A nurse in a prenatal clinic is discussing the risks of twin to twin transfusion syndrome with an 18 week pregnant client with monochorionic-monoamniotic (mono-mono) twins.
Which of the following statements by the client shows an understanding of the education?
"My twins are at higher risk of twin to twin transfusion because they share a placenta.”.
"Twin to twin transfusion results in over perfusion to both babies causing circulatory overload and CHF.”.
"Twin to twin transfusion is very common in all multiple gestation pregnancies.”.
"My twins are at a lower risk for twin to twin transfusion because they share the placenta.”. .
The Correct Answer is A
Choice A rationale
Monochorionic-monoamniotic twins share a single placenta and amniotic sac, increasing the risk for twin to twin transfusion syndrome (TTTS). This condition occurs due to unbalanced blood flow through the shared placenta, leading to discrepancies in blood volume between the twins.
Choice B rationale
TTTS does not result in overperfusion to both babies. Instead, it causes one twin (the donor) to become underperfused, leading to anemia and growth restriction, while the other twin (the recipient) becomes overperfused, causing polycythemia and circulatory overload, which can lead to heart failure.
Choice C rationale
TTTS is not very common in all multiple gestation pregnancies; it primarily affects monochorionic twins. In dichorionic twins, each twin has its own placenta, making TTTS highly unlikely.
Choice D rationale
Monochorionic twins sharing a placenta actually increases their risk for TTTS, not lowers it. The shared placenta creates a scenario where blood vessels can cross and lead to uneven blood flow between the twins. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","F"]
Explanation
Choice A rationale:
Cerebral manifestations, such as headaches and dizziness, can be indicative of severe preeclampsia, a condition that requires immediate attention to prevent complications for both the mother and the fetus.
Choice B rationale:
The fetal heart rate of 155 bpm is within the normal range for a fetus at 36 weeks of gestation (110-160 bpm). Therefore, this finding is not necessarily abnormal or concerning, and does not need immediate reporting to the provider.
Choice C rationale:
Deep tendon reflexes (DTRs) of 3+ are slightly brisk, but the absence of clonus makes this finding less concerning for severe preeclampsia or eclampsia, so it does not need immediate reporting.
Choice D rationale:
Gastrointestinal assessment findings, such as right upper quadrant pain and persistent "heartburn," are concerning for possible HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a severe form of preeclampsia that requires immediate attention.
Choice E rationale:
The respiratory rate of 20/min is within normal limits for an adult (12-20 breaths per minute) and does not indicate an immediate concern that needs to be reported to the provider.
Choice F rationale:
The blood pressure of 156/90 mm Hg is elevated and indicative of hypertension, which is concerning for preeclampsia and requires immediate attention to prevent complications for the mother and fetus.
Correct Answer is ["B","D","E"]
Explanation
Choice A rationale
Oligohydramnios refers to a condition characterized by a deficiency in amniotic fluid. It is not a common risk factor for hyperemesis gravidarum, which is more related to hormonal changes and genetic predisposition.
Choice B rationale
Twin gestations significantly increase the levels of human chorionic gonadotropin (hCG), leading to a higher incidence of hyperemesis gravidarum. Elevated hCG levels correlate directly with the severity of nausea and vomiting in pregnancy.
Choice C rationale
Anemia does not have a direct causal relationship with hyperemesis gravidarum. Hyperemesis may contribute to the development of anemia due to nutritional deficiencies, but it is not a predisposing risk factor.
Choice D rationale
Molar pregnancy, a gestational trophoblastic disease, causes significantly elevated levels of hCG, leading to an increased likelihood of hyperemesis gravidarum. This condition triggers extreme nausea and vomiting due to excessively high hormone levels.
Choice E rationale
A history of hyperemesis in previous pregnancies strongly predicts recurrence in subsequent pregnancies. This suggests a genetic or environmental predisposition to severe nausea and vomiting.
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