WGU D447
Women's & Children's Health
Objective Assessment
Actual Questions with Verified Answers
Take and pass the OA :)
What You Will Get:
➢60 OA Exam Questions w/ Answers
➢Expert Rationales included.
➢100+ OA PRACTICE QUESIONS
➢OA Study Guide & Clinical Prioritization
➢D447 Concept Map
, WGU D447 Women & Children Nursing
Preview Pages Below
Get the Complete PDF After Purchase
"If you require further clarification or in need of any study resources,
feel free to Message me."
Digital Preview Sample
,Table of Contents
D447 OA EXAM .......................................................................... 2
D447 OA PRACTICE TEST ............................................................... 52
D447 OA STUDY GUIDE ............................................................. 95
D447 Concept Map ............................................................. 105
D447 OA EXAM
1. A mother brings her male preschooler to the clinic because he has had
diarrhea, vomiting, and high fevers for the past three days. The child begins to
cry and cling to his mother when the nurse enters the examination room. Which
action should the nurse implement to get the child to cooperate?
A. Tell the child he is being silly and needs to be brave
B. Immediately begin the physical assessment while the mother holds him
C. Ask the mother to leave the room so the child learns independence
D. Talk to the mother and gradually focus on the child's toy
Correct Answer: D
Rationale: Preschoolers (ages 3–5 years) experience separation anxiety and fear
of strangers, especially when ill. The nurse should use therapeutic communication
techniques appropriate for this developmental stage. Talking to the mother first
while gradually engaging the child through his toy reduces anxiety by not forcing
immediate interaction. This approach respects the child's need for security
(mother's presence) while building rapport indirectly. Option A dismisses the
child's feelings and increases fear. Option B forces interaction too quickly. Option C
,increases separation anxiety and is inappropriate for a sick preschooler who needs
parental support for coping.
2. A 38-year-old primiparous client is 2 weeks postpartum. She was discharged
on day 2 and is exclusively breastfeeding. The client informs the nurse she is
breastfeeding 7 to 8 times a day for 10 minutes each feeding. The baby has been
fussier and wants to nurse all the time. The client went out shopping for 5 hours
while her mother watched the baby; the baby was fed pumped milk. The client
noticed a red, warm, firm spot on her breast. She also notes she feels chills,
achy, fatigued, and dizzy. She is bleeding a small amount of foul-smelling lochia.
Temp: 101.2°F, HR: 105 bpm, BP: 138/72. Discharge Hgb: 9.2 g/dL (on admission:
12 g/dL). Select the findings that will help determine the cause of the client's
condition.
Table
Finding Relevance
A. Breastfeeding 7 to Correct — Inadequate frequency and duration;
8 times a day for 10 breastfeeding should occur 8–12 times per 24
minutes hours or every 2–3 hours for 15–20 minutes to
ensure adequate emptying
B. Discharge Correct — Indicates postpartum anemia (normal
hemoglobin of 9.2 >11 g/dL), which explains fatigue, dizziness, and
g/dL chills
C. Current vital signs Correct — Fever and tachycardia indicate infection;
(Temp 101.2°F, HR temperature elevation supports mastitis or
105) endometritis
, Finding Relevance
D. Shopping yesterday Correct — Prolonged absence leads to milk stasis, a
for 5 hours primary risk factor for mastitis
E. Foul-smelling lochia Correct — Lochia rubra should be odorless; foul
rubra odor indicates possible endometritis
Rationale: Breastfeeding should occur 8–12 times in a 24-hour period, or every 2–
3 hours for 15–20 minutes. Less frequent or shorter feeding sessions result in
inadequate emptying of the breasts, leading to milk stasis and bacterial
overgrowth that causes mastitis. Any breastfeeding client with a fever should have
a breast exam to determine if mastitis is the cause of the elevated temperature.
Going for prolonged periods without feeding or pumping increases milk stasis risk.
A discharge hemoglobin less than 11 g/dL signals anemia, which may indicate
greater-than-anticipated blood loss; this anemia explains the client's fatigue,
dizziness, and feeling chilled. Lochia rubra at 2 weeks postpartum should not have
an odor—the foul smell may indicate endometritis, a uterine infection requiring
evaluation.
3. (NGN: Drop-Down/Select All That Apply Hybrid)
For each assessment finding, indicate whether the finding is generally associated
with mastitis, endometritis, or signs of both.
Table
Assessment Finding Classification
A. Pain rating of 4 on a 0– Both — Pain occurs with mastitis (breast
10 scale tenderness) and endometritis (uterine
cramping)
,C. Calcium
D. Vitamin D
Correct Answer: A
Rationale:
Folic acid supplementation is the primary preventive measure for neural tube
defects (NTDs), including anencephaly and spina bifida. The U.S. Public Health
Service and CDC recommend that all women of childbearing age consume 400
mcg (0.4 mg) of folic acid daily, beginning at least 1 month before conception and
continuing through the first trimester. For women with a previous pregnancy
affected by an NTD, a higher dose of 4 mg daily is recommended. Folic acid is
crucial for DNA synthesis, cell division, and proper neural tube closure, which
occurs between days 21 and 28 post-conception—often before a woman knows
she is pregnant. Iron (Option B) prevents anemia, calcium (Option C) supports
bone development, and vitamin D (Option D) aids calcium absorption and immune
function, but none of these prevent neural tube defects. The nurse should
emphasize that folic acid must be taken before conception for maximum
protective effect.
, D447 OA PRACTICE TEST
1. A nurse is caring for a 4-year-old with tetralogy of Fallot who suddenly becomes cyanotic
during a crying episode. Which position should the nurse place the child in immediately?
A. Supine with head elevated 30 degrees
B. Knee-chest position
C. Trendelenburg position
D. Left lateral recumbent position
Correct Answer: B
Rationale: The knee-chest position increases systemic vascular resistance, which reduces right-
to-left shunting through the ventricular septal defect and improves pulmonary blood flow. This
is the priority intervention during a "tet spell" (paroxysmal hypercyanotic episode). Supine with
head elevated does not increase SVR. Trendelenburg would increase venous return but not
specifically address the shunt. Left lateral recumbent is used for air embolism, not tet spells.
2. A pregnant client at 28 weeks has a 1-hour glucose challenge test result of 148 mg/dL.
What is the nurse's next action? (Select all that apply.)
A. Diagnose gestational diabetes and start insulin
B. Schedule a 3-hour oral glucose tolerance test (OGTT)
C. Reassure the client that this is a normal finding
D. Instruct the client to fast for at least 8 hours before the 3-hour test
E. Begin dietary modifications immediately
Correct Answers: B, D
Rationale: A 1-hour glucose challenge test value ≥140 mg/dL (some use ≥130 mg/dL) requires
follow-up with a diagnostic 3-hour OGTT. The client must fast for 8–12 hours prior to the 3-hour
test. Gestational diabetes cannot be diagnosed from the 1-hour screen alone. Dietary
modifications may be discussed but are not the priority next step until diagnosis is confirmed.
, These are generally considered a reassuring sign, indicating adequate fetal
oxygenation and a responsive autonomic nervous system.
Nonstress Test (NST): The most widely applied technique for antepartum evaluation
of the fetus.
Biophysical Profile (BPP): Uses real-time ultrasound to evaluate five fetal variables:
fetal heart rate, breathing movements, gross body movements, muscle tone, and
amniotic fluid volume.
Contraction Stress Test (CST): A stress test used to evaluate the ability of the fetus
to tolerate the stress of labor and delivery. Also called oxytocin challenge test.
Early Decelerations: Gradual decrease in FHR that mirrors the pattern of uterine
contractions. Onset coincides with the beginning of a contraction, and the nadir
aligns with the peak. Considered normal and benign.
Late Decelerations: Begin after the onset of a contraction, with the nadir occurring
after the peak. Associated with uteroplacental insufficiency and may indicate fetal
hypoxia.
Variable Decelerations: Abrupt decreases in FHR with varying shape (V, U, or W
patterns). Typically associated with umbilical cord compression.
Neural Tube Defects (NTDs)
Alpha-Fetoprotein (AFP): Serum levels used as a screening tool for NTDs in
pregnancy. High levels suggest NTDs.
AFP Screening Timing: Can be done between 15-20 weeks, ideally 16-18 weeks
gestation.
Anencephaly: Defect in closure of the cephalic portion of the neural tube resulting in
incomplete development of the brain and skull bones. Most drastic NTD; usually
results in stillbirth.
Spina Bifida: A type of NTD where the spine and spinal cord don't form properly.
Microcephaly: A condition where a baby's head is significantly smaller than
expected.
, Risk Factors for NTDs: History in prior pregnancy, folic acid deficiency, pregestational
diabetes, teratogen exposure.
Folate Sources: Leafy greens, fortified cereals, lentils, oranges, supplements.
Follow-up for High AFP: Ultrasound to confirm fetal age and verify single fetus.
Rh Incompatibility
RhoGAM Administration: Given at 28 weeks and again after delivery to Rh-negative
mothers carrying an Rh-positive fetus.
Coombs Test: Tests for the presence of anti-Rh factor antibodies in the blood, often
given to pregnant women who are Rh-negative.
HIV in Pregnancy
HAART: Highly active antiretroviral therapy. Administered orally and continued
throughout pregnancy. Goal is to rapidly lower viral load to undetectable level (<20
copies/mL) and maintain it.
Mother-Child Transmission: Treatment with HAART during pregnancy decreases
transmission to 1-2%.
Major Side Effect of HAART: Bone marrow suppression.
Vaccinations for HIV-Positive Women: Hepatitis B, pneumococcal infection,
Haemophilus influenzae type B, and viral influenza.
Vaginal Birth Option: May be an option for HIV-infected women with viral loads
<1,000 copies/mL at 36 weeks, if membranes have ruptured and labor is progressing
rapidly, or if she declines cesarean.
Cesarean Birth Recommendation: Recommended for HIV-positive women with viral
load >1,000 copies/mL at 38 weeks.
IV Zidovudine: Recommended during intrapartum period except for those with low
viral load (<1,000 copies) on HAART. Given at least 3 hours before scheduled
cesarean and continued until cord is clamped. Also given during labor for vaginal
birth and to infant for 6 weeks after birth.
, Intrapartum fever signals active maternal infection with high risk for neonatal sepsis.
Prolonged rupture of membranes, due to the direct link to increased transmission and risk of
severe neonatal infection, sepsis, meningitis.
Fetal tachycardia indicating possible fetal distress or early infection.
Inadequate or no intrapartum antibiotic prophylaxis.
4. Prioritizing Hypotheses
Hypothesis 1: There is a good likelihood that analgesics and antipyretics are able to control
the patient's fever, and uterine tenderness related to positive GBS infection.
Hypothesis 2: There is a good likelihood that prophylactic antibiotics will be given to reduce
the risk of the neonate developing early-onset GBS disease.
Hypothesis 3: There is a decreased risk of fetal compromise and neonatal infection when
appropriate education, screening, and prophylactic antibiotics are administered prior to
delivery.
5. Generated Solutions
Solution 1: The patient's fever and uterine tenderness will be controlled through the
administration of Acetaminophen.
Solution 2: The patient's risk of infecting their neonate will be reduced through the
administration of prophylactic antibiotics at least 4 hours prior to delivery.
Solution 3: The patient and fetus will have their vital signs monitored during the
administration of antibiotics, ensuring the treatment is safe and effective at reducing the
GBS colonization.
Solution 4: The patient will receive education on the risks and prevention of GBS disease,
providing effective strategies that ensure a safe and healthy delivery of the neonate.
6. Take Actions
Action 1: Administer Acetaminophen 650 to 1000mg every 4 to 6 hours as needed.
Action 2: Administer an initial dose of Penicillin G, 5 million units IV, and then 2.5 million
units every 4 hours until delivery.
Action 3: Monitor the patient's vitals to ensure safe administration of antibiotics to reduce
GBS colonization.
Women's & Children's Health
Objective Assessment
Actual Questions with Verified Answers
Take and pass the OA :)
What You Will Get:
➢60 OA Exam Questions w/ Answers
➢Expert Rationales included.
➢100+ OA PRACTICE QUESIONS
➢OA Study Guide & Clinical Prioritization
➢D447 Concept Map
, WGU D447 Women & Children Nursing
Preview Pages Below
Get the Complete PDF After Purchase
"If you require further clarification or in need of any study resources,
feel free to Message me."
Digital Preview Sample
,Table of Contents
D447 OA EXAM .......................................................................... 2
D447 OA PRACTICE TEST ............................................................... 52
D447 OA STUDY GUIDE ............................................................. 95
D447 Concept Map ............................................................. 105
D447 OA EXAM
1. A mother brings her male preschooler to the clinic because he has had
diarrhea, vomiting, and high fevers for the past three days. The child begins to
cry and cling to his mother when the nurse enters the examination room. Which
action should the nurse implement to get the child to cooperate?
A. Tell the child he is being silly and needs to be brave
B. Immediately begin the physical assessment while the mother holds him
C. Ask the mother to leave the room so the child learns independence
D. Talk to the mother and gradually focus on the child's toy
Correct Answer: D
Rationale: Preschoolers (ages 3–5 years) experience separation anxiety and fear
of strangers, especially when ill. The nurse should use therapeutic communication
techniques appropriate for this developmental stage. Talking to the mother first
while gradually engaging the child through his toy reduces anxiety by not forcing
immediate interaction. This approach respects the child's need for security
(mother's presence) while building rapport indirectly. Option A dismisses the
child's feelings and increases fear. Option B forces interaction too quickly. Option C
,increases separation anxiety and is inappropriate for a sick preschooler who needs
parental support for coping.
2. A 38-year-old primiparous client is 2 weeks postpartum. She was discharged
on day 2 and is exclusively breastfeeding. The client informs the nurse she is
breastfeeding 7 to 8 times a day for 10 minutes each feeding. The baby has been
fussier and wants to nurse all the time. The client went out shopping for 5 hours
while her mother watched the baby; the baby was fed pumped milk. The client
noticed a red, warm, firm spot on her breast. She also notes she feels chills,
achy, fatigued, and dizzy. She is bleeding a small amount of foul-smelling lochia.
Temp: 101.2°F, HR: 105 bpm, BP: 138/72. Discharge Hgb: 9.2 g/dL (on admission:
12 g/dL). Select the findings that will help determine the cause of the client's
condition.
Table
Finding Relevance
A. Breastfeeding 7 to Correct — Inadequate frequency and duration;
8 times a day for 10 breastfeeding should occur 8–12 times per 24
minutes hours or every 2–3 hours for 15–20 minutes to
ensure adequate emptying
B. Discharge Correct — Indicates postpartum anemia (normal
hemoglobin of 9.2 >11 g/dL), which explains fatigue, dizziness, and
g/dL chills
C. Current vital signs Correct — Fever and tachycardia indicate infection;
(Temp 101.2°F, HR temperature elevation supports mastitis or
105) endometritis
, Finding Relevance
D. Shopping yesterday Correct — Prolonged absence leads to milk stasis, a
for 5 hours primary risk factor for mastitis
E. Foul-smelling lochia Correct — Lochia rubra should be odorless; foul
rubra odor indicates possible endometritis
Rationale: Breastfeeding should occur 8–12 times in a 24-hour period, or every 2–
3 hours for 15–20 minutes. Less frequent or shorter feeding sessions result in
inadequate emptying of the breasts, leading to milk stasis and bacterial
overgrowth that causes mastitis. Any breastfeeding client with a fever should have
a breast exam to determine if mastitis is the cause of the elevated temperature.
Going for prolonged periods without feeding or pumping increases milk stasis risk.
A discharge hemoglobin less than 11 g/dL signals anemia, which may indicate
greater-than-anticipated blood loss; this anemia explains the client's fatigue,
dizziness, and feeling chilled. Lochia rubra at 2 weeks postpartum should not have
an odor—the foul smell may indicate endometritis, a uterine infection requiring
evaluation.
3. (NGN: Drop-Down/Select All That Apply Hybrid)
For each assessment finding, indicate whether the finding is generally associated
with mastitis, endometritis, or signs of both.
Table
Assessment Finding Classification
A. Pain rating of 4 on a 0– Both — Pain occurs with mastitis (breast
10 scale tenderness) and endometritis (uterine
cramping)
,C. Calcium
D. Vitamin D
Correct Answer: A
Rationale:
Folic acid supplementation is the primary preventive measure for neural tube
defects (NTDs), including anencephaly and spina bifida. The U.S. Public Health
Service and CDC recommend that all women of childbearing age consume 400
mcg (0.4 mg) of folic acid daily, beginning at least 1 month before conception and
continuing through the first trimester. For women with a previous pregnancy
affected by an NTD, a higher dose of 4 mg daily is recommended. Folic acid is
crucial for DNA synthesis, cell division, and proper neural tube closure, which
occurs between days 21 and 28 post-conception—often before a woman knows
she is pregnant. Iron (Option B) prevents anemia, calcium (Option C) supports
bone development, and vitamin D (Option D) aids calcium absorption and immune
function, but none of these prevent neural tube defects. The nurse should
emphasize that folic acid must be taken before conception for maximum
protective effect.
, D447 OA PRACTICE TEST
1. A nurse is caring for a 4-year-old with tetralogy of Fallot who suddenly becomes cyanotic
during a crying episode. Which position should the nurse place the child in immediately?
A. Supine with head elevated 30 degrees
B. Knee-chest position
C. Trendelenburg position
D. Left lateral recumbent position
Correct Answer: B
Rationale: The knee-chest position increases systemic vascular resistance, which reduces right-
to-left shunting through the ventricular septal defect and improves pulmonary blood flow. This
is the priority intervention during a "tet spell" (paroxysmal hypercyanotic episode). Supine with
head elevated does not increase SVR. Trendelenburg would increase venous return but not
specifically address the shunt. Left lateral recumbent is used for air embolism, not tet spells.
2. A pregnant client at 28 weeks has a 1-hour glucose challenge test result of 148 mg/dL.
What is the nurse's next action? (Select all that apply.)
A. Diagnose gestational diabetes and start insulin
B. Schedule a 3-hour oral glucose tolerance test (OGTT)
C. Reassure the client that this is a normal finding
D. Instruct the client to fast for at least 8 hours before the 3-hour test
E. Begin dietary modifications immediately
Correct Answers: B, D
Rationale: A 1-hour glucose challenge test value ≥140 mg/dL (some use ≥130 mg/dL) requires
follow-up with a diagnostic 3-hour OGTT. The client must fast for 8–12 hours prior to the 3-hour
test. Gestational diabetes cannot be diagnosed from the 1-hour screen alone. Dietary
modifications may be discussed but are not the priority next step until diagnosis is confirmed.
, These are generally considered a reassuring sign, indicating adequate fetal
oxygenation and a responsive autonomic nervous system.
Nonstress Test (NST): The most widely applied technique for antepartum evaluation
of the fetus.
Biophysical Profile (BPP): Uses real-time ultrasound to evaluate five fetal variables:
fetal heart rate, breathing movements, gross body movements, muscle tone, and
amniotic fluid volume.
Contraction Stress Test (CST): A stress test used to evaluate the ability of the fetus
to tolerate the stress of labor and delivery. Also called oxytocin challenge test.
Early Decelerations: Gradual decrease in FHR that mirrors the pattern of uterine
contractions. Onset coincides with the beginning of a contraction, and the nadir
aligns with the peak. Considered normal and benign.
Late Decelerations: Begin after the onset of a contraction, with the nadir occurring
after the peak. Associated with uteroplacental insufficiency and may indicate fetal
hypoxia.
Variable Decelerations: Abrupt decreases in FHR with varying shape (V, U, or W
patterns). Typically associated with umbilical cord compression.
Neural Tube Defects (NTDs)
Alpha-Fetoprotein (AFP): Serum levels used as a screening tool for NTDs in
pregnancy. High levels suggest NTDs.
AFP Screening Timing: Can be done between 15-20 weeks, ideally 16-18 weeks
gestation.
Anencephaly: Defect in closure of the cephalic portion of the neural tube resulting in
incomplete development of the brain and skull bones. Most drastic NTD; usually
results in stillbirth.
Spina Bifida: A type of NTD where the spine and spinal cord don't form properly.
Microcephaly: A condition where a baby's head is significantly smaller than
expected.
, Risk Factors for NTDs: History in prior pregnancy, folic acid deficiency, pregestational
diabetes, teratogen exposure.
Folate Sources: Leafy greens, fortified cereals, lentils, oranges, supplements.
Follow-up for High AFP: Ultrasound to confirm fetal age and verify single fetus.
Rh Incompatibility
RhoGAM Administration: Given at 28 weeks and again after delivery to Rh-negative
mothers carrying an Rh-positive fetus.
Coombs Test: Tests for the presence of anti-Rh factor antibodies in the blood, often
given to pregnant women who are Rh-negative.
HIV in Pregnancy
HAART: Highly active antiretroviral therapy. Administered orally and continued
throughout pregnancy. Goal is to rapidly lower viral load to undetectable level (<20
copies/mL) and maintain it.
Mother-Child Transmission: Treatment with HAART during pregnancy decreases
transmission to 1-2%.
Major Side Effect of HAART: Bone marrow suppression.
Vaccinations for HIV-Positive Women: Hepatitis B, pneumococcal infection,
Haemophilus influenzae type B, and viral influenza.
Vaginal Birth Option: May be an option for HIV-infected women with viral loads
<1,000 copies/mL at 36 weeks, if membranes have ruptured and labor is progressing
rapidly, or if she declines cesarean.
Cesarean Birth Recommendation: Recommended for HIV-positive women with viral
load >1,000 copies/mL at 38 weeks.
IV Zidovudine: Recommended during intrapartum period except for those with low
viral load (<1,000 copies) on HAART. Given at least 3 hours before scheduled
cesarean and continued until cord is clamped. Also given during labor for vaginal
birth and to infant for 6 weeks after birth.
, Intrapartum fever signals active maternal infection with high risk for neonatal sepsis.
Prolonged rupture of membranes, due to the direct link to increased transmission and risk of
severe neonatal infection, sepsis, meningitis.
Fetal tachycardia indicating possible fetal distress or early infection.
Inadequate or no intrapartum antibiotic prophylaxis.
4. Prioritizing Hypotheses
Hypothesis 1: There is a good likelihood that analgesics and antipyretics are able to control
the patient's fever, and uterine tenderness related to positive GBS infection.
Hypothesis 2: There is a good likelihood that prophylactic antibiotics will be given to reduce
the risk of the neonate developing early-onset GBS disease.
Hypothesis 3: There is a decreased risk of fetal compromise and neonatal infection when
appropriate education, screening, and prophylactic antibiotics are administered prior to
delivery.
5. Generated Solutions
Solution 1: The patient's fever and uterine tenderness will be controlled through the
administration of Acetaminophen.
Solution 2: The patient's risk of infecting their neonate will be reduced through the
administration of prophylactic antibiotics at least 4 hours prior to delivery.
Solution 3: The patient and fetus will have their vital signs monitored during the
administration of antibiotics, ensuring the treatment is safe and effective at reducing the
GBS colonization.
Solution 4: The patient will receive education on the risks and prevention of GBS disease,
providing effective strategies that ensure a safe and healthy delivery of the neonate.
6. Take Actions
Action 1: Administer Acetaminophen 650 to 1000mg every 4 to 6 hours as needed.
Action 2: Administer an initial dose of Penicillin G, 5 million units IV, and then 2.5 million
units every 4 hours until delivery.
Action 3: Monitor the patient's vitals to ensure safe administration of antibiotics to reduce
GBS colonization.
