A nurse in the prenatal clinic is monitoring a client who is pregnant with twins. The nurse monitors the client closely for which priority complication that is associated with a twin pregnancy?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

A twin pregnancy places a significantly higher demand on the mother for essential nutrients like iron and folate to support the growth of two fetuses.
The maternal plasma volume expands more dramatically in a twin pregnancy (hemodilution), which can lead to a physiological drop in hemoglobin concentration.
Due to these factors, iron-deficiency anemia is a very common and high-priority complication that requires close monitoring and management.
Untreated maternal anemia increases the risk for poor fetal growth, preterm birth, and maternal complications such as postpartum hemorrhage and infection.

Option A: Haemorrhoids are common discomforts in many pregnancies due to increased pelvic pressure and constipation. While they can be bothersome, they are not considered a high-priority medical complication that threatens maternal or fetal life.
Option B: This is factually incorrect. The overdistension of the uterus from carrying two fetuses is a major risk factor for preterm labor (labor before 37 weeks), not post-term labor (labor after 42 weeks).
Option D: While the risk of gestational diabetes is higher in twin pregnancies due to a larger placental mass producing more insulin-antagonizing hormones, maternal anemia is a more direct and universal physiological consequence that requires proactive monitoring from the start.

Clinical Relevance

Nursing practice connection: Use the key finding related to Priority complications in multiple gestation to guide bedside assessment, documentation, and the next nursing action.
Nurses play a crucial role in preventing and managing maternal anemia in twin pregnancies by ensuring adherence to iron and folate supplementation, monitoring lab values (Hb/Hct), and providing comprehensive dietary education.
Early detection and treatment of anemia are vital to prevent adverse outcomes such as intrauterine growth restriction (IUGR), preterm birth, and increased maternal morbidity from postpartum hemorrhage.
What if? If the client's hemoglobin drops to 9 g/dL despite oral iron supplements, the nurse should anticipate an order for intravenous (IV) iron infusion. This indicates severe anemia that may not be correctable with oral supplements alone before delivery, posing significant risks to both mother and fetuses.

How to Approach the Question

First, identify the key elements of the question: the patient is pregnant with twins, and the nurse is looking for the 'priority' complication.
Analyze each option based on the known pathophysiology of a multiple gestation pregnancy.
Eliminate 'Post-term labor' immediately, as twin pregnancies are a classic risk factor for the opposite condition: preterm labor.
Categorize 'Haemorrhoids' as a common discomfort rather than a high-priority medical complication that threatens maternal-fetal well-being.
Compare the remaining two options: 'Maternal anemia' and 'Gestational diabetes'. Both are valid risks.
Reason that the physiological demands of two fetuses (increased iron/folate needs) and greater hemodilution make anemia a more direct, common, and fundamental complication to monitor as a priority in all twin pregnancies.

Concept Tested & Keywords

Concept Tested: Priority complications in multiple gestation
Stem keywords: twin pregnancy, prenatal clinic, priority complication
Lead-in keywords: priority
Clinical cues: The presence of a twin pregnancy is the key clinical cue, as it significantly increases the risk for specific complications compared to a singleton pregnancy.
Negative lead-in flag: false

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 61-75, 58-72

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.