WGU D120 OBJECTIVE ASSESSMENT
Comprehensive Resource To Help You Ace
2026-2027 Includes Frequently Tested
Questions With ELABORATED 100% Correct
COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!!
Current Update!!
1. Describe the physiologic changes associated with each body system during pregnancy.
A- Cardiovascular system
Correct Answer: I. The disproportionate increase in plasma volume compared
with the red cell volume results in hemodilution with a decreased hematocrit reading,
sometimes referred to as physiologic anemia of pregnancy.
ii. diastolic pressure decreases more markedly; this reduction begins in the first
trimester,
iii. Pregnancy does not alter central venous pressures.
iv. Pregnancy does not alter central venous pressures.
v. Because of venous compression, the rate of blood flow in the lower veins is also
markedly reduced, causing a predisposition to thrombosis.
vi. During late pregnancy, the uterus can also partially compress the aorta and its
branches.
vii. Poseiro effect. femoral pulse is not palpable
viii. Pregnancy requires about 1 g of elemental iron: 0.7 g for mother and 0.3 g for the
placenta and fetus
ix. Plasma volume expands proportionately more than red blood cell volume, leading to
a fall in hematocrit.
x. Hematocrit readings below 27%, or above 39%, are associated with less favorable
outcomes. Despite the relatively low "optimal" hematocrit, the arteriovenous oxygen
difference in pregnancy is below nonpregnant levels.
,B. Renal system changes with pregnancy
Correct Answer: i. The urinary collecting system marked dilation in pregnancy,
ii. uterus enlarges, partial obstruction of the ureter at the pelvic brim in supine and the upright
positions.
iii. Increased (GFR) increase early in pregnancy. 40-50% above nonpregnant levels by mid-
gestation til term
iv. elevated GFR = lower serum creatinine and BUN,
v. Na balance is maintained.
vi. K metabolism unchanged
vii. Hyperventilation (low partial pressure of CO2 in arterial blood [PaCO2]) = respiratory
alkalosis = compensated by renal excretion of bicarb
viii. The maternal extracellular volume (intravascular and interstitial components) increases
throughout pregnancy = extracellular hypervolemia.
ix. Renin elevated throughout
x. The uterus and placenta- produce renin (extremely high concentrations in amniotic fluid)
C. Homeostasis during pregnancy
Correct Answer: i. altered insulin response - 10th week to term, fasting insulin elevated
and glucose reduced.
ii. Glycogen synthesis and storage by the liver increases, gluconeogenesis inhibited.
iii. After early pregnancy, insulin resistance = glucose tolerance impaired.
iv. Many humoral factors derived from the placenta = anti-insulin environment of latter
pregnancy. cytokines and human placental lactogen (hPL)
v. second half of pregnancy, rising hPL levels = lipolysis augmented, fasting plasma
concentrations of free fatty acids elevated.
vi. increased risk of ketoacidosis, especially after prolonged fasting.
vii. rise in fasting triglyceride concentration.
D. Endocrine changes in pregnancy
Correct Answer: i. The thyroid gland - moderate enlargement.
ii. Placenta-derived hCG has a TSH-effect on thyroid gland = abnormally low levels of TSH in 1st
trimester (hCG highest).
iii. TBG increased because the high estrogen levels induce increased hepatic synthesis.
iv. minimal amounts of thyroid hormone cross placenta - synthesizes thyroid hormone from its
own thyroid gland to meet its requirements
v. Adrenocorticotropic hormone (ACTH) and plasma cortisol levels elevated from 3 months'
,gestation to delivery
vi. mean unbound level of cortisol is elevated
E. Respiratory system changes during pregnancy
i. resting diaphragm rises 4 cm above its usual position (enlarging uterus)
ii. (VC) unchanged.
iii. Total body oxygen consumption increases by 15-20%
iv. elevated cardiac output and alveolar ventilation > than required to meet the increased
oxygen consumption.
v. rise in minute ventilation = 40% increase in TV at term; RR doesn't change
vi. progesterone increases ventilation.
vii. increased respiratory sensitivity to CO2 = hyperventilation.
viii. hyperventilation = respiratory alkalosis.
ix. slight, gradual decrease in arterial PO2
x. dyspnea is a common (60-70%), though no obstruction
2. What are the mechanisms of transfer from mother to fetus across the placenta?
a. simple diffusion, facilitated diffusion, and active transport.
b. Low molecular size and lipid solubility promote simple diffusion
c. Glucose is the main energy substrate of the fetus, although amino acids and lactate may
contribute up to 25% of fetal oxygen consumption.
a. Metabolism
i. Aldosterone is a mineralocorticoid (zona glomerulosa of maternal adrenals).
1. Aldosterone secretion - regulated by renin-angiotensin system.
2. Aldosterone = absorption of Na and the excretion of K in distal tubule = Na and K balance.
3. pregnancy-induced hypertension = low aldosterone levels
ii. Ca absorption is increased, total maternal serum calcium declines. The fall parallels serum
albumin,
1. Ionic calcium - constant throughout because of increased maternal parathyroid hormone -
>transfer of Ca fetus for bone development, and mobilization of Ca from mother's skeleton to
maintain adequate calcium homeostasis
2. Calcium ions (active transport across placenta) - fetal serum levels > maternal levels in late
pregnancy
Innate immunity
the first line of defense
surface barriers (mucosal immunity), saliva, tears, nasal secretions, perspiration, blood and
, tissue monocytes/macrophages, natural killer (NK) cells, endothelial cells, polymorphonuclear
neutrophils, the complement system, dendritic cells, and the normal microbial flora.
Adaptive immunity
composed of cell mediated (T lymphocytes) and humoral responses (B lymphocytes-antibodies).
Activation of T and consequently B lymphocytes is critical for the development of lifelong
immune responses.
iii. B cells exposed to antigen for the first time produce IgM
Development of fetal immunity
i. Fetal B cells secrete IgG or IgA during the second trimester,
ii. Fetal B cells are first detected in the liver by 8 weeks
iii. Maternal IgG crosses the placenta as early as the late first trimester, but the efficiency of the
transport is poor until 30 weeks = premature infants are not as well protected by maternal
antibodies. IgM, because of its larger molecular size, is unable to cross the placenta.
Physiologically, newborns have higher neutrophil and lymphocyte counts, and the proportion of
lymphocytes and the absolute lymphocyte count are higher in neonates than in adults
Immunologic responses during pregnancy
The mother's immunologic defense system remains intact: innate and adaptive not significantly
affected.
i. reasons vitamin D may be an important regulator of the immune system.
ii. Pregnant women at higher risk of severe infection and death from certain pathogens such as
viruses (hepatitis, influenza, varicella, cytomegalovirus, polio), bacteria (listeria, streptococcus,
gonorrhea, salmonella, leprosy), and parasites (malaria, coccidioidomycosis) compared with
nonpregnant women.
iii. SUPPLEMENT VITAMIN D 1000-2000 IU (4000 IU daily some sources)
3 reasons Vit D may be important immune system regulator during pregnancy
Deficiency makes pregnant women vulnerable to death from various infections (viral, bacterial,
parasites).
Decidua surrounding chorion + placenta produce active Vit D if mom has enough Vit D.
Active Vit D stimulates Treg cell production (suppress innate inflammation that may interfere
with pregnancy)
4 stages of parturition (labor)
a. Activation/Early labor onset
b. Stimulation
Comprehensive Resource To Help You Ace
2026-2027 Includes Frequently Tested
Questions With ELABORATED 100% Correct
COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!!
Current Update!!
1. Describe the physiologic changes associated with each body system during pregnancy.
A- Cardiovascular system
Correct Answer: I. The disproportionate increase in plasma volume compared
with the red cell volume results in hemodilution with a decreased hematocrit reading,
sometimes referred to as physiologic anemia of pregnancy.
ii. diastolic pressure decreases more markedly; this reduction begins in the first
trimester,
iii. Pregnancy does not alter central venous pressures.
iv. Pregnancy does not alter central venous pressures.
v. Because of venous compression, the rate of blood flow in the lower veins is also
markedly reduced, causing a predisposition to thrombosis.
vi. During late pregnancy, the uterus can also partially compress the aorta and its
branches.
vii. Poseiro effect. femoral pulse is not palpable
viii. Pregnancy requires about 1 g of elemental iron: 0.7 g for mother and 0.3 g for the
placenta and fetus
ix. Plasma volume expands proportionately more than red blood cell volume, leading to
a fall in hematocrit.
x. Hematocrit readings below 27%, or above 39%, are associated with less favorable
outcomes. Despite the relatively low "optimal" hematocrit, the arteriovenous oxygen
difference in pregnancy is below nonpregnant levels.
,B. Renal system changes with pregnancy
Correct Answer: i. The urinary collecting system marked dilation in pregnancy,
ii. uterus enlarges, partial obstruction of the ureter at the pelvic brim in supine and the upright
positions.
iii. Increased (GFR) increase early in pregnancy. 40-50% above nonpregnant levels by mid-
gestation til term
iv. elevated GFR = lower serum creatinine and BUN,
v. Na balance is maintained.
vi. K metabolism unchanged
vii. Hyperventilation (low partial pressure of CO2 in arterial blood [PaCO2]) = respiratory
alkalosis = compensated by renal excretion of bicarb
viii. The maternal extracellular volume (intravascular and interstitial components) increases
throughout pregnancy = extracellular hypervolemia.
ix. Renin elevated throughout
x. The uterus and placenta- produce renin (extremely high concentrations in amniotic fluid)
C. Homeostasis during pregnancy
Correct Answer: i. altered insulin response - 10th week to term, fasting insulin elevated
and glucose reduced.
ii. Glycogen synthesis and storage by the liver increases, gluconeogenesis inhibited.
iii. After early pregnancy, insulin resistance = glucose tolerance impaired.
iv. Many humoral factors derived from the placenta = anti-insulin environment of latter
pregnancy. cytokines and human placental lactogen (hPL)
v. second half of pregnancy, rising hPL levels = lipolysis augmented, fasting plasma
concentrations of free fatty acids elevated.
vi. increased risk of ketoacidosis, especially after prolonged fasting.
vii. rise in fasting triglyceride concentration.
D. Endocrine changes in pregnancy
Correct Answer: i. The thyroid gland - moderate enlargement.
ii. Placenta-derived hCG has a TSH-effect on thyroid gland = abnormally low levels of TSH in 1st
trimester (hCG highest).
iii. TBG increased because the high estrogen levels induce increased hepatic synthesis.
iv. minimal amounts of thyroid hormone cross placenta - synthesizes thyroid hormone from its
own thyroid gland to meet its requirements
v. Adrenocorticotropic hormone (ACTH) and plasma cortisol levels elevated from 3 months'
,gestation to delivery
vi. mean unbound level of cortisol is elevated
E. Respiratory system changes during pregnancy
i. resting diaphragm rises 4 cm above its usual position (enlarging uterus)
ii. (VC) unchanged.
iii. Total body oxygen consumption increases by 15-20%
iv. elevated cardiac output and alveolar ventilation > than required to meet the increased
oxygen consumption.
v. rise in minute ventilation = 40% increase in TV at term; RR doesn't change
vi. progesterone increases ventilation.
vii. increased respiratory sensitivity to CO2 = hyperventilation.
viii. hyperventilation = respiratory alkalosis.
ix. slight, gradual decrease in arterial PO2
x. dyspnea is a common (60-70%), though no obstruction
2. What are the mechanisms of transfer from mother to fetus across the placenta?
a. simple diffusion, facilitated diffusion, and active transport.
b. Low molecular size and lipid solubility promote simple diffusion
c. Glucose is the main energy substrate of the fetus, although amino acids and lactate may
contribute up to 25% of fetal oxygen consumption.
a. Metabolism
i. Aldosterone is a mineralocorticoid (zona glomerulosa of maternal adrenals).
1. Aldosterone secretion - regulated by renin-angiotensin system.
2. Aldosterone = absorption of Na and the excretion of K in distal tubule = Na and K balance.
3. pregnancy-induced hypertension = low aldosterone levels
ii. Ca absorption is increased, total maternal serum calcium declines. The fall parallels serum
albumin,
1. Ionic calcium - constant throughout because of increased maternal parathyroid hormone -
>transfer of Ca fetus for bone development, and mobilization of Ca from mother's skeleton to
maintain adequate calcium homeostasis
2. Calcium ions (active transport across placenta) - fetal serum levels > maternal levels in late
pregnancy
Innate immunity
the first line of defense
surface barriers (mucosal immunity), saliva, tears, nasal secretions, perspiration, blood and
, tissue monocytes/macrophages, natural killer (NK) cells, endothelial cells, polymorphonuclear
neutrophils, the complement system, dendritic cells, and the normal microbial flora.
Adaptive immunity
composed of cell mediated (T lymphocytes) and humoral responses (B lymphocytes-antibodies).
Activation of T and consequently B lymphocytes is critical for the development of lifelong
immune responses.
iii. B cells exposed to antigen for the first time produce IgM
Development of fetal immunity
i. Fetal B cells secrete IgG or IgA during the second trimester,
ii. Fetal B cells are first detected in the liver by 8 weeks
iii. Maternal IgG crosses the placenta as early as the late first trimester, but the efficiency of the
transport is poor until 30 weeks = premature infants are not as well protected by maternal
antibodies. IgM, because of its larger molecular size, is unable to cross the placenta.
Physiologically, newborns have higher neutrophil and lymphocyte counts, and the proportion of
lymphocytes and the absolute lymphocyte count are higher in neonates than in adults
Immunologic responses during pregnancy
The mother's immunologic defense system remains intact: innate and adaptive not significantly
affected.
i. reasons vitamin D may be an important regulator of the immune system.
ii. Pregnant women at higher risk of severe infection and death from certain pathogens such as
viruses (hepatitis, influenza, varicella, cytomegalovirus, polio), bacteria (listeria, streptococcus,
gonorrhea, salmonella, leprosy), and parasites (malaria, coccidioidomycosis) compared with
nonpregnant women.
iii. SUPPLEMENT VITAMIN D 1000-2000 IU (4000 IU daily some sources)
3 reasons Vit D may be important immune system regulator during pregnancy
Deficiency makes pregnant women vulnerable to death from various infections (viral, bacterial,
parasites).
Decidua surrounding chorion + placenta produce active Vit D if mom has enough Vit D.
Active Vit D stimulates Treg cell production (suppress innate inflammation that may interfere
with pregnancy)
4 stages of parturition (labor)
a. Activation/Early labor onset
b. Stimulation
