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
, Preview Pages Below
Get the Complete PDF After Purchase
STUDENT PREVIEW
If you require further clarification
or in need of any study resources,
feel free to Message me.
Preview the selected pages below before purchase.
,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)
, Assessment Finding Classification
B. Foul-smelling lochia Endometritis — Odorless lochia is normal;
rubra at 2 weeks PP foul-smelling lochia indicates uterine infection
C. Baby fed pumped breast Mastitis — Milk stasis from missed direct
milk during absence breastfeeding increases mastitis risk
D. Feeling chilled, achy, and Both — Systemic symptoms of infection occur
fatigued with both conditions
E. Temperature of 101.2°F Both — Fever is a systemic response to
infection in both mastitis and endometritis
F. Pulse of 105 beats/min Both — Tachycardia is a compensatory
response to infection and fever in both
conditions
Rationale: Mastitis is an inflammation of the breast tissue, usually caused by milk
stasis and bacterial infection, presenting with localized breast pain, erythema,
warmth, and fever. Endometritis is an infection of the uterine lining, typically
presenting with foul-smelling lochia, uterine tenderness, fever, and malaise.
Systemic symptoms (fever, chills, tachycardia, fatigue) overlap because both are
infectious processes. The key distinguishing features are localized breast findings
(red, warm, firm spot) for mastitis and foul-smelling lochia for endometritis.
4. (NGN: Cloze/Fill-in-the-Blank with Drop-Down)
Based on the assessment findings, the priority diagnosis suspected is _______.
This diagnosis places the client at risk for _______.
, 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.
,3. A nurse is assessing a newborn immediately after delivery. The infant's body is pink, but the
extremities are blue. The heart rate is 92 bpm, the infant grimaces when stimulated, shows
some flexion of extremities, and has slow, irregular respirations. What is the APGAR score?
A. 3
B. 5
C. 7
D. 9
Correct Answer: B
Rationale: Appearance (pink body, blue extremities) = 1; Pulse (90 bpm) = 1; Grimace = 1;
Activity (some flexion) = 1; Respiration (slow, irregular) = 1. Total = 5. An APGAR of 5 indicates
moderate depression requiring supportive care. A score of 7 would require at least two 2s; a
score of 3 would indicate severe depression.
4. A 6-month-old infant is diagnosed with respiratory syncytial virus (RSV) bronchiolitis.
Which nursing interventions are appropriate? (Select all that apply.)
A. Place the infant on contact precautions
B. Administer ribavirin via aerosol for all RSV cases
C. Provide humidified oxygen as needed
D. Encourage oral fluids in small, frequent amounts
E. Position the infant with head elevated 30 degrees
Correct Answers: A, C, D, E
Rationale: RSV is transmitted via respiratory secretions, so contact precautions are required.
Humidified oxygen supports respiratory status. Small, frequent oral fluids prevent dehydration.
Head elevation at 30 degrees facilitates breathing and reduces aspiration risk. Ribavirin is
reserved for severe, high-risk cases (e.g., immunocompromised), not all RSV cases.
5. A nurse is reviewing the results of a maternal serum alpha-fetoprotein (MSAFP) test at 16
weeks gestation. The level is elevated. Which actions should the nurse anticipate? (Select all
that apply.)
A. Schedule an ultrasound to confirm gestational age and assess fetal anatomy
B. Prepare the client for possible amniocentesis if ultrasound is abnormal
,C. Reassure the client that neural tube defects are a possible concern
D. Inform the client that elevated AFP always confirms a diagnosis
E. Schedule a biophysical profile immediately
Correct Answers: A, B, C
Rationale: Elevated MSAFP requires follow-up with ultrasound to rule out incorrect dating and
assess for neural tube defects (NTDs) such as spina bifida or anencephaly. If ultrasound is
abnormal, amniocentesis may be offered. Elevated AFP does NOT confirm a diagnosis—it is a
screening tool. A biophysical profile is not indicated at 16 weeks; it assesses fetal well-being in
the third trimester.
6. A client with severe preeclampsia is receiving magnesium sulfate. The nurse notes absent
deep tendon reflexes, respiratory rate of 10/min, and urine output of 15 mL/hr. What is the
priority nursing action?
A. Continue the infusion and notify the provider
B. Stop the magnesium sulfate infusion immediately
C. Increase the infusion rate to achieve therapeutic levels
D. Administer calcium chloride and prepare for intubation
Correct Answer: B
Rationale: Absent DTRs, RR <12/min, and decreased urine output are signs of magnesium
sulfate toxicity. The priority is to stop the infusion immediately to prevent respiratory arrest.
Calcium gluconate (not calcium chloride) is the antidote for magnesium toxicity. Continuing or
increasing the infusion would worsen toxicity. Intubation may be needed if respiratory arrest
occurs, but stopping the infusion is the first action.
7. A nurse is caring for a 2-year-old with croup. The parent asks what position would be most
comfortable for the child. What is the best response?
A. "Keep your child lying flat to improve airway patency."
B. "Your child will be most comfortable sitting upright or in your lap."
C. "Place your child in Trendelenburg position to reduce swelling."
D. "Have your child lie on the stomach with the head turned to the side."
, 105. A nurse is caring for a child with a suspected diagnosis of bacterial meningitis caused by
Neisseria meningitidis. Which isolation precautions are required?
A. Standard precautions only
B. Contact precautions
C. Droplet precautions
D. Airborne precautions
Correct Answer: C
Rationale: Neisseria meningitidis (meningococcal) meningitis requires droplet precautions due
to respiratory transmission. Standard precautions are always used. Contact precautions are for
direct contact transmission. Airborne precautions are for airborne pathogens.
106. A nurse is caring for a client with a positive CST. Which fetal heart rate pattern is most
concerning?
A. Early decelerations
B. Variable decelerations
C. Late decelerations
D. Accelerations
Correct Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency and are the concerning
pattern in a positive CST. Early decelerations are benign (head compression). Variable
decelerations indicate cord compression. Accelerations are reassuring.
D447 OA STUDY GUIDE
Fetal Assessment & Monitoring
Fetal Accelerations: Temporary, abrupt increases in the fetal heart rate (FHR) above
the established baseline, typically observed during labor or prenatal monitoring.
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
, Preview Pages Below
Get the Complete PDF After Purchase
STUDENT PREVIEW
If you require further clarification
or in need of any study resources,
feel free to Message me.
Preview the selected pages below before purchase.
,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)
, Assessment Finding Classification
B. Foul-smelling lochia Endometritis — Odorless lochia is normal;
rubra at 2 weeks PP foul-smelling lochia indicates uterine infection
C. Baby fed pumped breast Mastitis — Milk stasis from missed direct
milk during absence breastfeeding increases mastitis risk
D. Feeling chilled, achy, and Both — Systemic symptoms of infection occur
fatigued with both conditions
E. Temperature of 101.2°F Both — Fever is a systemic response to
infection in both mastitis and endometritis
F. Pulse of 105 beats/min Both — Tachycardia is a compensatory
response to infection and fever in both
conditions
Rationale: Mastitis is an inflammation of the breast tissue, usually caused by milk
stasis and bacterial infection, presenting with localized breast pain, erythema,
warmth, and fever. Endometritis is an infection of the uterine lining, typically
presenting with foul-smelling lochia, uterine tenderness, fever, and malaise.
Systemic symptoms (fever, chills, tachycardia, fatigue) overlap because both are
infectious processes. The key distinguishing features are localized breast findings
(red, warm, firm spot) for mastitis and foul-smelling lochia for endometritis.
4. (NGN: Cloze/Fill-in-the-Blank with Drop-Down)
Based on the assessment findings, the priority diagnosis suspected is _______.
This diagnosis places the client at risk for _______.
, 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.
,3. A nurse is assessing a newborn immediately after delivery. The infant's body is pink, but the
extremities are blue. The heart rate is 92 bpm, the infant grimaces when stimulated, shows
some flexion of extremities, and has slow, irregular respirations. What is the APGAR score?
A. 3
B. 5
C. 7
D. 9
Correct Answer: B
Rationale: Appearance (pink body, blue extremities) = 1; Pulse (90 bpm) = 1; Grimace = 1;
Activity (some flexion) = 1; Respiration (slow, irregular) = 1. Total = 5. An APGAR of 5 indicates
moderate depression requiring supportive care. A score of 7 would require at least two 2s; a
score of 3 would indicate severe depression.
4. A 6-month-old infant is diagnosed with respiratory syncytial virus (RSV) bronchiolitis.
Which nursing interventions are appropriate? (Select all that apply.)
A. Place the infant on contact precautions
B. Administer ribavirin via aerosol for all RSV cases
C. Provide humidified oxygen as needed
D. Encourage oral fluids in small, frequent amounts
E. Position the infant with head elevated 30 degrees
Correct Answers: A, C, D, E
Rationale: RSV is transmitted via respiratory secretions, so contact precautions are required.
Humidified oxygen supports respiratory status. Small, frequent oral fluids prevent dehydration.
Head elevation at 30 degrees facilitates breathing and reduces aspiration risk. Ribavirin is
reserved for severe, high-risk cases (e.g., immunocompromised), not all RSV cases.
5. A nurse is reviewing the results of a maternal serum alpha-fetoprotein (MSAFP) test at 16
weeks gestation. The level is elevated. Which actions should the nurse anticipate? (Select all
that apply.)
A. Schedule an ultrasound to confirm gestational age and assess fetal anatomy
B. Prepare the client for possible amniocentesis if ultrasound is abnormal
,C. Reassure the client that neural tube defects are a possible concern
D. Inform the client that elevated AFP always confirms a diagnosis
E. Schedule a biophysical profile immediately
Correct Answers: A, B, C
Rationale: Elevated MSAFP requires follow-up with ultrasound to rule out incorrect dating and
assess for neural tube defects (NTDs) such as spina bifida or anencephaly. If ultrasound is
abnormal, amniocentesis may be offered. Elevated AFP does NOT confirm a diagnosis—it is a
screening tool. A biophysical profile is not indicated at 16 weeks; it assesses fetal well-being in
the third trimester.
6. A client with severe preeclampsia is receiving magnesium sulfate. The nurse notes absent
deep tendon reflexes, respiratory rate of 10/min, and urine output of 15 mL/hr. What is the
priority nursing action?
A. Continue the infusion and notify the provider
B. Stop the magnesium sulfate infusion immediately
C. Increase the infusion rate to achieve therapeutic levels
D. Administer calcium chloride and prepare for intubation
Correct Answer: B
Rationale: Absent DTRs, RR <12/min, and decreased urine output are signs of magnesium
sulfate toxicity. The priority is to stop the infusion immediately to prevent respiratory arrest.
Calcium gluconate (not calcium chloride) is the antidote for magnesium toxicity. Continuing or
increasing the infusion would worsen toxicity. Intubation may be needed if respiratory arrest
occurs, but stopping the infusion is the first action.
7. A nurse is caring for a 2-year-old with croup. The parent asks what position would be most
comfortable for the child. What is the best response?
A. "Keep your child lying flat to improve airway patency."
B. "Your child will be most comfortable sitting upright or in your lap."
C. "Place your child in Trendelenburg position to reduce swelling."
D. "Have your child lie on the stomach with the head turned to the side."
, 105. A nurse is caring for a child with a suspected diagnosis of bacterial meningitis caused by
Neisseria meningitidis. Which isolation precautions are required?
A. Standard precautions only
B. Contact precautions
C. Droplet precautions
D. Airborne precautions
Correct Answer: C
Rationale: Neisseria meningitidis (meningococcal) meningitis requires droplet precautions due
to respiratory transmission. Standard precautions are always used. Contact precautions are for
direct contact transmission. Airborne precautions are for airborne pathogens.
106. A nurse is caring for a client with a positive CST. Which fetal heart rate pattern is most
concerning?
A. Early decelerations
B. Variable decelerations
C. Late decelerations
D. Accelerations
Correct Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency and are the concerning
pattern in a positive CST. Early decelerations are benign (head compression). Variable
decelerations indicate cord compression. Accelerations are reassuring.
D447 OA STUDY GUIDE
Fetal Assessment & Monitoring
Fetal Accelerations: Temporary, abrupt increases in the fetal heart rate (FHR) above
the established baseline, typically observed during labor or prenatal monitoring.
