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ATI RN Pediatric Nursing Exam
2026/2027 Actual Exam | NGN-Aligned
with Expert-Modeled Questions | Pass
Guaranteed - A+ Graded
UNFOLDING CASE STUDY: Infant with Respiratory Distress
Scenario Part 1 (Recognizing Cues):
A 4-month-old infant is brought to the emergency department by parents who report the infant
has been coughing and has difficulty breathing for the past 2 days. The infant is irritable, has a
temperature of 101.2°F (38.4°C), and has a runny nose. On assessment, the nurse notes nasal
flaring, intercostal retractions, and a respiratory rate of 68 breaths/min. The infant is feeding
poorly and has had only 2 wet diapers in the past 12 hours.
Q1: Which of the following cues are MOST significant for this infant? (Select all that apply)
A. [ ] Age 4 months
B. [X] Nasal flaring [CORRECT]
C. [X] Intercostal retractions [CORRECT]
D. [X] Respiratory rate 68 breaths/min [CORRECT]
E. [X] Poor feeding with decreased wet diapers [CORRECT]
Correct Answer: B, C, D, E
Rationale: Nasal flaring, retractions, tachypnea (RR >60 in infants), and signs of dehydration
are significant cues of respiratory distress and potential respiratory failure. Age (A) is
demographic but not an acute cue.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Recognizing Cues
Scenario Part 2 (Analyzing Cues):
The infant is diagnosed with bronchiolitis caused by respiratory syncytial virus (RSV). Oxygen
saturation is 89% on room air.
Q2: Based on the assessment findings, which of the following conditions is the infant
developing?
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A. Respiratory distress
B. Respiratory failure [CORRECT]
C. Pneumothorax
D. Apnea
Correct Answer: B
Rationale: Hypoxemia (O2 sat <90%) with signs of increased work of breathing indicates
respiratory failure. Option A (distress) precedes failure. Options C and D are specific
complications.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Analyzing Cues
Scenario Part 3 (Prioritizing Hypotheses):
The infant is admitted to the pediatric unit.
Q3: Which of the following is the priority nursing diagnosis for this infant?
A. Impaired gas exchange related to airway inflammation [CORRECT]
B. Risk for infection related to viral illness
C. Altered nutrition: less than body requirements related to poor feeding
D. Fluid volume deficit related to decreased intake
Correct Answer: A
Rationale: Impaired gas exchange is the priority as it directly affects oxygenation and may lead
to respiratory failure. Options B, C, and D are important but not the immediate priority.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Prioritizing Hypotheses
Scenario Part 4 (Generating Solutions):
The provider orders oxygen therapy, suctioning, and IV fluids.
Q4: Which of the following interventions are appropriate for this infant? (Select all that apply)
A. [X] Administer oxygen via nasal cannula to maintain O2 sat >92% [CORRECT]
B. [X] Suction the nares gently with a bulb syringe [CORRECT]
C. [ ] Encourage oral feedings every 2 hours
D. [X] Administer IV fluids as ordered [CORRECT]
E. [ ] Place the infant in a supine position
Correct Answer: A, B, D
Rationale: Oxygen, gentle suction, and IV fluids are appropriate. Option C (oral feedings) may
not be tolerated and increases aspiration risk. Option E (supine) may worsen work of breathing;
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positioning with head elevated is better.
Client Need: Physiological Integrity – Basic Care and Comfort
Cognitive Level: Generating Solutions
Scenario Part 5 (Taking Action):
The nurse is preparing to suction the infant's nares.
Q5: Which of the following actions is correct when suctioning an infant?
A. Suction for 10-15 seconds
B. Suction for 5-10 seconds [CORRECT]
C. Suction for 30 seconds
D. Suction for 1 minute
Correct Answer: B
Rationale: Suctioning should be limited to 5-10 seconds to prevent hypoxia. Options A, C, and
D are too long.
Client Need: Safe and Effective Care Environment – Safety and Infection Control
Cognitive Level: Taking Action
Scenario Part 6 (Evaluating Outcomes):
After 24 hours of treatment, the infant's oxygen saturation is 94% on room air, respiratory rate is
42 breaths/min, and the infant is feeding well.
Q6: Which of the following outcomes indicates that the infant's condition is improving?
A. Respiratory rate 68 breaths/min
B. Oxygen saturation 94% on room air [CORRECT]
C. Poor feeding
D. Nasal flaring present
Correct Answer: B
Rationale: Improved oxygen saturation to normal levels (>92%) indicates improvement.
Options A, C, and D indicate ongoing respiratory distress.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Evaluating Outcomes
UNFOLDING CASE STUDY: Child with Sickle Cell Crisis
Scenario Part 1 (Recognizing Cues):
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A 10-year-old child with sickle cell disease is admitted to the hospital with severe pain in the legs
and arms. The child reports pain 8/10. Vital signs: HR 120 bpm, BP 110/70 mmHg, RR 24/min,
temperature 99.8°F (37.7°C). The child is crying and holding the legs.
Q7: Which of the following cues are MOST significant? (Select all that apply)
A. [X] History of sickle cell disease [CORRECT]
B. [X] Severe pain in extremities [CORRECT]
C. [X] Heart rate 120 bpm [CORRECT]
D. [ ] Temperature 99.8°F
E. [ ] Crying
Correct Answer: A, B, C
Rationale: History of sickle cell disease with severe pain suggests vaso-occlusive crisis.
Tachycardia (C) indicates pain response. Temperature (D) is mildly elevated. Crying (E) is a pain
response but less specific.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Recognizing Cues
Scenario Part 2 (Analyzing Cues):
The child is diagnosed with a vaso-occlusive crisis. Laboratory results show hemoglobin 7.2
g/dL and hematocrit 21%.
Q8: Which of the following laboratory findings is consistent with sickle cell crisis?
A. Hemoglobin 12 g/dL
B. Hemoglobin 7.2 g/dL [CORRECT]
C. Platelet count 500,000/mm³
D. White blood cell count 15,000/mm³
Correct Answer: B
Rationale: Hemoglobin levels are typically low (7-10 g/dL) during sickle cell crisis due to
hemolysis. Option A is normal. Option C is elevated but not specific to sickle cell. Option D is
elevated but not specific to sickle cell.
Client Need: Physiological Integrity – Reduction of Risk Potential
Cognitive Level: Analyzing Cues
Scenario Part 3 (Prioritizing Hypotheses):
The child is receiving IV fluids and pain management.
Q9: Which of the following is the priority nursing intervention for this child?
A. Administer IV fluids as ordered [CORRECT]
ATI RN Pediatric Nursing Exam
2026/2027 Actual Exam | NGN-Aligned
with Expert-Modeled Questions | Pass
Guaranteed - A+ Graded
UNFOLDING CASE STUDY: Infant with Respiratory Distress
Scenario Part 1 (Recognizing Cues):
A 4-month-old infant is brought to the emergency department by parents who report the infant
has been coughing and has difficulty breathing for the past 2 days. The infant is irritable, has a
temperature of 101.2°F (38.4°C), and has a runny nose. On assessment, the nurse notes nasal
flaring, intercostal retractions, and a respiratory rate of 68 breaths/min. The infant is feeding
poorly and has had only 2 wet diapers in the past 12 hours.
Q1: Which of the following cues are MOST significant for this infant? (Select all that apply)
A. [ ] Age 4 months
B. [X] Nasal flaring [CORRECT]
C. [X] Intercostal retractions [CORRECT]
D. [X] Respiratory rate 68 breaths/min [CORRECT]
E. [X] Poor feeding with decreased wet diapers [CORRECT]
Correct Answer: B, C, D, E
Rationale: Nasal flaring, retractions, tachypnea (RR >60 in infants), and signs of dehydration
are significant cues of respiratory distress and potential respiratory failure. Age (A) is
demographic but not an acute cue.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Recognizing Cues
Scenario Part 2 (Analyzing Cues):
The infant is diagnosed with bronchiolitis caused by respiratory syncytial virus (RSV). Oxygen
saturation is 89% on room air.
Q2: Based on the assessment findings, which of the following conditions is the infant
developing?
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A. Respiratory distress
B. Respiratory failure [CORRECT]
C. Pneumothorax
D. Apnea
Correct Answer: B
Rationale: Hypoxemia (O2 sat <90%) with signs of increased work of breathing indicates
respiratory failure. Option A (distress) precedes failure. Options C and D are specific
complications.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Analyzing Cues
Scenario Part 3 (Prioritizing Hypotheses):
The infant is admitted to the pediatric unit.
Q3: Which of the following is the priority nursing diagnosis for this infant?
A. Impaired gas exchange related to airway inflammation [CORRECT]
B. Risk for infection related to viral illness
C. Altered nutrition: less than body requirements related to poor feeding
D. Fluid volume deficit related to decreased intake
Correct Answer: A
Rationale: Impaired gas exchange is the priority as it directly affects oxygenation and may lead
to respiratory failure. Options B, C, and D are important but not the immediate priority.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Prioritizing Hypotheses
Scenario Part 4 (Generating Solutions):
The provider orders oxygen therapy, suctioning, and IV fluids.
Q4: Which of the following interventions are appropriate for this infant? (Select all that apply)
A. [X] Administer oxygen via nasal cannula to maintain O2 sat >92% [CORRECT]
B. [X] Suction the nares gently with a bulb syringe [CORRECT]
C. [ ] Encourage oral feedings every 2 hours
D. [X] Administer IV fluids as ordered [CORRECT]
E. [ ] Place the infant in a supine position
Correct Answer: A, B, D
Rationale: Oxygen, gentle suction, and IV fluids are appropriate. Option C (oral feedings) may
not be tolerated and increases aspiration risk. Option E (supine) may worsen work of breathing;
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positioning with head elevated is better.
Client Need: Physiological Integrity – Basic Care and Comfort
Cognitive Level: Generating Solutions
Scenario Part 5 (Taking Action):
The nurse is preparing to suction the infant's nares.
Q5: Which of the following actions is correct when suctioning an infant?
A. Suction for 10-15 seconds
B. Suction for 5-10 seconds [CORRECT]
C. Suction for 30 seconds
D. Suction for 1 minute
Correct Answer: B
Rationale: Suctioning should be limited to 5-10 seconds to prevent hypoxia. Options A, C, and
D are too long.
Client Need: Safe and Effective Care Environment – Safety and Infection Control
Cognitive Level: Taking Action
Scenario Part 6 (Evaluating Outcomes):
After 24 hours of treatment, the infant's oxygen saturation is 94% on room air, respiratory rate is
42 breaths/min, and the infant is feeding well.
Q6: Which of the following outcomes indicates that the infant's condition is improving?
A. Respiratory rate 68 breaths/min
B. Oxygen saturation 94% on room air [CORRECT]
C. Poor feeding
D. Nasal flaring present
Correct Answer: B
Rationale: Improved oxygen saturation to normal levels (>92%) indicates improvement.
Options A, C, and D indicate ongoing respiratory distress.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Evaluating Outcomes
UNFOLDING CASE STUDY: Child with Sickle Cell Crisis
Scenario Part 1 (Recognizing Cues):
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A 10-year-old child with sickle cell disease is admitted to the hospital with severe pain in the legs
and arms. The child reports pain 8/10. Vital signs: HR 120 bpm, BP 110/70 mmHg, RR 24/min,
temperature 99.8°F (37.7°C). The child is crying and holding the legs.
Q7: Which of the following cues are MOST significant? (Select all that apply)
A. [X] History of sickle cell disease [CORRECT]
B. [X] Severe pain in extremities [CORRECT]
C. [X] Heart rate 120 bpm [CORRECT]
D. [ ] Temperature 99.8°F
E. [ ] Crying
Correct Answer: A, B, C
Rationale: History of sickle cell disease with severe pain suggests vaso-occlusive crisis.
Tachycardia (C) indicates pain response. Temperature (D) is mildly elevated. Crying (E) is a pain
response but less specific.
Client Need: Physiological Integrity – Physiological Adaptation
Cognitive Level: Recognizing Cues
Scenario Part 2 (Analyzing Cues):
The child is diagnosed with a vaso-occlusive crisis. Laboratory results show hemoglobin 7.2
g/dL and hematocrit 21%.
Q8: Which of the following laboratory findings is consistent with sickle cell crisis?
A. Hemoglobin 12 g/dL
B. Hemoglobin 7.2 g/dL [CORRECT]
C. Platelet count 500,000/mm³
D. White blood cell count 15,000/mm³
Correct Answer: B
Rationale: Hemoglobin levels are typically low (7-10 g/dL) during sickle cell crisis due to
hemolysis. Option A is normal. Option C is elevated but not specific to sickle cell. Option D is
elevated but not specific to sickle cell.
Client Need: Physiological Integrity – Reduction of Risk Potential
Cognitive Level: Analyzing Cues
Scenario Part 3 (Prioritizing Hypotheses):
The child is receiving IV fluids and pain management.
Q9: Which of the following is the priority nursing intervention for this child?
A. Administer IV fluids as ordered [CORRECT]
