Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?
a. A primigravida who is 17 years old
b. A 22-year-old multiparous client with ruptured membranes
c. A primigravida who has requested no analgesia during her labor
d. A multiparous client at 39 weeks of gestation who is expecting twins
ANS: D
Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this client's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.
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