The nurse is making patient assignments for the next shift. Which ...

[jake]

The nurse is making patient assignments for the next shift. Which patient is most likely to experience a complicated labor pattern?
 
  1. 34-year-old gravida 6 at 39 weeks' gestation with twins
  2. 22-year-old gravida 1 at 23 weeks' gestation with ruptured membranes
  3. 30-year-old gravida 3 at 41 weeks' gestation and estimated fetal weight 7 pounds 8 ounces
  4. 43-year-old gravida 2 at 37 weeks' gestation with hypertension

Question 2

The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the client asks for another. What is the best response from the nurse?
 
  1. I'll get you one right away.
  2. You only need to use one ice pack.
  3. You need to leave it off for at least 20 minutes and then reapply.
  4. I'll bring you an extra so that you can change it when you are ready.

[gasdhashg]

Answer to Question 1

1
Rationale 1: Twins at term will cause overdistention of the uterus, putting the patient at risk for development of a hypotonic labor pattern. Her high parity also increases the risk for a hypotonic labor pattern.
Rationale 2: Although this patient is high-risk, especially for infection, neonatal lung immaturity, and respiratory distress syndrome, she has no risk factors for an abnormal labor pattern.
Rationale 3: This patient has an average-sized fetus and no risk factors for either hypertonic or hypotonic labor pattern.
Rationale 4: Hypertension does not impact labor pattern; this patient has no risk factors for either hypertonic or hypotonic labor pattern.

Answer to Question 2

3
Explanation: 3. For optimal effect, the ice pack should be applied for 20 to 30 minutes and removed for at least 20 minutes before being reapplied.