A 25-year-old woman reports to her health care provider's office with reports of having been sexually assaulted by an acquaintance 4 days ago. The woman is concerned about pregnancy. What action is indicated by the nurse?
1. Advise the woman that the administration of emergency contraception is only used in the first 72 hours after the attack.
2. Determine any potential allergies to the components of the emergency contraception pills.
3. Assess the woman's financial resources to obtain the emergency contraception preparation.
4. Inform the woman she likely is already pregnant and will not benefit from the medication.
Advise the woman that the administration of emergency contraception is only used in the first 72 hours after the attack.
Rationale: Emergency contraception is provided in the first 72 hours after a sexual assault; the client has passed the window of eligibility. There is no need to assess for allergies or financial resources to obtain the medication. Advising the woman she is already pregnant may not be correct. In addition, the nurse is working beyond her scope of practice if she offers this medical counseling.
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