ATI RN PEDIATRICS | NEXT GEN (NGN)
PROCTORED EXAM
Question 1
A 4-year-old child with asthma presents to the ED with wheezing, accessory
muscle use, and an SpO₂ of 91% on room air. The child is anxious and unable to
speak in full sentences.
Which intervention should the nurse implement first?
A. Administer a nebulized albuterol treatment
B. Provide oxygen via non-rebreather mask
C. Obtain a peak expiratory flow measurement
D. Encourage pursed-lip breathing
Answer: B. Provide oxygen via non-rebreather mask
Rationale:
The priority is to correct hypoxia and improve oxygenation. A non-rebreather
delivers high FiO₂ and is indicated for moderate to severe respiratory distress.
Nebulized albuterol is important but oxygenation takes priority.
,Question 2
A 6-month-old infant is admitted with bronchiolitis. The nurse notes nasal flaring,
retractions, and RR of 70. The infant is feeding poorly and has a weak cry.
What is the nurse’s priority action?
A. Start IV fluids
B. Administer racemic epinephrine
C. Place the infant in a high Fowler’s position
D. Assess hydration and respiratory status
Answer: D. Assess hydration and respiratory status
Rationale:
Before interventions, the nurse must assess for severity of respiratory distress and
dehydration. This guides the next actions and prevents delayed recognition of
respiratory failure.
2. Medication / Pharmacology
Question 3
A 10-year-old child with diabetes mellitus type 1 has a blood glucose of 58 mg/dL
and is lethargic. The child is unable to swallow.
Which action should the nurse take?
A. Give 4 oz of orange juice
B. Administer 1 mg glucagon IM
C. Administer 10 units regular insulin
D. Give a glucose gel orally
Answer: B. Administer 1 mg glucagon IM
Rationale:
For hypoglycemia with altered mental status and inability to swallow, glucagon IM
is the safest and most effective intervention.
,3. Growth & Development
Question 4
A 2-year-old toddler is hospitalized and becomes upset when the parent leaves.
The nurse should expect this behavior as:
A. Separation anxiety
B. Stranger anxiety
C. Regression
D. Developmental delay
Answer: A. Separation anxiety
Rationale:
Toddlers commonly experience separation anxiety when separated from
caregivers, especially during hospitalization.
4.
Question 5
Scenario:
A 7-year-old child is admitted with appendicitis and is scheduled for surgery in 2
hours. The child is complaining of severe abdominal pain and is lying still on the
bed. Vital signs: HR 120, BP 90/58, RR 24, Temp 38.2°C.
Which nursing intervention is most important at this time?
A. Administer PRN morphine
B. Encourage the child to ambulate
C. Provide clear liquids
D. Apply a heating pad to the abdomen
Answer: A. Administer PRN morphine
Rationale:
Pain control is essential and does not increase risk of rupture. The child is likely
experiencing worsening inflammation. Ambulation and oral intake are
contraindicated pre-op, and heat can increase risk of rupture.
, 5. Infection Control
Question 6
A child with rotavirus is admitted to the pediatric unit. Which isolation precaution
is required?
A. Airborne
B. Droplet
C. Contact
D. Standard only
Answer: C. Contact
Rationale:
Rotavirus spreads via fecal-oral route; contact precautions prevent spread from
contaminated surfaces and hands.
6. Fluid & Electrolytes
Question 7
A 3-year-old child is diagnosed with dehydration after gastroenteritis. The child
has dry mucous membranes, sunken eyes, and decreased urine output.
Which type of IV fluid is most appropriate?
A. 0.9% Normal saline
B. D5W
C. 0.45% Normal saline
D. Lactated Ringer’s
Answer: A. 0.9% Normal saline
Rationale:
Isotonic fluids are used for initial fluid resuscitation in dehydration to restore
intravascular volume.
PROCTORED EXAM
Question 1
A 4-year-old child with asthma presents to the ED with wheezing, accessory
muscle use, and an SpO₂ of 91% on room air. The child is anxious and unable to
speak in full sentences.
Which intervention should the nurse implement first?
A. Administer a nebulized albuterol treatment
B. Provide oxygen via non-rebreather mask
C. Obtain a peak expiratory flow measurement
D. Encourage pursed-lip breathing
Answer: B. Provide oxygen via non-rebreather mask
Rationale:
The priority is to correct hypoxia and improve oxygenation. A non-rebreather
delivers high FiO₂ and is indicated for moderate to severe respiratory distress.
Nebulized albuterol is important but oxygenation takes priority.
,Question 2
A 6-month-old infant is admitted with bronchiolitis. The nurse notes nasal flaring,
retractions, and RR of 70. The infant is feeding poorly and has a weak cry.
What is the nurse’s priority action?
A. Start IV fluids
B. Administer racemic epinephrine
C. Place the infant in a high Fowler’s position
D. Assess hydration and respiratory status
Answer: D. Assess hydration and respiratory status
Rationale:
Before interventions, the nurse must assess for severity of respiratory distress and
dehydration. This guides the next actions and prevents delayed recognition of
respiratory failure.
2. Medication / Pharmacology
Question 3
A 10-year-old child with diabetes mellitus type 1 has a blood glucose of 58 mg/dL
and is lethargic. The child is unable to swallow.
Which action should the nurse take?
A. Give 4 oz of orange juice
B. Administer 1 mg glucagon IM
C. Administer 10 units regular insulin
D. Give a glucose gel orally
Answer: B. Administer 1 mg glucagon IM
Rationale:
For hypoglycemia with altered mental status and inability to swallow, glucagon IM
is the safest and most effective intervention.
,3. Growth & Development
Question 4
A 2-year-old toddler is hospitalized and becomes upset when the parent leaves.
The nurse should expect this behavior as:
A. Separation anxiety
B. Stranger anxiety
C. Regression
D. Developmental delay
Answer: A. Separation anxiety
Rationale:
Toddlers commonly experience separation anxiety when separated from
caregivers, especially during hospitalization.
4.
Question 5
Scenario:
A 7-year-old child is admitted with appendicitis and is scheduled for surgery in 2
hours. The child is complaining of severe abdominal pain and is lying still on the
bed. Vital signs: HR 120, BP 90/58, RR 24, Temp 38.2°C.
Which nursing intervention is most important at this time?
A. Administer PRN morphine
B. Encourage the child to ambulate
C. Provide clear liquids
D. Apply a heating pad to the abdomen
Answer: A. Administer PRN morphine
Rationale:
Pain control is essential and does not increase risk of rupture. The child is likely
experiencing worsening inflammation. Ambulation and oral intake are
contraindicated pre-op, and heat can increase risk of rupture.
, 5. Infection Control
Question 6
A child with rotavirus is admitted to the pediatric unit. Which isolation precaution
is required?
A. Airborne
B. Droplet
C. Contact
D. Standard only
Answer: C. Contact
Rationale:
Rotavirus spreads via fecal-oral route; contact precautions prevent spread from
contaminated surfaces and hands.
6. Fluid & Electrolytes
Question 7
A 3-year-old child is diagnosed with dehydration after gastroenteritis. The child
has dry mucous membranes, sunken eyes, and decreased urine output.
Which type of IV fluid is most appropriate?
A. 0.9% Normal saline
B. D5W
C. 0.45% Normal saline
D. Lactated Ringer’s
Answer: A. 0.9% Normal saline
Rationale:
Isotonic fluids are used for initial fluid resuscitation in dehydration to restore
intravascular volume.
