2026 Next Generation ATI RN Pediatrics
Proctored Exam 2026: 70 NGN-Style Questions
with Correct Answers, Bow-Tie Items, Case
Studies, and Detailed Rationales
SECTION 1: BOW-TIE STYLE QUESTIONS (Questions 1-5)
Bow-Tie Question Format: A central clinical scenario with a "drag and
drop" or selection of 1) Priority Condition, 2) Priority Action, and 3)
Parameter to Monitor.
BOW-TIE QUESTION #1
Scenario: A nurse in the emergency department is caring for a 2-year-
old child who was found by his parents crying and holding a container of
toilet bowl cleaner. The child's lips are edematous and inflamed, and he
is drooling.
Central Box (Select the Priority Condition):
A) Caustic Ingestion
B) Allergic Reaction
C) Viral Stomatitis
D) Foreign Body Aspiration
Left Box (Select the Priority Action the nurse should take first):
A) Remove the child's contaminated clothing
B) Administer an antidote
C) Establish IV access
D) Assess respiratory status
,Right Box (Select the Primary Parameter the nurse should
monitor):
A) Serum electrolyte levels
B) Airway patency
C) Gastric pH
D) White blood cell count
Correct ,,,,answer,,,s:
• Central Box: A) Caustic Ingestion (Rationale: The history of
holding a toilet bowl cleaner container combined with lip edema
and drooling is classic for caustic ingestion, typically alkaline
substances like sodium hydroxide, which cause rapid tissue
edema.)
• Left Box: D) Assess respiratory status (Rationale: Using the ABC
framework, Airway is the highest priority. Drooling indicates the
child cannot swallow saliva due to pain/swelling, which is a red
flag for impending airway obstruction. The nurse must assess for
stridor and respiratory distress first.)
• Right Box: B) Airway patency (Rationale: After the initial
assessment, continuous monitoring of airway patency is critical to
prevent respiratory failure.)
BOW-TIE QUESTION #2
Scenario: A nurse is assessing a 9-month-old infant whose parent
reports the infant is "not yet walking" and seems "floppy."
Central Box (Priority Concern):
A) Developmental Delay
,B) Failure to Thrive
C) Neuromuscular Disorder
D) Normal Variation
Left Box (Priority Action):
A) Refer to physical therapy
B) Obtain a serum creatine kinase level
C) Assess deep tendon reflexes and muscle tone
D) Reassure the parent that this is normal
Right Box (Parameter to Monitor):
A) Achievement of gross motor milestones
B) Daily caloric intake
C) Head circumference growth velocity
D) Sleep patterns
Correct ,,,,answer,,,s:
• Central Box: C) Neuromuscular Disorder (Rationale: While not
walking at 9 months is normal (walking typically begins 12-15
months), the descriptor "floppy" (hypotonia) is not normal and
suggests a possible neuromuscular disorder such as spinal
muscular atrophy or cerebral palsy. The presence of hypotonia
changes the clinical picture entirely .)
• Left Box: C) Assess deep tendon reflexes and muscle tone
(Rationale: Before any referral, the nurse must complete a full
neurological assessment to document the degree of hypotonia,
reflex changes, and any other abnormalities.)
• Right Box: A) Achievement of gross motor milestones (Rationale:
The primary parameter to monitor over time is whether the infant
, achieves gross motor milestones (sitting, crawling, standing) or
continues to regress/lag.)
BOW-TIE QUESTION #3
Scenario: A school-age child is receiving a blood transfusion. Fifteen
minutes after the start of the transfusion, the child reports flank pain and
appears flushed.
Central Box (Priority Condition):
A) Febrile non-hemolytic reaction
B) Acute hemolytic reaction
C) Bacterial contamination
D) Allergic reaction
Left Box (Priority Action):
A) Slow the infusion rate
B) Stop the transfusion immediately
C) Administer diphenhydramine
D) Obtain a urine sample
Right Box (Parameter to Monitor):
A) Temperature
B) Blood pressure
C) Urine output and color
D) Respiratory rate
Correct ,,,,answer,,,s:
• Central Box: B) Acute hemolytic reaction (Rationale: Flank pain,
flushing, and the timing (15 minutes in) are hallmark signs of an
Proctored Exam 2026: 70 NGN-Style Questions
with Correct Answers, Bow-Tie Items, Case
Studies, and Detailed Rationales
SECTION 1: BOW-TIE STYLE QUESTIONS (Questions 1-5)
Bow-Tie Question Format: A central clinical scenario with a "drag and
drop" or selection of 1) Priority Condition, 2) Priority Action, and 3)
Parameter to Monitor.
BOW-TIE QUESTION #1
Scenario: A nurse in the emergency department is caring for a 2-year-
old child who was found by his parents crying and holding a container of
toilet bowl cleaner. The child's lips are edematous and inflamed, and he
is drooling.
Central Box (Select the Priority Condition):
A) Caustic Ingestion
B) Allergic Reaction
C) Viral Stomatitis
D) Foreign Body Aspiration
Left Box (Select the Priority Action the nurse should take first):
A) Remove the child's contaminated clothing
B) Administer an antidote
C) Establish IV access
D) Assess respiratory status
,Right Box (Select the Primary Parameter the nurse should
monitor):
A) Serum electrolyte levels
B) Airway patency
C) Gastric pH
D) White blood cell count
Correct ,,,,answer,,,s:
• Central Box: A) Caustic Ingestion (Rationale: The history of
holding a toilet bowl cleaner container combined with lip edema
and drooling is classic for caustic ingestion, typically alkaline
substances like sodium hydroxide, which cause rapid tissue
edema.)
• Left Box: D) Assess respiratory status (Rationale: Using the ABC
framework, Airway is the highest priority. Drooling indicates the
child cannot swallow saliva due to pain/swelling, which is a red
flag for impending airway obstruction. The nurse must assess for
stridor and respiratory distress first.)
• Right Box: B) Airway patency (Rationale: After the initial
assessment, continuous monitoring of airway patency is critical to
prevent respiratory failure.)
BOW-TIE QUESTION #2
Scenario: A nurse is assessing a 9-month-old infant whose parent
reports the infant is "not yet walking" and seems "floppy."
Central Box (Priority Concern):
A) Developmental Delay
,B) Failure to Thrive
C) Neuromuscular Disorder
D) Normal Variation
Left Box (Priority Action):
A) Refer to physical therapy
B) Obtain a serum creatine kinase level
C) Assess deep tendon reflexes and muscle tone
D) Reassure the parent that this is normal
Right Box (Parameter to Monitor):
A) Achievement of gross motor milestones
B) Daily caloric intake
C) Head circumference growth velocity
D) Sleep patterns
Correct ,,,,answer,,,s:
• Central Box: C) Neuromuscular Disorder (Rationale: While not
walking at 9 months is normal (walking typically begins 12-15
months), the descriptor "floppy" (hypotonia) is not normal and
suggests a possible neuromuscular disorder such as spinal
muscular atrophy or cerebral palsy. The presence of hypotonia
changes the clinical picture entirely .)
• Left Box: C) Assess deep tendon reflexes and muscle tone
(Rationale: Before any referral, the nurse must complete a full
neurological assessment to document the degree of hypotonia,
reflex changes, and any other abnormalities.)
• Right Box: A) Achievement of gross motor milestones (Rationale:
The primary parameter to monitor over time is whether the infant
, achieves gross motor milestones (sitting, crawling, standing) or
continues to regress/lag.)
BOW-TIE QUESTION #3
Scenario: A school-age child is receiving a blood transfusion. Fifteen
minutes after the start of the transfusion, the child reports flank pain and
appears flushed.
Central Box (Priority Condition):
A) Febrile non-hemolytic reaction
B) Acute hemolytic reaction
C) Bacterial contamination
D) Allergic reaction
Left Box (Priority Action):
A) Slow the infusion rate
B) Stop the transfusion immediately
C) Administer diphenhydramine
D) Obtain a urine sample
Right Box (Parameter to Monitor):
A) Temperature
B) Blood pressure
C) Urine output and color
D) Respiratory rate
Correct ,,,,answer,,,s:
• Central Box: B) Acute hemolytic reaction (Rationale: Flank pain,
flushing, and the timing (15 minutes in) are hallmark signs of an
