Correct Answer: B

Rationale: The best approach to managing the patient with ascites who has responded to spironolactone with weight loss is to add a loop diuretic to the current regimen. Spironolactone is an aldosterone antagonist that primarily works on the distal convoluted tubule, while loop diuretics, such as furosemide, act on the thick ascending limb of the loop of Henle. Combining these two diuretics can result in a synergistic effect, increasing diuresis and reducing fluid retention in patients with ascites. This combination therapy is often used in patients who do not respond adequately to spironolactone alone, and it is considered a common strategy in the management of ascites due to cirrhosis.
Therefore, adding a loop diuretic to the spironolactone regimen is the most appropriate next step to optimize diuresis and fluid management in this patient.

Correct Answer: B

Rationale: Pulmonary embolism and varicosity are significant complications of deep venous thrombosis.

Correct Answer: B

Rationale: Corticosteroids accelerate fetal lung maturity to reduce the risk of respiratory distress syndrome.

Correct Answer: A

Rationale: Oligohydramnios can result from fetal kidney problems, leading to lack of urine production.

Correct Answer: B

Rationale: Monozygotic twins typically have a single chorion, not two.