NGN 2019 Pediatrics Proctored Exam B with 100 Questions
and Correct Answers with Rationales/ Pediatrics Proctored
Exam 2019 B with NGN Latest 2025-2026 Update
A nurse on a pediatric unit is caring for a toddler.
Medical History
Hemophilia A
Nurses' Notes
1100:
Guardian reports that the toddler fell at home while playing with toys. Since the
fall, the toddler has been very irritable, crying uncontrollably, and grabbing at their
left knee. The toddler can walk but insists on being picked up.
Physical Examination
1115: Toddler is alert during the exam. Extremities are warm and dry to touch.
Decreased movement of the left leg observed. Tenderness noted with palpation of
the left knee joint. Pain level assessed as 6 on a scale of 0 to 10 using the FLACC
scale.
1145: Toddler is fussy and crying. Pain assessed as 8 on scale of 0 to 10 using the
FLACC scale.
Left knee observed to be ecchymotic and edematous.
Vital Signs
1115:
Temperature 36.9° C (98.4° F)Heart rate 110/minRespiratory rate 28/minOxygen
saturation 98% on room air. - ANSWER-For each potential provider's
pg. 1
,prescription, click to specify if the potential prescription is anticipated or
contraindicated for the toddler.
Administer factor VIII is anticipated. The child is experiencing an acute episode of
hemophilia due to a recent fall. During this acute episode, there is potential for
internal bleeding into the joint spaces. Therefore, administering factor VIII is
anticipated to control bleeding.
Apply ice packs to the affected joints is anticipated. The child is experiencing an
acute episode of hemarthrosis due to a recent fall, as evidenced by the bruising and
swelling of the knee joint. Therefore, applying ice packs to the affected joints is
anticipated to manage discomfort and decrease bleeding into the joint.
Administer morphine PRN pain is anticipated. The child is experiencing severe
pain. Opioids can be administered in the inpatient setting to relieve pain.
Otherwise, acetaminophen can be given at home for pain. Aspirin and NSAIDs
should be avoided because they inhibit platelet function and might increase
bleeding.
Perform passive range-of-motion (ROM) exercises during the first 12 hr following
injury is contraindicated. The child is experiencing an acute episode of
hemarthrosis. Passive ROM exercises can increase bleeding into the joint for the
first 48 hr following injury. The toddler should be encouraged to exercise the joint
as tolerated.
Elevate the affected joints is anticipated. The child is experiencing an acute
episode of hemarthrosis due to a recent fall, as evidenced by the bruising and
swelling of the knee joint. Elevation of the joint, along with the application of ice,
is anticipated to help decrease bleeding and swelling in the joint.
A nurse on a pediatric unit is caring for a school-age child.
Vital Signs
1230:
pg. 2
,Temperature 38.2° C (100.8° F)Heart rate 110/min Respiratory rate 20/min Blood
pressure 90/60 mm Hg Pulse oximetry 97%
1330:
Temperature 38.2° C (100.8° F)Heart rate 100/min Respiratory rate 22minPulse
oximetry 92%
Physical Examination
Child is restless and crying. Swelling noted at hand joints. Capillary refill less than
3 seconds. Mucous membranes dry and sticky. Respirations regular and unlabored.
Abdomen soft, flat, and non-distended. Tenderness with light palpation. Child
reports pain as 8 on a scale of 0 to 10.
Diagnostic Results
CBC:
Hemoglobin 8.0 g/dL (10 to 15.5 g/dL)Hematocrit 28% (32% to 44%) RBC count
4.2 million/mm3 (4 to 5.5 million/mm3)WBC count 12,000/mm3 (5,000 to
10,000/mm3)Platelets 350,000/mm3 (150,000 to 400,000/mm3) Reticulocyte
count 3% (0.5% to 2%).
Medical History
Sickle cell anemia - ANSWER-After reviewing the information in the child's
medical record, which of the following findings should the nurse address first?
Oxygen saturation is correct. The child's pulse oximeter reading is below the
expected reference range. The nurse should take action to maintain the child's
oxygen saturation above 95%. When using the urgent vs. non-urgent approach to
client care, the nurse should identify that addressing the child's hypoxia is the
priority intervention.
pg. 3
, Pain is correct. The child reported their pain as 8 on a scale of 0 to 10, which
indicates severe pain. Vaso-occlusive crises can cause severe pain due to tissue
ischemia from sickled cells obstructing blood flow. When using the urgent vs. non-
urgent approach to client care, the nurse should identify that addressing the child's
pain is the priority after addressing the child's hypoxia.
Graphic Record
Temperature 37.5° C (99.5° F)
Heart rate 70/min
Respiratory rate 30/min
Birth weight 3.2 kg (7 lb)
Current weight 5.9 (13 lb)
Nurses' Notes
3 episodes of vomiting
6 wet diapers in 24 hr
Consumed 3 oz concentrated formula every 3 hr
Medication Administration Record
Digoxin 0.5 mcg PO Q12H
Furosemide 20 mg PO Q12H - ANSWER-Episodes of vomiting
When using the urgent vs. nonurgent approach to client care, the nurse should
determine that the priority finding is three episodes of vomiting. This can indicate
digoxin toxicity, which requires immediate intervention. Therefore, this is the
nurse's priority finding.
A nurse is caring for a preschooler who was recently admitted to a pediatric unit.
pg. 4
and Correct Answers with Rationales/ Pediatrics Proctored
Exam 2019 B with NGN Latest 2025-2026 Update
A nurse on a pediatric unit is caring for a toddler.
Medical History
Hemophilia A
Nurses' Notes
1100:
Guardian reports that the toddler fell at home while playing with toys. Since the
fall, the toddler has been very irritable, crying uncontrollably, and grabbing at their
left knee. The toddler can walk but insists on being picked up.
Physical Examination
1115: Toddler is alert during the exam. Extremities are warm and dry to touch.
Decreased movement of the left leg observed. Tenderness noted with palpation of
the left knee joint. Pain level assessed as 6 on a scale of 0 to 10 using the FLACC
scale.
1145: Toddler is fussy and crying. Pain assessed as 8 on scale of 0 to 10 using the
FLACC scale.
Left knee observed to be ecchymotic and edematous.
Vital Signs
1115:
Temperature 36.9° C (98.4° F)Heart rate 110/minRespiratory rate 28/minOxygen
saturation 98% on room air. - ANSWER-For each potential provider's
pg. 1
,prescription, click to specify if the potential prescription is anticipated or
contraindicated for the toddler.
Administer factor VIII is anticipated. The child is experiencing an acute episode of
hemophilia due to a recent fall. During this acute episode, there is potential for
internal bleeding into the joint spaces. Therefore, administering factor VIII is
anticipated to control bleeding.
Apply ice packs to the affected joints is anticipated. The child is experiencing an
acute episode of hemarthrosis due to a recent fall, as evidenced by the bruising and
swelling of the knee joint. Therefore, applying ice packs to the affected joints is
anticipated to manage discomfort and decrease bleeding into the joint.
Administer morphine PRN pain is anticipated. The child is experiencing severe
pain. Opioids can be administered in the inpatient setting to relieve pain.
Otherwise, acetaminophen can be given at home for pain. Aspirin and NSAIDs
should be avoided because they inhibit platelet function and might increase
bleeding.
Perform passive range-of-motion (ROM) exercises during the first 12 hr following
injury is contraindicated. The child is experiencing an acute episode of
hemarthrosis. Passive ROM exercises can increase bleeding into the joint for the
first 48 hr following injury. The toddler should be encouraged to exercise the joint
as tolerated.
Elevate the affected joints is anticipated. The child is experiencing an acute
episode of hemarthrosis due to a recent fall, as evidenced by the bruising and
swelling of the knee joint. Elevation of the joint, along with the application of ice,
is anticipated to help decrease bleeding and swelling in the joint.
A nurse on a pediatric unit is caring for a school-age child.
Vital Signs
1230:
pg. 2
,Temperature 38.2° C (100.8° F)Heart rate 110/min Respiratory rate 20/min Blood
pressure 90/60 mm Hg Pulse oximetry 97%
1330:
Temperature 38.2° C (100.8° F)Heart rate 100/min Respiratory rate 22minPulse
oximetry 92%
Physical Examination
Child is restless and crying. Swelling noted at hand joints. Capillary refill less than
3 seconds. Mucous membranes dry and sticky. Respirations regular and unlabored.
Abdomen soft, flat, and non-distended. Tenderness with light palpation. Child
reports pain as 8 on a scale of 0 to 10.
Diagnostic Results
CBC:
Hemoglobin 8.0 g/dL (10 to 15.5 g/dL)Hematocrit 28% (32% to 44%) RBC count
4.2 million/mm3 (4 to 5.5 million/mm3)WBC count 12,000/mm3 (5,000 to
10,000/mm3)Platelets 350,000/mm3 (150,000 to 400,000/mm3) Reticulocyte
count 3% (0.5% to 2%).
Medical History
Sickle cell anemia - ANSWER-After reviewing the information in the child's
medical record, which of the following findings should the nurse address first?
Oxygen saturation is correct. The child's pulse oximeter reading is below the
expected reference range. The nurse should take action to maintain the child's
oxygen saturation above 95%. When using the urgent vs. non-urgent approach to
client care, the nurse should identify that addressing the child's hypoxia is the
priority intervention.
pg. 3
, Pain is correct. The child reported their pain as 8 on a scale of 0 to 10, which
indicates severe pain. Vaso-occlusive crises can cause severe pain due to tissue
ischemia from sickled cells obstructing blood flow. When using the urgent vs. non-
urgent approach to client care, the nurse should identify that addressing the child's
pain is the priority after addressing the child's hypoxia.
Graphic Record
Temperature 37.5° C (99.5° F)
Heart rate 70/min
Respiratory rate 30/min
Birth weight 3.2 kg (7 lb)
Current weight 5.9 (13 lb)
Nurses' Notes
3 episodes of vomiting
6 wet diapers in 24 hr
Consumed 3 oz concentrated formula every 3 hr
Medication Administration Record
Digoxin 0.5 mcg PO Q12H
Furosemide 20 mg PO Q12H - ANSWER-Episodes of vomiting
When using the urgent vs. nonurgent approach to client care, the nurse should
determine that the priority finding is three episodes of vomiting. This can indicate
digoxin toxicity, which requires immediate intervention. Therefore, this is the
nurse's priority finding.
A nurse is caring for a preschooler who was recently admitted to a pediatric unit.
pg. 4
