Question 1

RESPIRATORY SYSTEM CHANGES TO REPORT TO PROVIDER

Accepted Answer

Severe or sudden dyspnea 
 SpO₂ < 95% 
Chest pain with breathing
 Hemoptysis (coughing blood)

Question 2

BLOOD PRESSURE: 1ST TRIMESTER

Accepted Answer

At pre-pregnancy levels

Question 3

BLOOD PRESSURE: 2ND TRIMESTER

Accepted Answer

Slightly low

Question 4

BLOOD PRESSURE: 3RD TRIMESTER

Accepted Answer

Returns to pre-pregnancy levels

Question 5

PULSE: 1ST TRIMESTER

Accepted Answer

Baseline

Question 6

PULSE: 2ND TRIMESTER

Accepted Answer

+10-15 bpm

Question 7

PULSE: 3RD TRIMESTER

Accepted Answer

+10-14 bpm

Question 8

BLOOD VOLUME: 1ST TRIMESTER

Accepted Answer

Begins rising

Question 9

BLOOD VOLUME: 2ND TRIMESTER

Accepted Answer

Increases 40-50% above baseline

Question 10

BLOOD VOLUME: 3RD TRIMESTER

Accepted Answer

Peak ~1500 mL above baseline

Question 11

CARDIAC OUTPUT: 1ST TRIMESTER

Accepted Answer

increase begins

Question 12

CARDIAC OUTPUT: 2ND TRIMESTER

Accepted Answer

increase 30-50%

Question 13

CARDIAC OUTPUT: 3RD TRIMESTER

Accepted Answer

increases 30-50%

Question 14

RBC ↑  30%; total blood volume ↑  40–45% → physiological
anemia (H/H ↓ )

Accepted Answer

expected

Question 15

Large amounts of gluocse in urine

Accepted Answer

We are concenred for gas diabetes... more than 300

Question 16

T OR F: Can women in pregnancies than asymptomatic UTIs?

Accepted Answer

TRUE

Question 17

T OR F: Glycosuria: small glucose in urine can be NORMAL in pregnancy due to ↑  GFR — does NOT always mean GDM 
P

Accepted Answer

TRUE

Question 18

Proteinuria > 300 mg/24 hrs ... abnormal or not?

Accepted Answer

ABNORMAL after 20 weeks — evaluate for preeclampsia

Question 19

Asymptomatic bacteriuria > 100k ...abnormal or not?

Accepted Answer

must be treated...can progress to pyelonephritis; screen at first prenatal visit

Question 20

T OR F Are pregnant women more at risk for falls?

Accepted Answer

TRUE

Question 21

Constipation teaching

Accepted Answer

Increase fiber

Question 22

Back pain teaching

Accepted Answer

Back belt

Question 23

Heartburn teaching

Accepted Answer

Avoid spicy food/ elevate head of bed

Question 24

Leg cramp teaching

Accepted Answer

Increase calcium.
Unilateral pain/swelling? It's DVT

Question 25

Recommended weight gain?

Accepted Answer

28-40lbs for underweight 
25-35lbs for healthy patients
15-25 lbs for overweight
11-20 lbs for obese

Question 26

Key Nutrients to Increase

Accepted Answer

Folic acid — 400 mcg/day preconception through 1st trimester; prevents neural tube defects 
 Iron — supports ↑  maternal RBC production; best absorbed with

Question 27

Key Nutrients to Increase

Accepted Answer

Vitamin C (orange juice) 
Calcium — fetal bone development; prevents maternal bone until steaming),
Protein — supports fetal, uterine, and placental development

Question 28

Avoid / Limit

Accepted Answer

Alcohol — NONE; causes fetal alcohol syndrome 

High-mercury fish: swordfish, shark, king mackerel, tilefish 

Listeria risk: soft cheeses, unpasteurized milk, deli meats (heat until steaming), raw sprouts 

Caffeine — limit to < 200 mg/day

Question 29

Common Discomforts — 1st & 2nd Trimester

Accepted Answer

Fatigue — Rest frequently; pace activities; iron-rich foods if anemic

Nausea & Vomiting — Small frequent meals, bland foods, ginger, vitamin B6; avoid triggers

Breast Tenderness — Supportive bra; avoid caffeine

Question 30

Common Discomforts — 1st & 2nd Trimester

Accepted Answer

Urinary Frequency — Kegel exercises; do NOT restrict fluids; void before sleep
Nasal Congestion/Nosebleeds — Saline spray, humidifier; apply direct pressure for nosebleeds

Question 31

Common Discomforts — 1st & 2nd Trimester

Accepted Answer

Lightheadedness — Change positions slowly; adequate hydration; avoid prolonged standing

Question 32

Hyperemesis Gravidarum — When Does Nausea Become a Problem?

Accepted Answer

Persistent vomiting + weight loss > 5% of pre-pregnancy weight + ketonuria + dehydration = HG → IV fluids, antiemetics, possible hospitalization

Question 33

Common Discomforts — 3rd Trimester & Physical Activity

Accepted Answer

Heartburn/GERD — Small meals, avoid fatty/spicy; don't eat 3 hrs before bed; elevate HOB

Constipation — ↑  fiber + fluids + light exercise; stool softeners if needed

Braxton Hicks — Hydration, ambulation, or rest; do NOT confuse with true labor

Question 34

Physical Activity During Pregnancy

Accepted Answer

mproves muscle tone, shortens labor, reduces back pain, improves mood, reduces GDM risk Guidelines: 150 min/week moderate activity; maintain adequate hydration and caloric intake; supine position after 1st trimester, and high-altitude activities

Question 35

Headaches + vision changes? Normal or abnormal?

Accepted Answer

ABNORMAL

Question 36

Braxton Hicks contractions

Accepted Answer

tightening of uterus
CERVICAL CHANGE? PAINFUL? RADIATING?... LABOR NOT CONTRACTIONS!

Question 37

REPORT TO PROVIDER:

Accepted Answer

Sudden facial, hand, or generalized edema
Severe headache after 20 wks (possible preeclampsia)
Persistent vomiting + weight loss > 5% (hyperemesis)

Question 38

REPORT TO PROVIDER:

Accepted Answer

Sudden severe dyspnea or chest pain (possible PE)
Regular contractions before 37 wks — preterm labor
Flashing lights, blind spots, double vision — preeclampsia

Question 39

REPORT TO PROVIDER:

Accepted Answer

Rupture of membranes, bloody show, foul-smelling discharge
Decreased or absent fetal movement — requires NST

Question 40

Is a dula a provider?

Accepted Answer

No. It's someone who provides emotional and information support. NO MEDICAL DECISION MAKING.

Question	Answer
RESPIRATORY SYSTEM CHANGES TO REPORT TO PROVIDER	Severe or sudden dyspnea SpO₂ < 95% Chest pain with breathing Hemoptysis (coughing blood)
BLOOD PRESSURE: 1ST TRIMESTER	At pre-pregnancy levels
BLOOD PRESSURE: 2ND TRIMESTER	Slightly low
BLOOD PRESSURE: 3RD TRIMESTER	Returns to pre-pregnancy levels
PULSE: 1ST TRIMESTER	Baseline
PULSE: 2ND TRIMESTER	+10-15 bpm
PULSE: 3RD TRIMESTER	+10-14 bpm
BLOOD VOLUME: 1ST TRIMESTER	Begins rising
BLOOD VOLUME: 2ND TRIMESTER	Increases 40-50% above baseline
BLOOD VOLUME: 3RD TRIMESTER	Peak ~1500 mL above baseline
CARDIAC OUTPUT: 1ST TRIMESTER	increase begins
CARDIAC OUTPUT: 2ND TRIMESTER	increase 30-50%
CARDIAC OUTPUT: 3RD TRIMESTER	increases 30-50%
RBC ↑ 30%; total blood volume ↑ 40–45% → physiological anemia (H/H ↓ )	expected
Large amounts of gluocse in urine	We are concenred for gas diabetes... more than 300
T OR F: Can women in pregnancies than asymptomatic UTIs?	TRUE
T OR F: Glycosuria: small glucose in urine can be NORMAL in pregnancy due to ↑ GFR — does NOT always mean GDM P	TRUE
Proteinuria > 300 mg/24 hrs ... abnormal or not?	ABNORMAL after 20 weeks — evaluate for preeclampsia
Asymptomatic bacteriuria > 100k ...abnormal or not?	must be treated...can progress to pyelonephritis; screen at first prenatal visit
T OR F Are pregnant women more at risk for falls?	TRUE
Constipation teaching	Increase fiber
Back pain teaching	Back belt
Heartburn teaching	Avoid spicy food/ elevate head of bed
Leg cramp teaching	Increase calcium. Unilateral pain/swelling? It's DVT
Recommended weight gain?	28-40lbs for underweight 25-35lbs for healthy patients 15-25 lbs for overweight 11-20 lbs for obese
Key Nutrients to Increase	Folic acid — 400 mcg/day preconception through 1st trimester; prevents neural tube defects Iron — supports ↑ maternal RBC production; best absorbed with
Key Nutrients to Increase	Vitamin C (orange juice) Calcium — fetal bone development; prevents maternal bone until steaming), Protein — supports fetal, uterine, and placental development
Avoid / Limit	Alcohol — NONE; causes fetal alcohol syndrome High-mercury fish: swordfish, shark, king mackerel, tilefish Listeria risk: soft cheeses, unpasteurized milk, deli meats (heat until steaming), raw sprouts Caffeine — limit to < 200 mg/day
Common Discomforts — 1st & 2nd Trimester	Fatigue — Rest frequently; pace activities; iron-rich foods if anemic Nausea & Vomiting — Small frequent meals, bland foods, ginger, vitamin B6; avoid triggers Breast Tenderness — Supportive bra; avoid caffeine
Common Discomforts — 1st & 2nd Trimester	Urinary Frequency — Kegel exercises; do NOT restrict fluids; void before sleep Nasal Congestion/Nosebleeds — Saline spray, humidifier; apply direct pressure for nosebleeds
Common Discomforts — 1st & 2nd Trimester	Lightheadedness — Change positions slowly; adequate hydration; avoid prolonged standing
Hyperemesis Gravidarum — When Does Nausea Become a Problem?	Persistent vomiting + weight loss > 5% of pre-pregnancy weight + ketonuria + dehydration = HG → IV fluids, antiemetics, possible hospitalization
Common Discomforts — 3rd Trimester & Physical Activity	Heartburn/GERD — Small meals, avoid fatty/spicy; don't eat 3 hrs before bed; elevate HOB Constipation — ↑ fiber + fluids + light exercise; stool softeners if needed Braxton Hicks — Hydration, ambulation, or rest; do NOT confuse with true labor
Physical Activity During Pregnancy	mproves muscle tone, shortens labor, reduces back pain, improves mood, reduces GDM risk Guidelines: 150 min/week moderate activity; maintain adequate hydration and caloric intake; supine position after 1st trimester, and high-altitude activities
Headaches + vision changes? Normal or abnormal?	ABNORMAL
Braxton Hicks contractions	tightening of uterus CERVICAL CHANGE? PAINFUL? RADIATING?... LABOR NOT CONTRACTIONS!
REPORT TO PROVIDER:	Sudden facial, hand, or generalized edema Severe headache after 20 wks (possible preeclampsia) Persistent vomiting + weight loss > 5% (hyperemesis)
REPORT TO PROVIDER:	Sudden severe dyspnea or chest pain (possible PE) Regular contractions before 37 wks — preterm labor Flashing lights, blind spots, double vision — preeclampsia
REPORT TO PROVIDER:	Rupture of membranes, bloody show, foul-smelling discharge Decreased or absent fetal movement — requires NST
Is a dula a provider?	No. It's someone who provides emotional and information support. NO MEDICAL DECISION MAKING.

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QUIZ 2