NGN ATI PEDS PROCTORED EXAM NEWEST 2026/2027 |
Forms A & B Complete | 250 Questions with Verified Answers
& Detailed Rationales | Pass Guaranteed - A+ Graded
FORM A: NGN Pediatric Proctored Examination
SECTION 1: Unfolding Case Studies (Questions 1-24)
Case Study 1: Respiratory Distress in Infant - Bronchiolitis
Scenario Part 1:
Emma, 8-month-old female, presents to the ED with her mother. Mother reports Emma
has had nasal congestion and cough for 3 days, but today she is breathing rapidly and
refusing to feed. Vital signs: Temp 38.2°C (100.8°F), HR 142, RR 56, SpO2 89% on room
air. Physical assessment reveals nasal flaring, intercostal retractions, and audible
wheezing on auscultation. Emma appears lethargic with poor skin turgor. Mother states
Emma has had only two wet diapers in the past 24 hours.
Q1: Recognizing Cues - Which assessment findings require immediate intervention by
the nurse? (Select all that apply)
A. Temperature 38.2°C (100.8°F)
B. Respiratory rate 56 breaths/min
C. SpO2 89% on room air [CORRECT]
D. Two wet diapers in 24 hours [CORRECT]
E. Audible wheezing on auscultation
F. Lethargy and poor skin turgor [CORRECT]
Correct Answer: C, D, F
Rationale (Clinical Judgment - Recognizing Cues):
,This question assesses the nurse's ability to identify life-threatening cues in a pediatric
patient with respiratory distress. According to the NGN Clinical Judgment Measurement
Model, recognizing cues involves identifying relevant and important information from
various sources.
Why C, D, F are correct:
● SpO2 89% represents moderate hypoxemia in an infant (normal >95%). Values
below 90% indicate significant respiratory compromise requiring immediate
supplemental oxygen and possible respiratory support.
● Decreased urine output (only 2 wet diapers/24hrs vs. normal 6-8) indicates
dehydration, likely from poor feeding and increased insensible losses from
tachypnea. This requires immediate fluid assessment and intervention.
● Lethargy in an infant with respiratory distress is a red flag for impending
respiratory failure. Poor skin turgor confirms dehydration. Together, these
indicate moderate-severe respiratory distress with systemic compromise.
Why others are incorrect:
● Temperature 38.2°C: While elevated, this is a low-grade fever consistent with viral
illness (likely RSV bronchiolitis). Not immediately life-threatening.
● RR 56: While tachypneic (normal RR for 8-month-old is 20-30), this alone doesn't
require immediate intervention if oxygenation is adequate.
● Wheezing: Expected finding in bronchiolitis; indicates air trapping but not
immediately dangerous without accompanying hypoxemia or altered mental
status.
Clinical Significance: The combination of hypoxemia, dehydration, and altered mental
status indicates this infant is progressing from compensated to uncompensated
respiratory distress, requiring immediate escalation of care.
Scenario Part 2:
Emma is placed on nasal cannula oxygen at 2L/min. After 30 minutes, her SpO2
improves to 94%. However, the nurse notes her respiratory rate has increased to 62
breaths/min, and she is now using accessory muscles with grunting. Capillary refill is 4
,seconds. Emma's mother asks if she can give Emma some water because she seems
thirsty.
Q2: Analyzing Cues & Prioritizing Hypotheses - What is the nurse's priority action at this
time?
A. Increase nasal cannula flow to 4L/min to improve oxygenation
B. Allow mother to give small sips of water to comfort the infant
C. Notify provider immediately for possible respiratory fatigue [CORRECT]
D. Position Emma supine to improve lung expansion
Correct Answer: C
Rationale (Clinical Judgment - Analyze Cues & Prioritize Hypotheses):
This question requires analysis of trends and prioritization of the most life-threatening
hypothesis.
Clinical Analysis:
Despite improved oxygen saturation, Emma shows signs of respiratory muscle
fatigue—the most dangerous development in pediatric respiratory distress:
● Increasing respiratory rate (56→62) despite supplemental O2
● New onset grunting (indicates attempt to maintain FRC and prevent alveolar
collapse)
● Prolonged capillary refill (4 seconds, normal <2-3 seconds) suggests poor
perfusion/early shock
● Use of accessory muscles indicates exhausting compensatory mechanisms
Why C is correct:
These findings suggest Emma is transitioning from compensated respiratory distress to
respiratory failure. The priority hypothesis is impending respiratory failure requiring
immediate provider notification for possible CPAP, high-flow nasal cannula, or
intubation. This follows the "Airway, Breathing, Circulation" priority framework.
Why others are incorrect:
, ● A: Increasing O2 flow is inappropriate without reassessment. The problem is not
hypoxemia (SpO2 is 94%) but ventilatory failure/work of breathing. More oxygen
won't address muscle fatigue.
● B: Giving water is contraindicated. Infants with respiratory distress are at
aspiration risk, and Emma needs IV fluids for dehydration. This option
demonstrates dangerous misunderstanding of priorities.
● D: Supine positioning worsens respiratory distress in infants. Semi-Fowler's or
upright positioning reduces work of breathing by allowing diaphragmatic
excursion and decreasing abdominal pressure on the lungs.
Developmental Consideration: Infants have type I respiratory muscle fiber
predominance (fatigue-resistant) but limited reserve. Once accessory muscle use
appears, decompensation can occur rapidly.
Scenario Part 3:
Emma is transferred to the pediatric unit. Over the next 24 hours, her respiratory status
stabilizes on high-flow nasal cannula. The nurse is monitoring trends in her clinical
status. The following data is collected:
Table
Time RR SpO2 Heart Rate Capillary Refill Feeding
0800 48 94% 138 3 seconds Refusing PO
1200 42 96% 128 2 seconds Took 2 oz formula
1600 38 97% 120 2 seconds Took 3 oz formula
2000 32 98% 112 2 seconds Took 4 oz formula
Forms A & B Complete | 250 Questions with Verified Answers
& Detailed Rationales | Pass Guaranteed - A+ Graded
FORM A: NGN Pediatric Proctored Examination
SECTION 1: Unfolding Case Studies (Questions 1-24)
Case Study 1: Respiratory Distress in Infant - Bronchiolitis
Scenario Part 1:
Emma, 8-month-old female, presents to the ED with her mother. Mother reports Emma
has had nasal congestion and cough for 3 days, but today she is breathing rapidly and
refusing to feed. Vital signs: Temp 38.2°C (100.8°F), HR 142, RR 56, SpO2 89% on room
air. Physical assessment reveals nasal flaring, intercostal retractions, and audible
wheezing on auscultation. Emma appears lethargic with poor skin turgor. Mother states
Emma has had only two wet diapers in the past 24 hours.
Q1: Recognizing Cues - Which assessment findings require immediate intervention by
the nurse? (Select all that apply)
A. Temperature 38.2°C (100.8°F)
B. Respiratory rate 56 breaths/min
C. SpO2 89% on room air [CORRECT]
D. Two wet diapers in 24 hours [CORRECT]
E. Audible wheezing on auscultation
F. Lethargy and poor skin turgor [CORRECT]
Correct Answer: C, D, F
Rationale (Clinical Judgment - Recognizing Cues):
,This question assesses the nurse's ability to identify life-threatening cues in a pediatric
patient with respiratory distress. According to the NGN Clinical Judgment Measurement
Model, recognizing cues involves identifying relevant and important information from
various sources.
Why C, D, F are correct:
● SpO2 89% represents moderate hypoxemia in an infant (normal >95%). Values
below 90% indicate significant respiratory compromise requiring immediate
supplemental oxygen and possible respiratory support.
● Decreased urine output (only 2 wet diapers/24hrs vs. normal 6-8) indicates
dehydration, likely from poor feeding and increased insensible losses from
tachypnea. This requires immediate fluid assessment and intervention.
● Lethargy in an infant with respiratory distress is a red flag for impending
respiratory failure. Poor skin turgor confirms dehydration. Together, these
indicate moderate-severe respiratory distress with systemic compromise.
Why others are incorrect:
● Temperature 38.2°C: While elevated, this is a low-grade fever consistent with viral
illness (likely RSV bronchiolitis). Not immediately life-threatening.
● RR 56: While tachypneic (normal RR for 8-month-old is 20-30), this alone doesn't
require immediate intervention if oxygenation is adequate.
● Wheezing: Expected finding in bronchiolitis; indicates air trapping but not
immediately dangerous without accompanying hypoxemia or altered mental
status.
Clinical Significance: The combination of hypoxemia, dehydration, and altered mental
status indicates this infant is progressing from compensated to uncompensated
respiratory distress, requiring immediate escalation of care.
Scenario Part 2:
Emma is placed on nasal cannula oxygen at 2L/min. After 30 minutes, her SpO2
improves to 94%. However, the nurse notes her respiratory rate has increased to 62
breaths/min, and she is now using accessory muscles with grunting. Capillary refill is 4
,seconds. Emma's mother asks if she can give Emma some water because she seems
thirsty.
Q2: Analyzing Cues & Prioritizing Hypotheses - What is the nurse's priority action at this
time?
A. Increase nasal cannula flow to 4L/min to improve oxygenation
B. Allow mother to give small sips of water to comfort the infant
C. Notify provider immediately for possible respiratory fatigue [CORRECT]
D. Position Emma supine to improve lung expansion
Correct Answer: C
Rationale (Clinical Judgment - Analyze Cues & Prioritize Hypotheses):
This question requires analysis of trends and prioritization of the most life-threatening
hypothesis.
Clinical Analysis:
Despite improved oxygen saturation, Emma shows signs of respiratory muscle
fatigue—the most dangerous development in pediatric respiratory distress:
● Increasing respiratory rate (56→62) despite supplemental O2
● New onset grunting (indicates attempt to maintain FRC and prevent alveolar
collapse)
● Prolonged capillary refill (4 seconds, normal <2-3 seconds) suggests poor
perfusion/early shock
● Use of accessory muscles indicates exhausting compensatory mechanisms
Why C is correct:
These findings suggest Emma is transitioning from compensated respiratory distress to
respiratory failure. The priority hypothesis is impending respiratory failure requiring
immediate provider notification for possible CPAP, high-flow nasal cannula, or
intubation. This follows the "Airway, Breathing, Circulation" priority framework.
Why others are incorrect:
, ● A: Increasing O2 flow is inappropriate without reassessment. The problem is not
hypoxemia (SpO2 is 94%) but ventilatory failure/work of breathing. More oxygen
won't address muscle fatigue.
● B: Giving water is contraindicated. Infants with respiratory distress are at
aspiration risk, and Emma needs IV fluids for dehydration. This option
demonstrates dangerous misunderstanding of priorities.
● D: Supine positioning worsens respiratory distress in infants. Semi-Fowler's or
upright positioning reduces work of breathing by allowing diaphragmatic
excursion and decreasing abdominal pressure on the lungs.
Developmental Consideration: Infants have type I respiratory muscle fiber
predominance (fatigue-resistant) but limited reserve. Once accessory muscle use
appears, decompensation can occur rapidly.
Scenario Part 3:
Emma is transferred to the pediatric unit. Over the next 24 hours, her respiratory status
stabilizes on high-flow nasal cannula. The nurse is monitoring trends in her clinical
status. The following data is collected:
Table
Time RR SpO2 Heart Rate Capillary Refill Feeding
0800 48 94% 138 3 seconds Refusing PO
1200 42 96% 128 2 seconds Took 2 oz formula
1600 38 97% 120 2 seconds Took 3 oz formula
2000 32 98% 112 2 seconds Took 4 oz formula
