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NCPD Connection

How NPs can eliminate practice barriers to intrauterine device use

Author Information
doi: 10.1097/01.NPR.0000831004.19061.96
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INSTRUCTIONS How NPs can eliminate practice barriers to intrauterine device use

TEST INSTRUCTIONS

  • Read the article. The test for this CE activity is to be taken online at www.nursingcenter.com/CE/NP. Tests can no longer be mailed or faxed.
  • You'll need to create (it's free!) and log in to your personal CE Planner account before taking online tests. Your planner will keep track of all your Lippincott Professional Development online CE activities for you.
  • There's only one correct answer for each question. A passing score for this test is 7 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost.
  • For questions, contact Lippincott Professional Development: 1-800-787-8985.
  • Registration deadline is March 7, 2025.

PROVIDER ACCREDITATION

Lippincott Professional Development will award 2.0 contact hours for this continuing nursing education activity and 0.5 pharmacology consult hour for this continuing nursing education activity.

Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, West Virginia, New Mexico, South Carolina, and Florida, CE Broker #50-1223. Your certificate is valid in all states.

Payment: The registration fee for this test is $21.95

How NPs can eliminate practice barriers to intrauterine device use

Learning Outcomes: Seventy-five percent of participants will be able to demonstrate an increase in knowledge for eliminating practice barriers to intrauterine device (IUD) use by achieving a posttest score of 70% or greater.

Learning Objectives: After reading the article and completing the posttest, the participant will be able to: 1. Recognize the risks, benefits, and contraceptive effectiveness of IUDs. 2. Identify common barriers associated with IUD use for women. 3. Select evidence-based best practice measures for safe IUD placement.

Posttest:

Questions #1 - 2 are knowledge-based questions.

  1. According to Diamond-Smith et al., the percentage of women who reported difficulties accessing reproductive healthcare because clinics were closed, shelter-in-place orders limited movement, and childcare/household responsibilities increased due to COVID-19 was approximately
    1. 5%.
    2. 50%.
    3. 70%.
  2. According to the CDC, which contraceptive method had the lowest rate of unintended pregnancy within the first year of use?
    1. injectable
    2. copper IUD
    3. combined oral contraceptives
    4. Questions #3 - #10 are based on the below Case Scenario.
      Case-Based Assessment: Placing yourself in the role of the NP, use the scenario below to apply knowledge and skills learned in the attached article.
      Case Scenario: AK is a healthy 22-year-old Gravida 2 Para 1011 female. Six weeks ago, she delivered a full-term baby boy by spontaneous vaginal delivery without complications. She states that she lives with her boyfriend and has been in a monogamous relationship with him for the past 2 years. Today she arrives at the clinic for her postpartum visit. You are the NP assigned to provide her care. Her electronic health records show no history of medical issues. In the past she had an unintended pregnancy and miscarried during the first trimester. AK states that she had a normal menstrual period 1 week ago. She reports having unprotected coitus one time prior to her menses onset. She does not desire another pregnancy for at least the next few years.
  3. You review efficacy of contraceptive methods with AK and explain that long-acting reversible contraceptive (LARC) options have the lowest rates of unintended pregnancy. You provide her with some examples of LARC methods, which include
    1. subcutaneous implants and IUDs.
    2. vaginal rings and topical patches.
    3. spermicide and male condoms.
  4. When you mention IUD use, AK voices concern that this may impact her fertility in the future. You explain that it has been found in a literature review of 22 studies that after discontinuing IUD use, pregnancy rates were
    1. similar to rates for women who used other contraceptive methods.
    2. lower than rates for women who used other contraceptive methods.
    3. higher than rates for women who used other contraceptive methods.
  5. After further discussion, AK states that she is interested in having an IUD for contraception but is concerned since she delivered her baby 6 weeks ago that the IUD could fall out of her uterus. You explain that the highest rate of IUD expulsion occurs
    1. within the first 10 minutes of placental delivery.
    2. between 10 minutes after placental delivery and 4 weeks postpartum.
    3. after 4 weeks postpartum.
  6. AK is interested in having an IUD insertion today. Prior to performing the IUD insertion, it is imperative to
    1. rule out pregnancy.
    2. screen for a urinary tract infection.
    3. diagnose and treat asymptomatic sexually transmitted infections (STIs).
  7. Prior to IUD insertion, you perform a speculum and bimanual exam, which yields normal findings. You explain that you will be taking samples for STI testing. You state that if you had found any abnormal cervical discharge or cervical motion tenderness, you would have
    1. initiated presumptive treatment for chlamydia and gonorrhea after the IUD insertion.
    2. diagnosed the infection and postponed IUD insertion until 3 months after successful treatment.
    3. avoided IUD insertion for at least 6 months after presumptively treating for STI infections.
  8. You discuss various types of IUDs to determine AK's preferred choice. AK asks if there is an IUD that will help reduce her heavy menstrual periods with cramps. You explain that
    1. all available IUDs usually cause an increase in menstrual bleeding and cramping.
    2. the copper-IUD has received an FDA indication for treating dysmenorrhea and menorrhagia.
    3. there is one levonorgestrel-releasing-IUD that received an FDA indication for treating heavy menstrual bleeding.
  9. AK asks about the risk of her experiencing an infection after having an IUD placement. You explain it is rare to have any infection within the first 2 years. However, if infection occurs, it can be treated with antibiotics and
    1. often the IUD can remain in place.
    2. it will be necessary to immediately remove the IUD and use a different contraceptive method.
    3. the IUD will be removed, and a different IUD type or brand can be inserted the same day.
  10. AK states that her mother is concerned that she would experience an ectopic pregnancy with IUD use. You explain that women using an IUD have been found to
    1. experience frequent ectopic pregnancies.
    2. have a lower risk of ectopic pregnancy as compared with women not using an IUD.
    3. have a slightly increased risk of experiencing an ectopic pregnancy.
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