WGU D447 Women and Children's Health OA - Western
Governors University - 2026/2027 Academic Year - Questions
and Answers Covering Four Core Domains - 150 Questions
with Answers
Page 1
,Q1. A pregnant woman at 28 weeks gestation presents with new-onset hypertension
(BP 152/96 mmHg) and proteinuria (urine protein/creatinine ratio 0.4). She is
asymptomatic. Which finding would most strongly suggest severe preeclampsia
rather than gestational hypertension?
A. Platelet count of 110,000/µL
B. Serum creatinine of 0.9 mg/dL
C. Aspartate aminotransferase (AST) of 40 U/L
D. Fetal heart rate of 150 bpm
Correct Answer: A. Platelet count of 110,000/µL
Rationale: Severe preeclampsia is diagnosed with any of: systolic BP "e160 mmHg,
diastolic 110 mmHg, thrombocytopenia (<100,000/µL), impaired liver function (AST >70
U/L), new renal insufficiency, pulmonary edema, or cerebral/visual symptoms. A platelet
count of 110,000/µL is borderline but does not meet the threshold; however, among the
options it is the only one that approaches a severe feature. The other values are normal or
non-specific.
Why Wrong:
B - Creatinine 0.9 mg/dL is within normal range for pregnancy, not indicative of
severe preeclampsia.
C - AST 40 U/L is normal; severe liver involvement requires >70 U/L.
D - Fetal heart rate is normal and not a criterion for severe preeclampsia.
Reference: ACOG Practice Bulletin No. 222, Gestational Hypertension and Preeclampsia
(2020)
Q2. During a prolonged latent phase of labor, a patient receives an epidural. Which
combination of findings would most likely indicate an unintended intrathecal block
rather than an epidural block?
A. Rapid onset of dense motor block and hypotension within 2 minutes
B. Gradual sensory loss over 20 minutes with sparing of motor function
C. Patchy anesthesia with unilateral leg weakness
D. Delayed respiratory depression 30 minutes after dosing
Correct Answer: A. Rapid onset of dense motor block and hypotension within 2
minutes
Rationale: An intrathecal (subarachnoid) injection produces a rapid, profound motor and
sensory block with significant hypotension due to sympathectomy, often within minutes.
Epidural blocks typically have a slower onset (10-20 min) and can be patchy. Respiratory
depression from local anesthetic toxicity would be delayed and not necessarily associated
with rapid motor block.
Why Wrong:
B - Gradual sensory loss with motor sparing is characteristic of epidural, not
Page 2
, intrathecal.
C - Patchy anesthesia suggests inadequate epidural spread, not intrathecal injection.
D - Delayed respiratory depression may indicate systemic toxicity or high epidural
block, not immediate intrathecal effect.
Reference: Chestnut, D.H., et al. (2019). Chestnut's Obstetric Anesthesia: Principles and
Practice, 6th Ed., Ch. 12
Q3. A term newborn, delivered vaginally, has a cephalohematoma. Which statement
about this condition is correct?
A. It is a subperiosteal hemorrhage that does not cross suture lines.
B. It is a subcutaneous collection that crosses suture lines and may obscure the
fontanelle.
C. It typically requires needle aspiration to prevent calcification.
D. It is associated with a higher risk of underlying skull fracture than caput
succedaneum.
Correct Answer: A. It is a subperiosteal hemorrhage that does not cross suture lines.
Rationale: A cephalohematoma is a subperiosteal bleed that is limited by suture lines, so it
does not cross them. It is usually benign and reabsorbs over weeks; aspiration is not
indicated. Caput succedaneum is subcutaneous and crosses suture lines. While a skull
fracture can occur with cephalohematoma, it is not more common than with caput
succedaneum; the latter is more often associated with vacuum extraction.
Why Wrong:
B - This describes caput succedaneum, not cephalohematoma.
C - Aspiration is contraindicated due to risk of infection and bleeding; conservative
management is standard.
D - Skull fracture is not more common with cephalohematoma; both can occur, but
caput succedaneum is not a risk factor for fracture.
Reference: Gomella, T.L., & Eichenwald, E.C. (2020). Neonatology: Management,
Procedures, On-Call Problems, Diseases, and Drugs, 8th Ed., Ch. 12
Q4. A 45-year-old woman with a body mass index (BMI) of 34 kg/m² and a history of
venous thromboembolism (VTE) is considering combined oral contraceptive (COC)
use. Which recommendation is most appropriate?
A. COCs are contraindicated due to elevated VTE risk; a progestin-only pill is a safer
alternative.
B. COCs can be used if she is on anticoagulation therapy; the benefits outweigh the
risks.
C. COCs are safe because her BMI is below 35 kg/m² and she has no other
cardiovascular risk factors.
Page 3
, D. A levonorgestrel intrauterine device (IUD) is contraindicated because of her history
of VTE.
Correct Answer: A. COCs are contraindicated due to elevated VTE risk; a
progestin-only pill is a safer alternative.
Rationale: Combined hormonal contraceptives are contraindicated in women with a
history of VTE, regardless of anticoagulation, because they increase the risk of recurrent
VTE. Progestin-only methods (pill, implant, IUD) are considered safe as they do not
increase VTE risk. Obesity (BMI 30) is a relative contraindication for COCs, but the
history of VTE is an absolute contraindication.
Why Wrong:
B - Anticoagulation does not negate the increased VTE risk; COCs are still
contraindicated.
C - History of VTE is an absolute contraindication, not just BMI.
D - Levonorgestrel IUD is actually a safe option for women with VTE history.
Reference: ACOG Practice Bulletin No. 206, Use of Hormonal Contraception in Women
with Coexisting Medical Conditions (2019)
Q5. A 6-year-old child presents with a 2-day history of fever, sore throat, and a fine,
sandpaper-like rash that began on the trunk. The child's tongue is erythematous with
prominent papillae. Which diagnostic finding would confirm the suspected diagnosis?
A. Positive rapid antigen detection test for group A Streptococcus
B. Positive heterophile antibody test
C. Elevated serum measles IgM antibody
D. Positive reverse transcription-polymerase chain reaction (RT-PCR) for enterovirus
Correct Answer: A. Positive rapid antigen detection test for group A Streptococcus
Rationale: The clinical picture is classic for scarlet fever, caused by group A
Streptococcus (GAS). A rapid antigen detection test (RADT) is specific and can confirm
the diagnosis. Heterophile antibody test is for infectious mononucleosis, measles IgM for
measles, and enterovirus RT-PCR for other viral exanthems, which are not consistent with
this presentation.
Why Wrong:
B - Heterophile antibodies are specific to Epstein-Barr virus, not scarlet fever.
C - Measles rash is maculopapular and typically starts on the face, not sandpaper-like
on the trunk.
D - Enterovirus infections often cause hand-foot-mouth disease or herpangina, not this
rash.
Reference: AAP Red Book (2021-2024). Group A Streptococcal Infections, 31st Ed., pp.
694-706
Page 4
Governors University - 2026/2027 Academic Year - Questions
and Answers Covering Four Core Domains - 150 Questions
with Answers
Page 1
,Q1. A pregnant woman at 28 weeks gestation presents with new-onset hypertension
(BP 152/96 mmHg) and proteinuria (urine protein/creatinine ratio 0.4). She is
asymptomatic. Which finding would most strongly suggest severe preeclampsia
rather than gestational hypertension?
A. Platelet count of 110,000/µL
B. Serum creatinine of 0.9 mg/dL
C. Aspartate aminotransferase (AST) of 40 U/L
D. Fetal heart rate of 150 bpm
Correct Answer: A. Platelet count of 110,000/µL
Rationale: Severe preeclampsia is diagnosed with any of: systolic BP "e160 mmHg,
diastolic 110 mmHg, thrombocytopenia (<100,000/µL), impaired liver function (AST >70
U/L), new renal insufficiency, pulmonary edema, or cerebral/visual symptoms. A platelet
count of 110,000/µL is borderline but does not meet the threshold; however, among the
options it is the only one that approaches a severe feature. The other values are normal or
non-specific.
Why Wrong:
B - Creatinine 0.9 mg/dL is within normal range for pregnancy, not indicative of
severe preeclampsia.
C - AST 40 U/L is normal; severe liver involvement requires >70 U/L.
D - Fetal heart rate is normal and not a criterion for severe preeclampsia.
Reference: ACOG Practice Bulletin No. 222, Gestational Hypertension and Preeclampsia
(2020)
Q2. During a prolonged latent phase of labor, a patient receives an epidural. Which
combination of findings would most likely indicate an unintended intrathecal block
rather than an epidural block?
A. Rapid onset of dense motor block and hypotension within 2 minutes
B. Gradual sensory loss over 20 minutes with sparing of motor function
C. Patchy anesthesia with unilateral leg weakness
D. Delayed respiratory depression 30 minutes after dosing
Correct Answer: A. Rapid onset of dense motor block and hypotension within 2
minutes
Rationale: An intrathecal (subarachnoid) injection produces a rapid, profound motor and
sensory block with significant hypotension due to sympathectomy, often within minutes.
Epidural blocks typically have a slower onset (10-20 min) and can be patchy. Respiratory
depression from local anesthetic toxicity would be delayed and not necessarily associated
with rapid motor block.
Why Wrong:
B - Gradual sensory loss with motor sparing is characteristic of epidural, not
Page 2
, intrathecal.
C - Patchy anesthesia suggests inadequate epidural spread, not intrathecal injection.
D - Delayed respiratory depression may indicate systemic toxicity or high epidural
block, not immediate intrathecal effect.
Reference: Chestnut, D.H., et al. (2019). Chestnut's Obstetric Anesthesia: Principles and
Practice, 6th Ed., Ch. 12
Q3. A term newborn, delivered vaginally, has a cephalohematoma. Which statement
about this condition is correct?
A. It is a subperiosteal hemorrhage that does not cross suture lines.
B. It is a subcutaneous collection that crosses suture lines and may obscure the
fontanelle.
C. It typically requires needle aspiration to prevent calcification.
D. It is associated with a higher risk of underlying skull fracture than caput
succedaneum.
Correct Answer: A. It is a subperiosteal hemorrhage that does not cross suture lines.
Rationale: A cephalohematoma is a subperiosteal bleed that is limited by suture lines, so it
does not cross them. It is usually benign and reabsorbs over weeks; aspiration is not
indicated. Caput succedaneum is subcutaneous and crosses suture lines. While a skull
fracture can occur with cephalohematoma, it is not more common than with caput
succedaneum; the latter is more often associated with vacuum extraction.
Why Wrong:
B - This describes caput succedaneum, not cephalohematoma.
C - Aspiration is contraindicated due to risk of infection and bleeding; conservative
management is standard.
D - Skull fracture is not more common with cephalohematoma; both can occur, but
caput succedaneum is not a risk factor for fracture.
Reference: Gomella, T.L., & Eichenwald, E.C. (2020). Neonatology: Management,
Procedures, On-Call Problems, Diseases, and Drugs, 8th Ed., Ch. 12
Q4. A 45-year-old woman with a body mass index (BMI) of 34 kg/m² and a history of
venous thromboembolism (VTE) is considering combined oral contraceptive (COC)
use. Which recommendation is most appropriate?
A. COCs are contraindicated due to elevated VTE risk; a progestin-only pill is a safer
alternative.
B. COCs can be used if she is on anticoagulation therapy; the benefits outweigh the
risks.
C. COCs are safe because her BMI is below 35 kg/m² and she has no other
cardiovascular risk factors.
Page 3
, D. A levonorgestrel intrauterine device (IUD) is contraindicated because of her history
of VTE.
Correct Answer: A. COCs are contraindicated due to elevated VTE risk; a
progestin-only pill is a safer alternative.
Rationale: Combined hormonal contraceptives are contraindicated in women with a
history of VTE, regardless of anticoagulation, because they increase the risk of recurrent
VTE. Progestin-only methods (pill, implant, IUD) are considered safe as they do not
increase VTE risk. Obesity (BMI 30) is a relative contraindication for COCs, but the
history of VTE is an absolute contraindication.
Why Wrong:
B - Anticoagulation does not negate the increased VTE risk; COCs are still
contraindicated.
C - History of VTE is an absolute contraindication, not just BMI.
D - Levonorgestrel IUD is actually a safe option for women with VTE history.
Reference: ACOG Practice Bulletin No. 206, Use of Hormonal Contraception in Women
with Coexisting Medical Conditions (2019)
Q5. A 6-year-old child presents with a 2-day history of fever, sore throat, and a fine,
sandpaper-like rash that began on the trunk. The child's tongue is erythematous with
prominent papillae. Which diagnostic finding would confirm the suspected diagnosis?
A. Positive rapid antigen detection test for group A Streptococcus
B. Positive heterophile antibody test
C. Elevated serum measles IgM antibody
D. Positive reverse transcription-polymerase chain reaction (RT-PCR) for enterovirus
Correct Answer: A. Positive rapid antigen detection test for group A Streptococcus
Rationale: The clinical picture is classic for scarlet fever, caused by group A
Streptococcus (GAS). A rapid antigen detection test (RADT) is specific and can confirm
the diagnosis. Heterophile antibody test is for infectious mononucleosis, measles IgM for
measles, and enterovirus RT-PCR for other viral exanthems, which are not consistent with
this presentation.
Why Wrong:
B - Heterophile antibodies are specific to Epstein-Barr virus, not scarlet fever.
C - Measles rash is maculopapular and typically starts on the face, not sandpaper-like
on the trunk.
D - Enterovirus infections often cause hand-foot-mouth disease or herpangina, not this
rash.
Reference: AAP Red Book (2021-2024). Group A Streptococcal Infections, 31st Ed., pp.
694-706
Page 4
