NGN Peds Proctored Exam
NGN 2019 Pediatrics Proctored Exam B
with 200 Questions and Correct Answers
with Rationales/ Pediatrics Proctored
Exam 2019 B with NGN Latest Update
16-year-old male seen in pediatric office today for routine annual sports exam and physical. Labs
and imaging completed one week earlier. Parent accompanies. PMH significant for exercise-
induced asthma. Medications limited to albuterol inhaler. Denies current alcohol or tobacco use.
The nurse reviews the electronic health record for pre-appointment labs and imaging, and
documents visit-related care in the nursing progress notes. Provides education as appropriate.
The nurse reviews the history to find an adolescent has a tattoo on the neck and piercings on the
ear and eyebrow. During the next visit, the nurse finds a new tattoo on the right upper arm and
another piercing on the nose. Which intervention will the nurse prioritize in this situation? Select
all that apply. One, some, or all responses may be correct. - Correct Answer :Correct:
Screen the adolescent for human immunodeficiency virus (HIV).
Schedule an appointment for administering the hepatitis vaccine.
Rationale:
Infection-causing viruses such as human immunodeficiency virus (HIV), and hepatitis C virus can
be transmitted through body art needles from one person to another. The nurse would have the
client tested for HIV and schedule an appointment for administering the hepatitis vaccine to
ensure safety and reduce the risk of infection. Safety is the priority intervention over health
promotion activities such as a proper diet plan, screening electrocardiogram, and exercise. It is
important for adolescents to wear sunscreen and avoid sunburn to avoid increasing the risk of
cancer, but this is not the priority for this client. Additional non-priority health promotion
interventions associated with adolescents include adequate sleep and routine dental
examinations.
1-month-old infant brought into pediatrician office by parent for 2nd scheduled health and
wellness visit. Initial HepB immunization administered at initial appointment, 2nd dose
A+ TEST BANK 1
, NGN Peds Proctored Exam
scheduled for this visit. Parent denies any signs of illness but reports that the infant only sleeps
for short periods at a time.
The nurse reviews the electronic health record and documents visit-related care in the nursing
progress notes. Implements provider orders and provides education as appropriate.
The nurse is assessing a 1-month-old's ears at a well-child visit. Which step is appropriate for
performing the assessment in this client? Select all that apply. One, some, or all responses may
be correct. –
Correct Answer :Correct:
Observe for skin tags anterior to the ear.
Manipulate the ear to straighten the curvature of the canal.
Pull the pinna down and back to the 6 to 9 o'clock range.
Perform auditory tests by placing electrodes on the child's head.
Document any malformations of the ear.
Inspect ears for position and rotation.
Rationale:
When inspecting the ear, attention should be paid to skin tags or small pits found anterior to the
ear, which could possibly indicate renal abnormalities. The ear canal curves upward in infants.
The nurse needs to pull the pinna down and back to the 6 to 9 o'clock range to straighten the
canal for introducing the speculum. The auditory brainstem response (ABR) is used in newborns
whereby activity in auditory nerve and brainstem pathways is measured by placing electrodes on
the child's head. Malformations of the ears can indicate chromosomal abnormalities or
congenital problems. Ears that are low or posteriorly rotated may be indicators of genetic
diseases and require further evaluation. Restraint is needed for younger children because the
ear examination upsets them; older children usually cooperate and do not need restraint. The
nurse would not insert the speculum past the cartilaginous portion of the canal, usually a
distance of 0.60 to 1.25 cm (0.23-0.5 inch) in older children. In neonates and young infants, the
walls of the canal are pliable and floppy. The very small 2-mm speculum usually needs to be
inserted deeper into the canal than in older children.
2-month-old male infant brought into emergency department via personal vehicle by parent
following a reported accident at home in which the client was dropped by a sibling that was
A+ TEST BANK 2
, NGN Peds Proctored Exam
carrying him. Client awake and crying. No significant findings in EHR. Immunizations up to date.
On-call pediatrician paged.
The nurse interviews the client's parent and reviews the electronic health record. Care is
documented in the nursing progress notes. Diagnostics completed per provider orders.
The nurse observes bleeding into the subgaleal compartment upon reviewing an infant's
computerized tomography (CT) results. Which other finding would the nurse expect to assess?
Select all that apply. One, some, or all responses may be correct. - Correct Answer :Correct:
Thrombocytopenia
Pallor of skin
Lowered hematocrit levels
Hypotonia
Tachypnea
Rationale:
Bleeding into the subgaleal compartment indicates subgaleal hemorrhage in an infant. Subgaleal
hemorrhage is also associated with disseminated intravascular coagulation, which results in
thrombocytopenia or decreased blood platelets in the body. The hemorrhage causes decreased
circulating blood volume, which contributes to a pale color of the skin. An infant with subgaleal
hemorrhage experiences destruction of red blood cells within the hematoma; therefore, the
infant will have decreased hematocrit. Neurological symptoms associated with this type of
bleeding include hypotonia and seizures. Tachypnea is a sign of the circulatory shock that will
develop as the infant continues to lose blood. Subgaleal hemorrhage is characterized by
tachycardia, not decreased heart rate or bradycardia. Subgaleal hemorrhage is characterized by
hyperbilirubinemia because of degradation of red blood cells. An infant with subgaleal
hemorrhage shows megacephaly, not decreased head circumference.
18-month-old female child brought into pediatrician office by parent for scheduled health and
wellness visit. Vaccines up to date, due this visit: HepB (3rd dose), DTaP (4th dose), and
Inactivated Poliovirus (3rd Dose). Parent denies any signs of illness but reports that the child
sometimes has a bulge in the right groin area.
The nurse reviews the electronic health record and documents visit-related care in the nursing
progress notes. Implements provider orders and provides education as appropriate.
The nurse is inspecting the abdomen of an 18-month-old child. Which method would the nurse
adopt to inspect for inguinal hernia? –
A+ TEST BANK 3
, NGN Peds Proctored Exam
Correct Answer :Correct:
Visualize the inguinal sacral area for obvious bulging.
Have the child blow a bubble.
Get the child to laugh to raise the intra-abdominal pressure.
Palpate the hernia sac for ovaries in a female client.
Examine the client in both standing and supine positions.
Rationale:
The most common presenting symptom of an inguinal hernia is an obvious bulge in the inguinal
sacral area. Typically, to locate an inguinal hernia, the nurse positions his or her finger at the
proper site and asks the child to cough. However, if the child is too young to cough when asked
to, such as at 18 months of age, the nurse can have the child blow a bubble or laugh to raise the
intra-abdominal pressure sufficiently to demonstrate the presence of an inguinal hernia. It is not
unusual to palpate an ovary in the hernia sac of a female infant. The area should be visualized
both when the client is standing and in the supine position. In case of umbilical hernias, the
nurse palpates the sac for abdominal contents and estimates the approximate size of the
opening. In the case of a femoral hernia, it is felt or seen as a small mass on the anterior surface
of the thigh just below the inguinal ligament in the femoral canal, the nurse would feel for a
hernia by placing the index finger of the right hand on the child's right femoral pulse and the
middle finger flat against the skin toward the midline. For a child who is old enough to cough
when instructed, the nurse can slide the little finger into the external inguinal ring in the
inguinoscrotal region of males or the inguinolabial region of females and ask the child to cough.
If a hernia is present, it will hit the tip of the finger.
3-year-old child brought into pediatrician office by parent for routine health and wellness visit.
No significant PMH findings indicated in EHR. Immunizations up to date. Parent denies any signs
of illness but reports that the child often bumps into doorways and furniture.
The nurse reviews the electronic health record and documents visit-related care in the nursing
progress notes. Implements provider orders and provides education as appropriate.
While assessing a pediatric client, a nurse notices that the child is unable to focus on an object
with both eyes simultaneously. Which other finding in the client will suggest strabismus? Select
all that apply. One, some, or all responses may be correct.
A+ TEST BANK 4
NGN 2019 Pediatrics Proctored Exam B
with 200 Questions and Correct Answers
with Rationales/ Pediatrics Proctored
Exam 2019 B with NGN Latest Update
16-year-old male seen in pediatric office today for routine annual sports exam and physical. Labs
and imaging completed one week earlier. Parent accompanies. PMH significant for exercise-
induced asthma. Medications limited to albuterol inhaler. Denies current alcohol or tobacco use.
The nurse reviews the electronic health record for pre-appointment labs and imaging, and
documents visit-related care in the nursing progress notes. Provides education as appropriate.
The nurse reviews the history to find an adolescent has a tattoo on the neck and piercings on the
ear and eyebrow. During the next visit, the nurse finds a new tattoo on the right upper arm and
another piercing on the nose. Which intervention will the nurse prioritize in this situation? Select
all that apply. One, some, or all responses may be correct. - Correct Answer :Correct:
Screen the adolescent for human immunodeficiency virus (HIV).
Schedule an appointment for administering the hepatitis vaccine.
Rationale:
Infection-causing viruses such as human immunodeficiency virus (HIV), and hepatitis C virus can
be transmitted through body art needles from one person to another. The nurse would have the
client tested for HIV and schedule an appointment for administering the hepatitis vaccine to
ensure safety and reduce the risk of infection. Safety is the priority intervention over health
promotion activities such as a proper diet plan, screening electrocardiogram, and exercise. It is
important for adolescents to wear sunscreen and avoid sunburn to avoid increasing the risk of
cancer, but this is not the priority for this client. Additional non-priority health promotion
interventions associated with adolescents include adequate sleep and routine dental
examinations.
1-month-old infant brought into pediatrician office by parent for 2nd scheduled health and
wellness visit. Initial HepB immunization administered at initial appointment, 2nd dose
A+ TEST BANK 1
, NGN Peds Proctored Exam
scheduled for this visit. Parent denies any signs of illness but reports that the infant only sleeps
for short periods at a time.
The nurse reviews the electronic health record and documents visit-related care in the nursing
progress notes. Implements provider orders and provides education as appropriate.
The nurse is assessing a 1-month-old's ears at a well-child visit. Which step is appropriate for
performing the assessment in this client? Select all that apply. One, some, or all responses may
be correct. –
Correct Answer :Correct:
Observe for skin tags anterior to the ear.
Manipulate the ear to straighten the curvature of the canal.
Pull the pinna down and back to the 6 to 9 o'clock range.
Perform auditory tests by placing electrodes on the child's head.
Document any malformations of the ear.
Inspect ears for position and rotation.
Rationale:
When inspecting the ear, attention should be paid to skin tags or small pits found anterior to the
ear, which could possibly indicate renal abnormalities. The ear canal curves upward in infants.
The nurse needs to pull the pinna down and back to the 6 to 9 o'clock range to straighten the
canal for introducing the speculum. The auditory brainstem response (ABR) is used in newborns
whereby activity in auditory nerve and brainstem pathways is measured by placing electrodes on
the child's head. Malformations of the ears can indicate chromosomal abnormalities or
congenital problems. Ears that are low or posteriorly rotated may be indicators of genetic
diseases and require further evaluation. Restraint is needed for younger children because the
ear examination upsets them; older children usually cooperate and do not need restraint. The
nurse would not insert the speculum past the cartilaginous portion of the canal, usually a
distance of 0.60 to 1.25 cm (0.23-0.5 inch) in older children. In neonates and young infants, the
walls of the canal are pliable and floppy. The very small 2-mm speculum usually needs to be
inserted deeper into the canal than in older children.
2-month-old male infant brought into emergency department via personal vehicle by parent
following a reported accident at home in which the client was dropped by a sibling that was
A+ TEST BANK 2
, NGN Peds Proctored Exam
carrying him. Client awake and crying. No significant findings in EHR. Immunizations up to date.
On-call pediatrician paged.
The nurse interviews the client's parent and reviews the electronic health record. Care is
documented in the nursing progress notes. Diagnostics completed per provider orders.
The nurse observes bleeding into the subgaleal compartment upon reviewing an infant's
computerized tomography (CT) results. Which other finding would the nurse expect to assess?
Select all that apply. One, some, or all responses may be correct. - Correct Answer :Correct:
Thrombocytopenia
Pallor of skin
Lowered hematocrit levels
Hypotonia
Tachypnea
Rationale:
Bleeding into the subgaleal compartment indicates subgaleal hemorrhage in an infant. Subgaleal
hemorrhage is also associated with disseminated intravascular coagulation, which results in
thrombocytopenia or decreased blood platelets in the body. The hemorrhage causes decreased
circulating blood volume, which contributes to a pale color of the skin. An infant with subgaleal
hemorrhage experiences destruction of red blood cells within the hematoma; therefore, the
infant will have decreased hematocrit. Neurological symptoms associated with this type of
bleeding include hypotonia and seizures. Tachypnea is a sign of the circulatory shock that will
develop as the infant continues to lose blood. Subgaleal hemorrhage is characterized by
tachycardia, not decreased heart rate or bradycardia. Subgaleal hemorrhage is characterized by
hyperbilirubinemia because of degradation of red blood cells. An infant with subgaleal
hemorrhage shows megacephaly, not decreased head circumference.
18-month-old female child brought into pediatrician office by parent for scheduled health and
wellness visit. Vaccines up to date, due this visit: HepB (3rd dose), DTaP (4th dose), and
Inactivated Poliovirus (3rd Dose). Parent denies any signs of illness but reports that the child
sometimes has a bulge in the right groin area.
The nurse reviews the electronic health record and documents visit-related care in the nursing
progress notes. Implements provider orders and provides education as appropriate.
The nurse is inspecting the abdomen of an 18-month-old child. Which method would the nurse
adopt to inspect for inguinal hernia? –
A+ TEST BANK 3
, NGN Peds Proctored Exam
Correct Answer :Correct:
Visualize the inguinal sacral area for obvious bulging.
Have the child blow a bubble.
Get the child to laugh to raise the intra-abdominal pressure.
Palpate the hernia sac for ovaries in a female client.
Examine the client in both standing and supine positions.
Rationale:
The most common presenting symptom of an inguinal hernia is an obvious bulge in the inguinal
sacral area. Typically, to locate an inguinal hernia, the nurse positions his or her finger at the
proper site and asks the child to cough. However, if the child is too young to cough when asked
to, such as at 18 months of age, the nurse can have the child blow a bubble or laugh to raise the
intra-abdominal pressure sufficiently to demonstrate the presence of an inguinal hernia. It is not
unusual to palpate an ovary in the hernia sac of a female infant. The area should be visualized
both when the client is standing and in the supine position. In case of umbilical hernias, the
nurse palpates the sac for abdominal contents and estimates the approximate size of the
opening. In the case of a femoral hernia, it is felt or seen as a small mass on the anterior surface
of the thigh just below the inguinal ligament in the femoral canal, the nurse would feel for a
hernia by placing the index finger of the right hand on the child's right femoral pulse and the
middle finger flat against the skin toward the midline. For a child who is old enough to cough
when instructed, the nurse can slide the little finger into the external inguinal ring in the
inguinoscrotal region of males or the inguinolabial region of females and ask the child to cough.
If a hernia is present, it will hit the tip of the finger.
3-year-old child brought into pediatrician office by parent for routine health and wellness visit.
No significant PMH findings indicated in EHR. Immunizations up to date. Parent denies any signs
of illness but reports that the child often bumps into doorways and furniture.
The nurse reviews the electronic health record and documents visit-related care in the nursing
progress notes. Implements provider orders and provides education as appropriate.
While assessing a pediatric client, a nurse notices that the child is unable to focus on an object
with both eyes simultaneously. Which other finding in the client will suggest strabismus? Select
all that apply. One, some, or all responses may be correct.
A+ TEST BANK 4
