ATI PEDIATRIC NURSING EXAM
Child Health Assessment & Family-Centered Care
Comprehensive Assessment | 2026/2027
75 Questions with Verified Correct Answers and Rationales
Select the BEST answer for each question. Correct answers are highlighted in bold cyan.
Growth & Development Milestones (Newborn to Adolescent)
1. A nurse is assessing a 4-month-old infant at a well-child visit. The mother asks which motor milestones she
should expect her infant to achieve by this age. Which response by the nurse is most appropriate?
A. Sitting independently without support
B. Rolling from front to back and holding the head steady when pulled to a sitting position
C. Walking while holding onto furniture (cruising)
D. Transferring objects from one hand to the other voluntarily
Rationale: By 4 months, an infant should roll front-to-back and demonstrate good head control (no head lag when pulled to
sit). Sitting independently typically emerges around 6–7 months, cruising around 9–12 months, and voluntary transfer
around 5–6 months. These milestones align with CDC and AAP developmental surveillance guidelines.
2. A 2-year-old child is seen in the pediatric clinic. The parent reports the child uses approximately 20 single
words but does not combine words into two-word phrases. The child's hearing screening is normal. Which action
should the nurse take first?
A. Reassure the parent that language development varies widely at this age
B. Refer the child for a comprehensive developmental evaluation
C. Advise the parent to read to the child for 30 minutes daily and recheck in 6 months
D. Teach the parent sign language to facilitate communication until speech develops
Rationale: By 24 months, children should have a vocabulary of at least 50 words and be combining two-word phrases. This
child has a significant expressive language delay with fewer than 50 words and no word combinations, despite normal
hearing. AAP recommends referral for a comprehensive developmental and speech-language evaluation when red flags for
speech delay are identified. Reassurance without further action would delay needed intervention.
3. A nurse is providing anticipatory guidance to the parents of a 12-month-old infant. The nurse explains the
infant's developmental stage using Erikson's psychosocial theory. Which developmental task should the nurse
identify as the primary focus for this age?
A. Trust versus mistrust
B. Autonomy versus shame and doubt
C. Initiative versus guilt
D. Industry versus inferiority
Rationale: According to Erikson, the stage of autonomy versus shame and doubt spans from approximately 18 months to 3
years. However, many nursing frameworks place the toddler period (1–3 years) in this stage, and anticipatory guidance at
12 months should begin addressing emerging autonomy (e.g., encouraging self-feeding, simple choices). Trust versus
1
,mistrust (infancy, 0–18 months) is the correct stage for the first year. Industry versus inferiority (school age, 6–12 years)
and initiative versus guilt (preschool, 3–6 years) occur later.
4. A nurse observes a 3-year-old child in the playroom stacking blocks to build a tower and explaining, 'The big
block goes on the bottom so it won't fall down.' According to Piaget's theory of cognitive development, which
stage is this child demonstrating?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
Rationale: The preoperational stage (ages 2–7 years) is characterized by symbolic thought, egocentrism, and the use of
language to describe the world. This child demonstrates symbolic representation through pretend play with blocks and
verbal reasoning. The sensorimotor stage (birth to 2 years) involves learning through senses and motor actions without
language. The concrete operational stage (7–11 years) involves logical thought about concrete objects, and formal
operations (12+ years) involves abstract reasoning.
5. During a health assessment of a 9-month-old infant, the nurse notes that the infant cannot sit unsupported even
briefly, does not babble, and does not reach for objects. Which interpretation of these findings is most accurate?
A. These findings are within normal limits for a 9-month-old who was born at 34 weeks' gestation
B. These findings indicate significant developmental delay and require immediate referral
C. These findings suggest mild delay; the nurse should schedule a follow-up in 2 months
D. These findings are typical for a 9-month-old who is the youngest child in a large family
Rationale: By 9 months, an infant should sit without support, babble (with consonant-vowel combinations like 'ba-ba' or
'da-da'), and reach for and grasp objects. The absence of all three milestones across different developmental domains
(gross motor, language, and fine motor) constitutes significant global developmental delay requiring prompt referral.
Preterm birth alone at 34 weeks does not account for delays this extensive at 9 months corrected age, and family birth order
does not explain these deficits.
6. A school nurse is conducting a health screening for an 8-year-old child. The child expresses frustration about
not being 'as good as the other kids' at math and says, 'I'm stupid.' Based on Erikson's psychosocial theory, which
nursing intervention best supports this child's developmental stage?
A. Provide one-on-one tutoring sessions in math after school each week
B. Recognize and praise the child's accomplishments and effort across various activities
C. Encourage the child to set academic goals independently without adult input
D. Refer the child to a school counselor for psychosocial evaluation
Rationale: The school-age child (6–12 years) is in Erikson's industry versus inferiority stage, where the child develops a
sense of competence through mastery of tasks. Praising accomplishments and effort helps build self-efficacy and a sense of
industry. While tutoring and counseling may be appropriate in specific contexts, the broadest developmental intervention is
to reinforce competence and achievement. Allowing the child to set goals independently without support does not address
the child's feelings of inferiority.
2
, 7. A nurse is assessing a 15-year-old adolescent who reports feeling isolated from peers and says, 'I don't know
who I am or what I want to do with my life.' The nurse recognizes that this adolescent is struggling with which
developmental task according to Erikson?
A. Identity versus role confusion
B. Intimacy versus isolation
C. Autonomy versus shame and doubt
D. Initiative versus guilt
Rationale: Erikson's identity versus role confusion stage occurs during adolescence (approximately 12–18 years). The
primary developmental task is forming a coherent sense of self, exploring values, beliefs, and future goals. This adolescent's
statements directly reflect identity confusion. Intimacy versus isolation occurs in young adulthood, autonomy versus shame
and doubt in toddlerhood, and initiative versus guilt in the preschool years.
8. A nurse is assessing a 5-year-old child who is hospitalized for an appendectomy. The child says, 'I'm being
punished because I didn't eat my vegetables.' Which developmental concept best explains this child's
interpretation of hospitalization?
A. Animism, a characteristic of the preoperational stage
B. Transductive reasoning, a characteristic of the preoperational stage
C. Conservation, a characteristic of the concrete operational stage
D. Object permanence, a characteristic of the sensorimotor stage
Rationale: Transductive reasoning is a hallmark of Piaget's preoperational stage (ages 2–7), in which children draw
illogical cause-and-effect conclusions between unrelated events. This child connects not eating vegetables (an unrelated
prior event) with hospitalization (a medical event), which is characteristic of preoperational transductive reasoning.
Animism refers to attributing lifelike qualities to inanimate objects, conservation refers to understanding quantity remains
the same despite changes in shape, and object permanence is a sensorimotor achievement.
Pediatric Assessment Techniques
9. A nurse is obtaining vital signs on a 3-year-old child in the pediatric clinic. Which set of vital signs is within
the expected reference range for this child's age?
A. Heart rate 80/min, respiratory rate 14/min, blood pressure 90/60 mm Hg
B. Heart rate 130/min, respiratory rate 30/min, blood pressure 110/70 mm Hg
C. Heart rate 100/min, respiratory rate 24/min, blood pressure 98/64 mm Hg
D. Heart rate 60/min, respiratory rate 10/min, blood pressure 120/80 mm Hg
Rationale: For a 3-year-old child, expected vital signs include a heart rate of 80–130/min, respiratory rate of 20–30/min,
and blood pressure approximately 90–110/55–75 mm Hg. The values in option C fall squarely within these ranges. Option
A shows a heart rate and respiratory rate at the very low end. Option B shows blood pressure that is slightly elevated for
age. Option D shows vital signs that are too low for a toddler and more consistent with an adult range.
10. A nurse is performing a head-to-toe assessment on a 6-month-old infant. In which order should the nurse
perform the assessment to minimize distress?
A. Auscultate heart and lungs first, then examine ears and mouth, then palpate the abdomen
B. Examine ears and mouth first, then auscultate heart and lungs, then palpate extremities
C. Palpate the abdomen first, then auscultate heart and lungs, then examine ears and mouth
3
Child Health Assessment & Family-Centered Care
Comprehensive Assessment | 2026/2027
75 Questions with Verified Correct Answers and Rationales
Select the BEST answer for each question. Correct answers are highlighted in bold cyan.
Growth & Development Milestones (Newborn to Adolescent)
1. A nurse is assessing a 4-month-old infant at a well-child visit. The mother asks which motor milestones she
should expect her infant to achieve by this age. Which response by the nurse is most appropriate?
A. Sitting independently without support
B. Rolling from front to back and holding the head steady when pulled to a sitting position
C. Walking while holding onto furniture (cruising)
D. Transferring objects from one hand to the other voluntarily
Rationale: By 4 months, an infant should roll front-to-back and demonstrate good head control (no head lag when pulled to
sit). Sitting independently typically emerges around 6–7 months, cruising around 9–12 months, and voluntary transfer
around 5–6 months. These milestones align with CDC and AAP developmental surveillance guidelines.
2. A 2-year-old child is seen in the pediatric clinic. The parent reports the child uses approximately 20 single
words but does not combine words into two-word phrases. The child's hearing screening is normal. Which action
should the nurse take first?
A. Reassure the parent that language development varies widely at this age
B. Refer the child for a comprehensive developmental evaluation
C. Advise the parent to read to the child for 30 minutes daily and recheck in 6 months
D. Teach the parent sign language to facilitate communication until speech develops
Rationale: By 24 months, children should have a vocabulary of at least 50 words and be combining two-word phrases. This
child has a significant expressive language delay with fewer than 50 words and no word combinations, despite normal
hearing. AAP recommends referral for a comprehensive developmental and speech-language evaluation when red flags for
speech delay are identified. Reassurance without further action would delay needed intervention.
3. A nurse is providing anticipatory guidance to the parents of a 12-month-old infant. The nurse explains the
infant's developmental stage using Erikson's psychosocial theory. Which developmental task should the nurse
identify as the primary focus for this age?
A. Trust versus mistrust
B. Autonomy versus shame and doubt
C. Initiative versus guilt
D. Industry versus inferiority
Rationale: According to Erikson, the stage of autonomy versus shame and doubt spans from approximately 18 months to 3
years. However, many nursing frameworks place the toddler period (1–3 years) in this stage, and anticipatory guidance at
12 months should begin addressing emerging autonomy (e.g., encouraging self-feeding, simple choices). Trust versus
1
,mistrust (infancy, 0–18 months) is the correct stage for the first year. Industry versus inferiority (school age, 6–12 years)
and initiative versus guilt (preschool, 3–6 years) occur later.
4. A nurse observes a 3-year-old child in the playroom stacking blocks to build a tower and explaining, 'The big
block goes on the bottom so it won't fall down.' According to Piaget's theory of cognitive development, which
stage is this child demonstrating?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
Rationale: The preoperational stage (ages 2–7 years) is characterized by symbolic thought, egocentrism, and the use of
language to describe the world. This child demonstrates symbolic representation through pretend play with blocks and
verbal reasoning. The sensorimotor stage (birth to 2 years) involves learning through senses and motor actions without
language. The concrete operational stage (7–11 years) involves logical thought about concrete objects, and formal
operations (12+ years) involves abstract reasoning.
5. During a health assessment of a 9-month-old infant, the nurse notes that the infant cannot sit unsupported even
briefly, does not babble, and does not reach for objects. Which interpretation of these findings is most accurate?
A. These findings are within normal limits for a 9-month-old who was born at 34 weeks' gestation
B. These findings indicate significant developmental delay and require immediate referral
C. These findings suggest mild delay; the nurse should schedule a follow-up in 2 months
D. These findings are typical for a 9-month-old who is the youngest child in a large family
Rationale: By 9 months, an infant should sit without support, babble (with consonant-vowel combinations like 'ba-ba' or
'da-da'), and reach for and grasp objects. The absence of all three milestones across different developmental domains
(gross motor, language, and fine motor) constitutes significant global developmental delay requiring prompt referral.
Preterm birth alone at 34 weeks does not account for delays this extensive at 9 months corrected age, and family birth order
does not explain these deficits.
6. A school nurse is conducting a health screening for an 8-year-old child. The child expresses frustration about
not being 'as good as the other kids' at math and says, 'I'm stupid.' Based on Erikson's psychosocial theory, which
nursing intervention best supports this child's developmental stage?
A. Provide one-on-one tutoring sessions in math after school each week
B. Recognize and praise the child's accomplishments and effort across various activities
C. Encourage the child to set academic goals independently without adult input
D. Refer the child to a school counselor for psychosocial evaluation
Rationale: The school-age child (6–12 years) is in Erikson's industry versus inferiority stage, where the child develops a
sense of competence through mastery of tasks. Praising accomplishments and effort helps build self-efficacy and a sense of
industry. While tutoring and counseling may be appropriate in specific contexts, the broadest developmental intervention is
to reinforce competence and achievement. Allowing the child to set goals independently without support does not address
the child's feelings of inferiority.
2
, 7. A nurse is assessing a 15-year-old adolescent who reports feeling isolated from peers and says, 'I don't know
who I am or what I want to do with my life.' The nurse recognizes that this adolescent is struggling with which
developmental task according to Erikson?
A. Identity versus role confusion
B. Intimacy versus isolation
C. Autonomy versus shame and doubt
D. Initiative versus guilt
Rationale: Erikson's identity versus role confusion stage occurs during adolescence (approximately 12–18 years). The
primary developmental task is forming a coherent sense of self, exploring values, beliefs, and future goals. This adolescent's
statements directly reflect identity confusion. Intimacy versus isolation occurs in young adulthood, autonomy versus shame
and doubt in toddlerhood, and initiative versus guilt in the preschool years.
8. A nurse is assessing a 5-year-old child who is hospitalized for an appendectomy. The child says, 'I'm being
punished because I didn't eat my vegetables.' Which developmental concept best explains this child's
interpretation of hospitalization?
A. Animism, a characteristic of the preoperational stage
B. Transductive reasoning, a characteristic of the preoperational stage
C. Conservation, a characteristic of the concrete operational stage
D. Object permanence, a characteristic of the sensorimotor stage
Rationale: Transductive reasoning is a hallmark of Piaget's preoperational stage (ages 2–7), in which children draw
illogical cause-and-effect conclusions between unrelated events. This child connects not eating vegetables (an unrelated
prior event) with hospitalization (a medical event), which is characteristic of preoperational transductive reasoning.
Animism refers to attributing lifelike qualities to inanimate objects, conservation refers to understanding quantity remains
the same despite changes in shape, and object permanence is a sensorimotor achievement.
Pediatric Assessment Techniques
9. A nurse is obtaining vital signs on a 3-year-old child in the pediatric clinic. Which set of vital signs is within
the expected reference range for this child's age?
A. Heart rate 80/min, respiratory rate 14/min, blood pressure 90/60 mm Hg
B. Heart rate 130/min, respiratory rate 30/min, blood pressure 110/70 mm Hg
C. Heart rate 100/min, respiratory rate 24/min, blood pressure 98/64 mm Hg
D. Heart rate 60/min, respiratory rate 10/min, blood pressure 120/80 mm Hg
Rationale: For a 3-year-old child, expected vital signs include a heart rate of 80–130/min, respiratory rate of 20–30/min,
and blood pressure approximately 90–110/55–75 mm Hg. The values in option C fall squarely within these ranges. Option
A shows a heart rate and respiratory rate at the very low end. Option B shows blood pressure that is slightly elevated for
age. Option D shows vital signs that are too low for a toddler and more consistent with an adult range.
10. A nurse is performing a head-to-toe assessment on a 6-month-old infant. In which order should the nurse
perform the assessment to minimize distress?
A. Auscultate heart and lungs first, then examine ears and mouth, then palpate the abdomen
B. Examine ears and mouth first, then auscultate heart and lungs, then palpate extremities
C. Palpate the abdomen first, then auscultate heart and lungs, then examine ears and mouth
3
