, benefits and risks of long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and implants? How would you counsel a patient who is interested in using a LARC method?

• Indications: LARCs are suitable for most women who want to prevent pregnancy, regardless of age, parity, or medical history. They are especially recommended for women who have difficulty adhering to other methods, have a high risk of unintended pregnancy, or prefer a highly effective and convenient method.
• Contraindications: LARCs are contraindicated in women who have current or recent pelvic inflammatory disease (PID), endometritis, septic abortion, or cervical cancer; have a distorted uterine cavity or an unexplained vaginal bleeding; have a known or suspected pregnancy; have a current breast cancer; or have a hypersensitivity or allergy to the device or its components.
• Benefits: LARCs are the most effective reversible contraceptive methods, with failure rates of less than 1% per year. They are also cost-effective in the long term, require minimal user involvement, have a rapid return to fertility after removal, and may have non-contraceptive benefits such as reducing menstrual bleeding and dysmenorrhea (for hormonal IUDs) or protecting against endometrial cancer (for copper IUDs).
• Risks: LARCs have some potential risks and side effects, such as pain, bleeding, infection, expulsion, perforation, ectopic pregnancy, or hormonal changes (for hormonal IUDs and implants). However, these are rare and usually mild or manageable. Most women are satisfied with their LARC method and continue using it for several years.
• Counseling: A patient who is interested in using a LARC method should be provided with accurate and balanced information about the indications, contraindications, benefits and risks of each option. The patient should be encouraged to ask questions and express their preferences and concerns. The patient should be informed about the insertion and removal procedures, the possible need for backup contraception during the first week of use, the expected changes in their menstrual patterns, and the signs and symptoms of complications that require prompt medical attention. The patient should be reassured that LARCs do not affect their future fertility or increase their risk of infertility or STDs. The patient should be advised to use condoms or other barrier methods to prevent STDs if they have multiple or casual partners. The patient should be supported to make an informed and voluntary decision that suits their needs and values.

2. What are the components of a comprehensive sexual history taking for a patient who presents with a reproductive health concern? What are some strategies to facilitate a respectful and non-judgmental communication with the patient?

• Components: A comprehensive sexual history taking should include the following components:
  • Demographic information: age, gender identity, sexual orientation, relationship status, education level, occupation, etc.
  • Reproductive goals: current contraceptive use, pregnancy history and plans, abortion history and attitudes, etc.
  • Sexual behaviors: number and type of sexual partners (current and past), frequency and type of sexual activities (vaginal, oral, anal, etc.), use of condoms or other barrier methods, etc.
  • Sexual health: history of STDs (including HIV) and their treatment outcomes, current symptoms or signs of STDs (such as discharge, ulcers, warts, etc.), history of sexual abuse or violence, etc.
  • Sexual function: satisfaction with sexual life, presence of any sexual problems (such as pain, dryness, difficulty with arousal or orgasm, etc.), use of any medications or substances that may affect sexual function, etc.
  • Sexual attitudes and beliefs: values and norms regarding sexuality and reproduction, sources of information and education about sexuality and reproduction, etc.
• Strategies: Some strategies to facilitate a respectful and non-judgmental communication with the patient are:
  • Explain the purpose and importance of taking a sexual history for addressing their reproductive health

concern and obtaining their consent before proceeding.

• Use a patient-centered approach that respects their autonomy, privacy, confidentiality