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2026 NGN ATI RN Pediatrics Proctored Exam
2023 Retake: 70 Questions with Correct Answers
& Detailed Rationales – Includes Bow-Tie Style
Questions, Case Studies, Scenarios, and Matrix
Multiple Response
Original paper
SECTION 1: PRIORITY SETTING & ABC FRAMEWORK
Question 1
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. Which of the following is the priority action by
the nurse?
A) Remove the child's contaminated clothing
B) Check the child's respiratory status
C) Administer an antidote to the child
D) Establish IV access for the child
Correct ,,,,answer,,,: B
Rationale: When applying the ABC (Airway, Breathing, Circulation)
priority setting framework, airway is always the highest priority.
Edematous, inflamed lips and drooling indicate potential airway
compromise from caustic ingestion. The airway must be patent for
1
,2
oxygen exchange to occur. Breathing assessment follows airway.
Removing clothing, administering antidotes, and establishing IV access
are important but secondary to ensuring a clear airway.
Elaboration: Caustic ingestion (toilet bowl cleaner often contains
sodium hydroxide or other alkaline substances) causes rapid tissue
edema. Drooling suggests the child cannot swallow saliva due to pain or
swelling, which is a red flag for impending airway obstruction. The
nurse should first assess for stridor, respiratory distress, and ability to
maintain airway patency.
Question 2
A charge nurse is preparing to make a room assignment for a newly
admitted school-age child. Which of the following considerations is
the nurse's priority?
A) Length of stay
B) Treatment schedule
C) Disease process
D) Self-care ability
Correct ,,,,answer,,,: C
Rationale: The transmission of infectious diseases is the greatest
risk to this child and other children on the unit. Therefore, the child's
disease process is the nurse's priority consideration. While length of
stay, treatment schedule, and self-care ability are important factors in
room assignment, infection control takes precedence.
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Question 3
A nurse is receiving change-of-shift report for four children. Which
of the following children should the nurse assess first?
A) A toddler who has a concussion and an episode of forceful vomiting
B) An adolescent who has infective endocarditis and reports having a
headache
C) An adolescent who was placed into halo traction 1 hour ago and
reports pain as 6 on a scale of 0-10
D) A school-age child who has acute glomerulonephritis and brown-
colored urine
Correct ,,,,answer,,,: A
Rationale: When using the urgent vs. nonurgent approach to client
care, the nurse should assess this child first. An episode of forceful
vomiting is an indication of increased intracranial pressure in a
toddler who has a concussion. This is a medical emergency requiring
immediate intervention. The other findings are expected or nonurgent.
Question 4
A school nurse is caring for a child following a tonic-clonic seizure.
Which of the following actions should the nurse take first?
A) Check the child for a head injury
B) Observe for oral bleeding
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C) Check the child's respiratory rate
D) Observe for extremity weakness
Correct ,,,,answer,,,: C
Rationale: When using the airway, breathing, and circulation (ABC)
approach to client care, the nurse should determine the priority action is
to assess the child's respiratory rate. If the child is not breathing, the
nurse should administer rescue breaths. While head injury and oral
bleeding are concerns, airway and breathing take precedence.
Question 5
A nurse is caring for a school-age child who is receiving a blood
transfusion. Which of the following manifestations should alert the
nurse to a possible hemolytic transfusion reaction?
A) Urticaria
B) Fever
C) Flank pain
D) Hypotension
Correct ,,,,answer,,,: C
Rationale: The nurse should recognize that flank pain is caused by the
breakdown of RBCs and is an indication of a hemolytic reaction to the
blood transfusion. This is a medical emergency requiring immediate
stopping of the transfusion. Urticaria and fever may indicate allergic or
febrile reactions but are not specific to hemolytic reactions.
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2026 NGN ATI RN Pediatrics Proctored Exam
2023 Retake: 70 Questions with Correct Answers
& Detailed Rationales – Includes Bow-Tie Style
Questions, Case Studies, Scenarios, and Matrix
Multiple Response
Original paper
SECTION 1: PRIORITY SETTING & ABC FRAMEWORK
Question 1
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. Which of the following is the priority action by
the nurse?
A) Remove the child's contaminated clothing
B) Check the child's respiratory status
C) Administer an antidote to the child
D) Establish IV access for the child
Correct ,,,,answer,,,: B
Rationale: When applying the ABC (Airway, Breathing, Circulation)
priority setting framework, airway is always the highest priority.
Edematous, inflamed lips and drooling indicate potential airway
compromise from caustic ingestion. The airway must be patent for
1
,2
oxygen exchange to occur. Breathing assessment follows airway.
Removing clothing, administering antidotes, and establishing IV access
are important but secondary to ensuring a clear airway.
Elaboration: Caustic ingestion (toilet bowl cleaner often contains
sodium hydroxide or other alkaline substances) causes rapid tissue
edema. Drooling suggests the child cannot swallow saliva due to pain or
swelling, which is a red flag for impending airway obstruction. The
nurse should first assess for stridor, respiratory distress, and ability to
maintain airway patency.
Question 2
A charge nurse is preparing to make a room assignment for a newly
admitted school-age child. Which of the following considerations is
the nurse's priority?
A) Length of stay
B) Treatment schedule
C) Disease process
D) Self-care ability
Correct ,,,,answer,,,: C
Rationale: The transmission of infectious diseases is the greatest
risk to this child and other children on the unit. Therefore, the child's
disease process is the nurse's priority consideration. While length of
stay, treatment schedule, and self-care ability are important factors in
room assignment, infection control takes precedence.
2
,3
Question 3
A nurse is receiving change-of-shift report for four children. Which
of the following children should the nurse assess first?
A) A toddler who has a concussion and an episode of forceful vomiting
B) An adolescent who has infective endocarditis and reports having a
headache
C) An adolescent who was placed into halo traction 1 hour ago and
reports pain as 6 on a scale of 0-10
D) A school-age child who has acute glomerulonephritis and brown-
colored urine
Correct ,,,,answer,,,: A
Rationale: When using the urgent vs. nonurgent approach to client
care, the nurse should assess this child first. An episode of forceful
vomiting is an indication of increased intracranial pressure in a
toddler who has a concussion. This is a medical emergency requiring
immediate intervention. The other findings are expected or nonurgent.
Question 4
A school nurse is caring for a child following a tonic-clonic seizure.
Which of the following actions should the nurse take first?
A) Check the child for a head injury
B) Observe for oral bleeding
3
, 4
C) Check the child's respiratory rate
D) Observe for extremity weakness
Correct ,,,,answer,,,: C
Rationale: When using the airway, breathing, and circulation (ABC)
approach to client care, the nurse should determine the priority action is
to assess the child's respiratory rate. If the child is not breathing, the
nurse should administer rescue breaths. While head injury and oral
bleeding are concerns, airway and breathing take precedence.
Question 5
A nurse is caring for a school-age child who is receiving a blood
transfusion. Which of the following manifestations should alert the
nurse to a possible hemolytic transfusion reaction?
A) Urticaria
B) Fever
C) Flank pain
D) Hypotension
Correct ,,,,answer,,,: C
Rationale: The nurse should recognize that flank pain is caused by the
breakdown of RBCs and is an indication of a hemolytic reaction to the
blood transfusion. This is a medical emergency requiring immediate
stopping of the transfusion. Urticaria and fever may indicate allergic or
febrile reactions but are not specific to hemolytic reactions.
4
