ATI RN PEDIATRIC NURSING PROCTORED EXAM WITH NGN

ATI RN PEDIATRIC NURSING PROCTORED EXAM WITH NGN 2023 Edition | 70 Questions with NGN Comprehensive Study Guide with Rationales Exam Format Proctored Assessment ⏱ Time Allotted 120 Minutes Total Questions 70 Questions (includes NGN) Level RN — Bachelor's Entry Level CONTENT AREAS COVERED Respiratory System Cardiovascular System Gastrointestinal System Genitourinary/Renal Neurological System Hematology & Oncology Musculoskeletal Endocrine & Metabolic NGN / Next-Gen NCLEX For NCLEX-RN Preparation & ATI Proctored Assessment Practice EXAM INSTRUCTIONS & OVERVIEW ️ IMPORTANT — NGN Item Types This exam includes Next Generation NCLEX (NGN) style questions beginning at Question 56. NGN item types include Extended Multiple Response, Drop-Down (Prioritization), Matrix, Bow-Tie, and Case Study formats. These items require clinical judgment across multiple steps. General Instructions 1. This proctored exam consists of 70 questions covering pediatric nursing content aligned with the ATI RN Pediatric Nursing Content Mastery Series. 2. Questions 1–55 are standard multiple-choice (single best answer) questions. 3. Questions 56–70 are Next Generation NCLEX (NGN) style items requiring clinical judgment. 4. Read each question and all answer options carefully before selecting your response. 5. Do not leave any questions blank. If unsure, use the process of elimination and select your best answer. 6. Time limit: 120 minutes. Pace yourself — approximately 1.7 minutes per question. NGN Clinical Judgment Measurement Model (CJMM) NGN items measure six cognitive skills of clinical judgment: • Recognize Cues — What matters most from the client data? • Analyze Cues — What do the cues mean? • Prioritize Hypotheses — What is the most likely/urgent problem? • Generate Solutions — What should the nurse do? • Take Actions — Implement care based on clinical judgment • Evaluate Outcomes — Did interventions achieve the expected goals? ATI Scoring ATI Level Score Range NCLEX Likelihood Level 3 ≥ 90% Very High Level 2 75% – 89% High Level 1 75% Moderate SECTION 1 — RESPIRATORY SYSTEM (Q1–Q10) 1. A nurse is caring for a 4-year-old child admitted with croup. Which of the following assessment findings should the nurse report to the provider immediately? [Standard] A. Barky cough B. Hoarseness C. Inspiratory stridor at rest D. Low-grade fever Answer: C Rationale: Inspiratory stridor at rest indicates significant upper airway obstruction and is a medical emergency requiring immediate intervention. Barky cough, hoarseness, and low-grade fever are expected findings with croup. 2. A nurse is caring for an infant with respiratory syncytial virus (RSV) bronchiolitis. Which of the following interventions is the priority? [Standard] A. Administer ribavirin as prescribed B. Maintain airway patency with bulb syringe suctioning C. Administer antibiotics as prescribed D. Encourage oral fluids every 2 hours Answer: B Rationale: The priority intervention for RSV bronchiolitis is maintaining airway patency. Suctioning the nares before feedings helps clear mucus secretions. RSV is viral so antibiotics are not indicated. Ribavirin is rarely used. Oral fluids are important but secondary to airway. 3. A nurse is assessing a child with asthma. Which of the following findings indicates a severe asthma exacerbation? [Standard] A. SpO₂ 95% on room air B. Mild expiratory wheezing C. Use of accessory muscles and SpO₂ 88% D. Peak flow 80% of personal best Answer: C Rationale: Use of accessory muscles combined with SpO₂ below 90% indicates a severe asthma exacerbation requiring immediate intervention. A peak flow ≥80% is in the green zone; SpO₂ 95% is acceptable; mild wheezing suggests mild exacerbation. 4. A nurse is providing teaching to the parents of a child newly diagnosed with cystic fibrosis. Which statement by the parent indicates understanding of the disease? [Standard] A. 'My child should limit fluid intake to prevent excess mucus.' B. 'Chest physiotherapy should be done twice daily before meals.' C. 'My child will need antibiotic therapy only when symptomatic.' D. 'A low-fat, low-calorie diet is recommended.' Answer: B Rationale: Chest physiotherapy performed twice daily before meals helps mobilize thick secretions and prevent respiratory infections in CF. Fluid restriction is contraindicated. Prophylactic antibiotic therapy is common. Children with CF need high-calorie, high-fat diets due to pancreatic enzyme insufficiency. 5. A nurse is caring for a child who had a tonsillectomy 6 hours ago. Which assessment finding requires immediate intervention? [Standard] A. Complaints of throat pain rated 4/10 B. Frequent swallowing and restlessness C. Ice pack applied to the neck D. Preference for cool, clear liquids Answer: B Rationale: Frequent swallowing and restlessness after tonsillectomy are warning signs of post-operative hemorrhage. The child may be swallowing blood. This is a surgical emergency. Throat pain, ice packs, and preference for cool liquids are all expected after tonsillectomy. 6. A nurse is administering a tuberculin skin test (TST/Mantoux) to a 7-year-old child. Which of the following actions is correct? [Standard] A. Inject 0.1 mL intradermally on the dorsal forearm B. Inject 0.1 mL subcutaneously on the inner forearm C. Inject 0.1 mL intradermally on the inner forearm D. Inject 0.5 mL intradermally on the inner forearm Answer: C Rationale: The Mantoux tuberculin skin test is administered intradermally (not subcutaneously) on the inner forearm using 0.1 mL of PPD solution. A wheal of 6–10 mm should appear at the injection site. 7. A 2-year-old child is suspected of having epiglottitis. Which of the following actions should the nurse prioritize? [Standard] A. Prepare for throat culture B. Place child in a supine position C. Keep child calm and avoid agitating procedures D. Administer oral fluids immediately Answer: C Rationale: Epiglottitis can cause complete airway obstruction if the child becomes agitated or cries. The nurse should keep the child as calm as possible, allow the child to assume a position of comfort, and avoid any procedures (including throat exam, IV access) until the airway is secured. 8. A nurse is reviewing the medication orders for a child with asthma. Which medication should the nurse recognize as a long-term controller medication? [Standard] A. Albuterol (short-acting beta-2 agonist) B. Fluticasone (inhaled corticosteroid) C. Epinephrine (racemic) D. Ipratropium bromide (short-acting anticholinergic) Answer: B Rationale: Fluticasone is an inhaled corticosteroid used for long-term asthma control by reducing airway inflammation. Albuterol, ipratropium, and racemic epinephrine are all short-acting, used for acute bronchospasm relief. 9. A nurse is caring for a premature infant receiving oxygen therapy. Which complication should the nurse monitor for related to high oxygen concentrations? [Standard] A. Retinopathy of prematurity B. Hyaline membrane disease C. Intraventricular hemorrhage D. Necrotizing enterocolitis Answer: A Rationale: Retinopathy of prematurity (ROP) is caused by exposure to high concentrations of oxygen in premature infants, leading to abnormal retinal vessel development and potential blindness. SpO₂ levels should be maintained between 90–95% in premature infants. 10. A nurse is teaching parents about home management of a child with asthma. Which statement about peak flow monitoring is accurate? [Standard] A. 'A reading in the red zone means your child needs rescue inhaler therapy.' B. 'Peak flow meters measure oxygen saturation.' C. 'A green zone reading means the child's asthma is poorly controlled.' D. 'Peak flow readings are taken only when symptoms appear.' Answer: A Rationale: A red zone peak flow reading (below 50% of personal best) indicates severe airway obstruction and requires immediate rescue inhaler use and medical attention. Green zone (80–100%) is well-controlled; yellow zone (50–80%) requires caution. Peak flow meters measure expiratory flow rate, not oxygen saturation. SECTION 2 — CARDIOVASCULAR SYSTEM (Q11–Q18) 11. A nurse is assessing a 6-week-old infant with a suspected ventricular septal defect (VSD). Which assessment finding is most consistent with this diagnosis? [Standard] A. Cyanosis that worsens with crying B. Harsh holosystolic murmur at the left lower sternal border C. Bounding pulses in all extremities D. Clubbing of fingers and toes Answer: B Rationale: A harsh, holosystolic (pansystolic) murmur heard best at the left lower sternal border is characteristic of a VSD due to blood shunting from left to right through the ventricular defect. Cyanosis with crying suggests tetralogy of Fallot; bounding pulses indicate PDA; clubbing occurs with chronic cyanosis. 12. A nurse is caring for an infant with heart failure. Which of the following assessment findings requires immediate intervention? [Standard] A. Heart rate 140 bpm B. Respiratory rate 36/min C. Weight gain of 60 g/day D. Respiratory rate 72/min with retractions Answer: D Rationale: A respiratory rate of 72/min with retractions indicates severe respiratory distress requiring immediate intervention. Normal infant RR is 30–60/min. In heart failure, pulmonary congestion causes increased work of breathing. Mild tachycardia and modest weight gain are expected findings in heart failure. 13. A nurse is preparing to administer digoxin to an infant. The apical heart rate is 88 bpm. What action should the nurse take? [Standard] A. Administer the medication as ordered B. Hold the medication and notify the provider C. Reassess in 30 minutes and then administer D. Administer half the dose Answer: B Rationale: Digoxin should be held and the provider notified if the apical heart rate is below 90–100 bpm in infants (parameters may vary by institution, but 90 bpm is a common threshold). Digoxin toxicity can cause bradycardia, heart block, and dysrhythmias. 14. A nurse is teaching parents of a child with tetralogy of Fallot (TOF). Which instruction is most important regarding 'Tet spells' (hypercyanotic episodes)? [Standard] A. Place the child in a supine position during a spell B. Administer oxygen and place child in knee-chest position C. Encourage the child to cry to increase blood flow D. Give the child oral fluids to improve cardiac output Answer: B Rationale: During a Tet spell (hypercyanotic episode), the nurse should administer oxygen and place the child in a knee-chest position (squatting position). This increases systemic vascular resistance, decreases right-to-left shunting, and improves pulmonary blood flow. Morphine may also be given. 15. A nurse is assessing a child with Kawasaki disease in the acute phase. Which finding is expected? [Standard] A. Temperature 36.8°C (98.2°F) B. Bilateral purulent conjunctivitis C. Strawberry tongue and cracked lips D. Widespread petechial rash Answer: C Rationale: Kawasaki disease is characterized by strawberry tongue, cracked/red lips, high fever ≥5 days, non-exudative conjunctivitis (bilateral but NOT purulent), polymorphous rash, cervical lymphadenopathy, and extremity changes. The conjunctivitis is non-purulent, distinguishing it from bacterial conjunctivitis. 16. A nurse is caring for a child following cardiac catheterization via the femoral artery. Which of the following findings should be reported immediately? [Standard] A. Mild soreness at the insertion site B. Blood pressure 108/68 mmHg C. Pedal pulse 2+ in both feet D. Extremity distal to insertion site pale, cool, and pulseless Answer: D Rationale: Absence of a pulse, pallor, and coolness distal to the catheterization insertion site indicate arterial occlusion or spasm, which is a vascular emergency. This requires immediate notification of the provider and could result in limb ischemia. 17. A nurse is reviewing laboratory results for a child receiving furosemide for heart failure. Which electrolyte imbalance is most important to monitor? [Standard] A. Hypernatremia B. Hypokalemia C. Hyperkalemia D. Hypercalcemia Answer: B Rationale: Furosemide is a loop diuretic that causes urinary loss of potassium, sodium, and chloride. Hypokalemia is the most critical electrolyte imbalance to monitor because it potentiates digoxin toxicity. Dietary potassium supplementation or potassium supplements may be required. 18. A nurse is providing education about rheumatic fever prevention. Which statement by the parent indicates understanding? [Standard] A. 'Rheumatic fever follows viral respiratory infections.' B. 'My child must complete the full course of antibiotics for strep throat.' C. 'The disease primarily affects the kidneys.' D. 'Antibiotics are not needed if symptoms improve after 3 days.' Answer: B Rationale: Acute rheumatic fever is a complication of untreated or inadequately treated Group A streptococcal pharyngitis. Completing the full 10-day course of antibiotics (typically penicillin) is essential for eradicating the bacteria and preventing rheumatic fever and its cardiac complications.