ATI RN Pediatric Nursing Proctored
Exam (2026/27 Edition) Includes NGN
and Detailed Rationales
Exam Structure: 120 Questions (100 Scored + 20 Unscored Pilot)
• Section I: Growth & Development (20 Questions)
• Section II: Cardiovascular & Respiratory Disorders (15 Questions)
• Section III: Neurologic & Musculoskeletal Disorders (15 Questions)
• Section IV: GI, Renal, & Metabolic Disorders (15 Questions)
• Section V: Infectious & Integumentary Disorders (10 Questions)
• Section VI: Safety, Pharmacology, & Immunizations (15 Questions)
• Section VII: Next Generation NCLEX (NGN) Case Studies (30 Questions)
Section I: Growth & Development (20 Questions)
1. A nurse in a pediatric clinic is assessing a 4-month-old infant. Which of the following developmental
milestones should the nurse expect to observe?
A. Sitting independently without support
B. Grasping a rattle briefly
C. Crawling on hands and knees
D. Transferring objects from hand to hand
Answer & Rationale:
• Answer B. Grasping a rattle briefly
• Rationale: At 4 months, infants typically can grasp objects briefly, hold a rattle, and bring
objects to their mouth. Sitting independently occurs around 6-8 months (A). Crawling occurs at
8-10 months (C). Transferring objects occurs around 6-7 months (D).
2. A nurse is providing anticipatory guidance to parents of a 12-month-old. Which statement indicates
an understanding of injury prevention?
A. "We will place crib bumper pads to prevent the baby from hitting their head."
B. "We will turn the water heater temperature to 140°F (60°C) for sterilization."
,C. "We will keep the car seat rear-facing until at least age 2."
D. "We will give whole milk in a sippy cup at bedtime to help them sleep."
Answer & Rationale:
• Answer C. "We will keep the car seat rear-facing until at least age 2."
• Rationale: The AAP recommends rear-facing car seats until age 2 or until the child reaches the
maximum height/weight limit. Bumper pads (A) are a suffocation/SIDS risk. Water heaters
should be set to 120°F (49°C) to prevent burns (B). Bedtime bottles/sippy cups cause "bottle
mouth caries" (early childhood cavities) (D).
3. A school nurse is teaching a class about physical development. According to Erikson, a 7-year-old
child is in which psychosocial stage, and what is the primary conflict?
A. Trust vs. Mistrust
B. Initiative vs. Guilt
C. Industry vs. Inferiority
D. Identity vs. Role Confusion
Answer & Rationale:
• Answer C. Industry vs. Inferiority
• Rationale: Erikson’s stages: Industry vs. Inferiority corresponds to school-age children (6-12
years) where they focus on mastering skills and receiving recognition. Initiative vs. Guilt (B) is
preschool age (3-5). Trust vs. Mistrust (A) is infancy. Identity vs. Role Confusion (D) is
adolescence.
4. A nurse is assessing a 3-year-old child. Which finding is a developmental red flag that should be
reported to the provider?
A. The child is unable to ride a tricycle.
B. The child is unable to copy a circle.
C. The child is unable to build a tower of 9 blocks.
D. The child is unable to jump with both feet.
Answer & Rationale:
• Answer A. The child is unable to ride a tricycle.
• Rationale: By age 3, a child should be able to pedal a tricycle. Inability to do so may indicate
gross motor delay. Copying a circle (B) is a 4-year-old milestone. Building a tower of 9-10 blocks
and jumping with both feet (C & D) are expected by 36 months, but the absence may require
further assessment; however, tricycle riding is a classic 3-year-old gross motor skill.
5. A nurse is teaching a parent about play activities for a hospitalized 2-year-old. Which activity is
most developmentally appropriate to reduce anxiety?
A. Playing a board game with rules
B. Playing with a large puzzle with a parent
C. Watching a movie alone in bed
D. Building a model airplane
,Answer & Rationale:
• Answer B. Playing with a large puzzle with a parent
• Rationale: Toddlers engage in parallel play but benefit from simple, structured activities with a
parent present (familial presence reduces separation anxiety). Board games (A) are for school-
age. Watching a movie alone (C) isolates the child. Model airplanes (D) require fine motor skills
for older children.
6. A parent asks the nurse, "My 15-month-old walks well but falls a lot. When will they be able to walk
up stairs?" The nurse should respond that this skill usually occurs by what age?
A. 18 months
B. 24 months
C. 30 months
D. 36 months
Answer & Rationale:
• Answer B. 24 months (2 years)
• Rationale: While an 18-month-old can walk up stairs with help, walking up and down stairs
alone (holding rail) is typically achieved by 24 months.
7. A nurse is assessing a 7-month-old infant. Which finding requires immediate intervention by the
nurse?
A. The infant has a social smile.
B. The infant has a positive Babinski reflex.
C. The infant cannot sit unsupported.
D. The infant cannot say "mama" specifically.
Answer & Rationale:
• Answer C. The infant cannot sit unsupported.
• Rationale: By 7 months, most infants can sit unsupported. Failure to do so may indicate a gross
motor delay.
• Distractors: Social smile (A) emerges at 2 months, so present at 7 is normal. Babinski reflex (B)
disappears around 12 months, so present is normal. Saying "mama" specifically (D) is a 10-12
month milestone, so absence at 7 is normal.
8. A nurse is providing education to the parents of a preschool-age child about sleep. Which
intervention should the nurse recommend to manage nightmares?
A. Allow the child to sleep in the parents' bed permanently.
B. Provide a night light and reassure the child there are no monsters.
C. Force the child to stay in their room alone to build independence.
D. Give the child a heavy meal right before bed.
Answer & Rationale:
• Answer B. Provide a night light and reassure the child there are no monsters.
, • Rationale: Nightmares are common in preschoolers due to vivid imaginations. A night light and
reassurance ("magic spray") validate their fear without reinforcing it.
• Rationale for incorrect answers: Co-sleeping (A) can be a hard habit to break. Forcing isolation
(C) increases anxiety. Heavy meals (D) cause GI discomfort and worse sleep.
9. A nurse in a well-child clinic is assessing a 9-year-old child. Which physical assessment finding is
expected?
Answer & Rationale:
• Answer B. Menarche
• Rationale: Menarche (first menstruation) usually occurs between ages 10 and 16. Growth of
axillary hair (A) begins around age 10-14. Widening of hips (C) occurs during puberty (age 9-14).
Deepening of voice (D) is a male secondary sex characteristic occurring around age 12-16.
10. A nurse is observing a 6-month-old infant during a well-child visit. The parent asks the nurse if the
infant understands the game of peek-a-boo. The nurse should explain that this game helps develop
which concept?
A. Egocentrism
B. Object permanence
C. Conservation
D. Abstract reasoning
Answer & Rationale:
• Answer B. Object permanence
• Rationale: According to Piaget, object permanence (understanding that objects/people continue
to exist even when not seen) develops during the Sensorimotor stage (birth-2 years). Peek-a-boo
helps reinforce that the parent is coming back.
11. A nurse is assessing a 2-week-old newborn. Which reflex is expected to be present at this
age? (Select all that apply)
A. Moro reflex
B. Tonic neck reflex
C. Rooting reflex
D. Stepping reflex
Answer & Rationale:
• Correct Answers: A, B, C, D (All of the above)
• Rationale: All primitive reflexes (Moro, Tonic neck, Rooting, Sucking, Babinski, Stepping) are
present at birth. Rooting disappears around 4 months. Moro disappears around 6 months. Tonic
neck (fencer position) disappears around 4-6 months.
12. The mother of a 16-month-old toddler tells the nurse, "My child is so picky. Yesterday they only
ate crackers." What is the nurse’s best response?
A. "You should force them to eat vegetables before leaving the table."
Exam (2026/27 Edition) Includes NGN
and Detailed Rationales
Exam Structure: 120 Questions (100 Scored + 20 Unscored Pilot)
• Section I: Growth & Development (20 Questions)
• Section II: Cardiovascular & Respiratory Disorders (15 Questions)
• Section III: Neurologic & Musculoskeletal Disorders (15 Questions)
• Section IV: GI, Renal, & Metabolic Disorders (15 Questions)
• Section V: Infectious & Integumentary Disorders (10 Questions)
• Section VI: Safety, Pharmacology, & Immunizations (15 Questions)
• Section VII: Next Generation NCLEX (NGN) Case Studies (30 Questions)
Section I: Growth & Development (20 Questions)
1. A nurse in a pediatric clinic is assessing a 4-month-old infant. Which of the following developmental
milestones should the nurse expect to observe?
A. Sitting independently without support
B. Grasping a rattle briefly
C. Crawling on hands and knees
D. Transferring objects from hand to hand
Answer & Rationale:
• Answer B. Grasping a rattle briefly
• Rationale: At 4 months, infants typically can grasp objects briefly, hold a rattle, and bring
objects to their mouth. Sitting independently occurs around 6-8 months (A). Crawling occurs at
8-10 months (C). Transferring objects occurs around 6-7 months (D).
2. A nurse is providing anticipatory guidance to parents of a 12-month-old. Which statement indicates
an understanding of injury prevention?
A. "We will place crib bumper pads to prevent the baby from hitting their head."
B. "We will turn the water heater temperature to 140°F (60°C) for sterilization."
,C. "We will keep the car seat rear-facing until at least age 2."
D. "We will give whole milk in a sippy cup at bedtime to help them sleep."
Answer & Rationale:
• Answer C. "We will keep the car seat rear-facing until at least age 2."
• Rationale: The AAP recommends rear-facing car seats until age 2 or until the child reaches the
maximum height/weight limit. Bumper pads (A) are a suffocation/SIDS risk. Water heaters
should be set to 120°F (49°C) to prevent burns (B). Bedtime bottles/sippy cups cause "bottle
mouth caries" (early childhood cavities) (D).
3. A school nurse is teaching a class about physical development. According to Erikson, a 7-year-old
child is in which psychosocial stage, and what is the primary conflict?
A. Trust vs. Mistrust
B. Initiative vs. Guilt
C. Industry vs. Inferiority
D. Identity vs. Role Confusion
Answer & Rationale:
• Answer C. Industry vs. Inferiority
• Rationale: Erikson’s stages: Industry vs. Inferiority corresponds to school-age children (6-12
years) where they focus on mastering skills and receiving recognition. Initiative vs. Guilt (B) is
preschool age (3-5). Trust vs. Mistrust (A) is infancy. Identity vs. Role Confusion (D) is
adolescence.
4. A nurse is assessing a 3-year-old child. Which finding is a developmental red flag that should be
reported to the provider?
A. The child is unable to ride a tricycle.
B. The child is unable to copy a circle.
C. The child is unable to build a tower of 9 blocks.
D. The child is unable to jump with both feet.
Answer & Rationale:
• Answer A. The child is unable to ride a tricycle.
• Rationale: By age 3, a child should be able to pedal a tricycle. Inability to do so may indicate
gross motor delay. Copying a circle (B) is a 4-year-old milestone. Building a tower of 9-10 blocks
and jumping with both feet (C & D) are expected by 36 months, but the absence may require
further assessment; however, tricycle riding is a classic 3-year-old gross motor skill.
5. A nurse is teaching a parent about play activities for a hospitalized 2-year-old. Which activity is
most developmentally appropriate to reduce anxiety?
A. Playing a board game with rules
B. Playing with a large puzzle with a parent
C. Watching a movie alone in bed
D. Building a model airplane
,Answer & Rationale:
• Answer B. Playing with a large puzzle with a parent
• Rationale: Toddlers engage in parallel play but benefit from simple, structured activities with a
parent present (familial presence reduces separation anxiety). Board games (A) are for school-
age. Watching a movie alone (C) isolates the child. Model airplanes (D) require fine motor skills
for older children.
6. A parent asks the nurse, "My 15-month-old walks well but falls a lot. When will they be able to walk
up stairs?" The nurse should respond that this skill usually occurs by what age?
A. 18 months
B. 24 months
C. 30 months
D. 36 months
Answer & Rationale:
• Answer B. 24 months (2 years)
• Rationale: While an 18-month-old can walk up stairs with help, walking up and down stairs
alone (holding rail) is typically achieved by 24 months.
7. A nurse is assessing a 7-month-old infant. Which finding requires immediate intervention by the
nurse?
A. The infant has a social smile.
B. The infant has a positive Babinski reflex.
C. The infant cannot sit unsupported.
D. The infant cannot say "mama" specifically.
Answer & Rationale:
• Answer C. The infant cannot sit unsupported.
• Rationale: By 7 months, most infants can sit unsupported. Failure to do so may indicate a gross
motor delay.
• Distractors: Social smile (A) emerges at 2 months, so present at 7 is normal. Babinski reflex (B)
disappears around 12 months, so present is normal. Saying "mama" specifically (D) is a 10-12
month milestone, so absence at 7 is normal.
8. A nurse is providing education to the parents of a preschool-age child about sleep. Which
intervention should the nurse recommend to manage nightmares?
A. Allow the child to sleep in the parents' bed permanently.
B. Provide a night light and reassure the child there are no monsters.
C. Force the child to stay in their room alone to build independence.
D. Give the child a heavy meal right before bed.
Answer & Rationale:
• Answer B. Provide a night light and reassure the child there are no monsters.
, • Rationale: Nightmares are common in preschoolers due to vivid imaginations. A night light and
reassurance ("magic spray") validate their fear without reinforcing it.
• Rationale for incorrect answers: Co-sleeping (A) can be a hard habit to break. Forcing isolation
(C) increases anxiety. Heavy meals (D) cause GI discomfort and worse sleep.
9. A nurse in a well-child clinic is assessing a 9-year-old child. Which physical assessment finding is
expected?
Answer & Rationale:
• Answer B. Menarche
• Rationale: Menarche (first menstruation) usually occurs between ages 10 and 16. Growth of
axillary hair (A) begins around age 10-14. Widening of hips (C) occurs during puberty (age 9-14).
Deepening of voice (D) is a male secondary sex characteristic occurring around age 12-16.
10. A nurse is observing a 6-month-old infant during a well-child visit. The parent asks the nurse if the
infant understands the game of peek-a-boo. The nurse should explain that this game helps develop
which concept?
A. Egocentrism
B. Object permanence
C. Conservation
D. Abstract reasoning
Answer & Rationale:
• Answer B. Object permanence
• Rationale: According to Piaget, object permanence (understanding that objects/people continue
to exist even when not seen) develops during the Sensorimotor stage (birth-2 years). Peek-a-boo
helps reinforce that the parent is coming back.
11. A nurse is assessing a 2-week-old newborn. Which reflex is expected to be present at this
age? (Select all that apply)
A. Moro reflex
B. Tonic neck reflex
C. Rooting reflex
D. Stepping reflex
Answer & Rationale:
• Correct Answers: A, B, C, D (All of the above)
• Rationale: All primitive reflexes (Moro, Tonic neck, Rooting, Sucking, Babinski, Stepping) are
present at birth. Rooting disappears around 4 months. Moro disappears around 6 months. Tonic
neck (fencer position) disappears around 4-6 months.
12. The mother of a 16-month-old toddler tells the nurse, "My child is so picky. Yesterday they only
ate crackers." What is the nurse’s best response?
A. "You should force them to eat vegetables before leaving the table."
