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. .
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Correct Answer is C
Explanation
Choice A rationale
Aminoinfusion is a procedure where fluid is infused into the amniotic sac. It is used to treat certain complications during labor but is not related to treating an incompetent cervix.
Choice B rationale
Hysterectomy is a surgical procedure to remove the uterus and is not a treatment for an incompetent cervix. It is typically performed for conditions such as cancer, severe bleeding, or other significant uterine issues.
Choice C rationale
Cerclage is the correct term for the surgical procedure used to treat an incompetent cervix. It involves stitching the cervix closed to prevent premature dilation, which can lead to miscarriage or preterm birth.
Choice D rationale
Beta-adrenergic agonist therapy is used to delay preterm labor by relaxing the uterus but does not address the structural issue of an incompetent cervix. It is a medication-based approach rather than a surgical one. .
Correct Answer is D
Explanation
Choice A rationale
Prescribing insulin is premature based on a single elevated glucose test without further diagnostic confirmation through a 3-hour Glucose Tolerance Test.
Choice B rationale
Increasing carbohydrate intake is not recommended for managing elevated glucose levels in gestational diabetes.
Choice C rationale
No changes are recommended only if the GTT results are within the expected range. Further testing is required due to the elevated result.
Choice D rationale
A 3-hour Glucose Tolerance Test is needed to confirm gestational diabetes following an elevated 1-hour test result to ensure accurate diagnosis and appropriate management.
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