Each case presents a real patient scenario with 6–7 linked clinical-judgment questions — exactly the NCSBN April 2026 NGN format. Bow-tie, matrix, cloze, trend, and extended-response items across all 6 CJMM layers.
The nurse reviews the assessment data for this 6-year-old brought to the ED with fever, headache, and neck stiffness.
The nurse performs a rapid assessment of the 3-year-old brought to the pediatric ED by his parents.
[NURSE'S NOTES] Sophia Chen is a 7-month-old female (pre-illness weight 7.6 kg, current weight 6.8 kg — 10.5% weight loss) brought to the pediatric ED with severe dehydration secondary to viral gastroenteritis (4 days of vomiting and diarrhea). Breastfed exclusively. Last wet diaper >10 hours ago. A
Elijah Brown is a 4-year-old unvaccinated male (parents declined Hib vaccine) brought to the ED by his parents after sudden onset of fever, severe sore throat, and difficulty breathing starting 3 hours ago. He is sitting bolt upright, leaning forward on both hands with his neck extended (tripod/snif
Carlos Rivera is a 3-year-old male brought to the pediatrician for 8 consecutive days of high fever (39.1-40.2°C) unresponsive to antipyretics. His mother reports he has been irritable and 'not himself.' On examination: bilateral non-exudative conjunctival injection; oral mucosa shows strawberry ton
Emma Chen is a 5-year-old female brought to the pediatrician by her mother who noticed 'puffy eyes' for the past week. The puffiness is worse in the morning and improves slightly during the day. She has developed a progressively distended abdomen and visible swelling of her legs. She had a URI 2 wee
CASE 4 — Baby Elias, 18-day-old male neonate. GBS status unknown. Parents report 12-hour history: not eating, very sleepy, one episode of whole-body stiffening lasting 45 seconds, and a high-pitched cry. Fontanelle looks 'puffier than normal.' T 38.9C (rectal), HR 192 bpm, RR 58, SpO2 94% (room air)
Noah Castillo is an 18-month-old male brought to the pediatric ED by his mother's boyfriend, who states, 'He fell off the couch while I was watching him.' The child's records show two prior ED visits. Assessment: Weight 11.2 kg (25th percentile), GCS 11, VS: BP 90/58, HR 148, RR 26, Temp 37.0°C, SpO
[NURSE'S NOTES] Patient: Noah Castillo, 18-month-old male Setting: Pediatric Emergency Department Clinical Context: Noah is an 18-month-old male brought to the pediatric ED by his mother's boyfriend, who states, "He fell off the couch while I was watching him — he landed on his head and started cryi
[NURSE'S NOTES] Patient: Baby Olivia Chen, Neonate — 18 hours of life Setting: Mother-Baby Unit / Neonatal ICU Clinical Context: Baby Olivia Chen is an 18-hour-old female neonate, born at 38+5 weeks via vaginal delivery to a 29-year-old G2P2 mother (Lily Chen). The delivery was uncomplicated, Apgar
Jake Morrison, 15-year-old male, is brought to the pediatric ED by his mother at 2:00 AM. He woke from sleep with sudden onset severe right testicular pain 2 hours ago. He has vomited twice. He denies trauma, sexual activity, and dysuria. Assessment: T 37.1C, HR 116, BP 136/84, RR 20. Right testicle
Ms. Petrov, 31F G2P1 at 39+2 weeks with diet-controlled GDM and macrosomic fetus. Develops intrapartum hyperglycemia and shoulder dystocia requiring McRoberts maneuver.
Marcus, 6M with nephrotic syndrome. Corticosteroids, home urine dipstick, pneumococcal vaccination, aggressive diuresis contraindicated.
A 12-month-old male, Noah Rodriguez, presents with his mother for his 12-month well-child visit. He was born full-term with no complications (birth we...
Mr. William Carver, a 79-year-old male with metastatic pancreatic cancer (diagnosed 8 months ago), is admitted to the inpatient palliative care unit at his own request following a goals-of-care conversation with his oncologist and palliative care team. He and his family have decided to pursue comfort-focused care — no further chemotherapy, no CPR (DNR/DNI order on file), no ICU admission. He has an advance directive naming his daughter, Sarah, as healthcare proxy. He is alert and oriented, though increasingly fatigued. His primary symptoms: severe pain (7/10, poorly controlled at home on oxycodone 10 mg q4h), nausea, decreased appetite, and profound fatigue. He reports his biggest fear is suffering in pain at the end. His wife and three adult children are present. He has been a farmer his whole life and describes his faith as 'very important' to him.
An 8-month-old male is brought to the emergency department by his parents. Mother reports the infant has had episodes of sudden inconsolable screaming approximately every 15-20 minutes for the past 8 hours, during which he pulls his knees up to his chest and becomes pale and diaphoretic. Between episodes, the infant appears limp and lethargic. He has vomited four times, with the most recent emesis appearing green-tinged. Twenty minutes ago he passed a stool described by the mother as 'red and sl
Complete the Bow-Tie clinical reasoning diagram for a 4-week-old male with projectile vomiting. Select the condition most consistent with the presentation, TWO priority nursing actions, and TWO parameters to monitor.
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