,ATI RN Pediatric Proctored Exam Advanced
Prep: Master Pediatric Clinical Judgment &
Nursing Practice Questions
Subject: Pediatric Nursing | Subtopic: Comprehensive Clinical Judgment,
Growth & Development, and Pediatric Pathophysiology
Question 1: A nurse is caring for a 4-year-old child diagnosed with acute glomerulonephritis
(AGN). Which assessment finding is the priority for the nurse to report to the provider?
A) Serum potassium level of 5.8 mEq/L
B) Periorbital edema upon waking
C) Blood pressure of 115/78 mmHg
D) Tea-colored urine output
Correct Answer: A) Serum potassium level of 5.8 mEq/L
Explanation: In AGN, decreased glomerular filtration rate (GFR) leads to sodium and water
retention, and in severe cases, impaired potassium excretion. While periorbital edema,
hypertension, and hematuria (tea-colored urine) are classic clinical manifestations of AGN,
hyperkalemia (5.8 mEq/L) is a life-threatening complication that can cause fatal cardiac
arrhythmias. The nurse must prioritize electrolyte stabilization over the expected symptomatic
findings of the disease process.
Question 2: A nurse is assessing an 18-month-old toddler during a routine well-child visit.
Which finding should the nurse identify as a potential developmental delay requiring further
evaluation?
A) The toddler uses 10–15 words.
B) The toddler is unable to walk independently.
C) The toddler engages in parallel play with peers.
D) The toddler builds a tower of two blocks.
Correct Answer: B) The toddler is unable to walk independently.
Explanation: Most toddlers achieve independent walking by 12–15 months of age. An 18-month-
old who cannot walk independently indicates a significant motor developmental delay. Using
,10–15 words is within normal limits for an 18-month-old (who typically has a vocabulary of at
least 10 words). Parallel play and building a two-block tower are age-appropriate
developmental milestones for a toddler.
Question 3: A nurse is providing discharge teaching to the parents of a school-age child with
juvenile idiopathic arthritis (JIA). Which of the following instructions should the nurse include?
A) "Limit the movement of the child’s large joints to prevent further inflammation."
B) "Encourage the child to perform independent self-care activities."
C) "Provide the child with a soft mattress to cushion aching joints."
D) "Schedule a 2-hour daily nap in the afternoon to prevent fatigue."
Correct Answer: B) Encourage the child to perform independent self-care.
Explanation: Encouraging self-care is essential in JIA to promote independence and maintain
range of motion. Limiting movement (Option A) leads to joint contractures and muscle atrophy.
A firm mattress (Option C) is generally recommended to provide support. While rest is
important, a 2-hour daily nap (Option D) may interfere with the child’s school and social
development; rest should be balanced with activity.
Question 4: A nurse is caring for a child experiencing an anaphylactic reaction in the emergency
department. Which action is the nurse’s priority?
A) Elevate the head of the bed to facilitate breathing.
B) Insert a large-bore IV catheter for fluid resuscitation.
C) Administer intramuscular (IM) epinephrine.
D) Determine the allergen that caused the reaction.
Correct Answer: C) Administer intramuscular (IM) epinephrine.
Explanation: In an anaphylactic reaction, systemic histamine release causes vasodilation and
bronchoconstriction, which can lead to shock and airway obstruction. Epinephrine is the life-
saving priority as it acts as both a bronchodilator and a vasoconstrictor to reverse these effects.
While obtaining IV access is important, it must not delay the administration of epinephrine.
Question 5: A nurse is caring for a 6-month-old infant who is receiving treatment for severe
dehydration. Which finding is the most critical priority to report to the provider?
A) Heart rate of 170 bpm
, B) WBC count of 12,000/mm³
C) Decreased skin turgor
D) Sunken fontanel
Correct Answer: A) Heart rate of 170 bpm
Explanation: Tachycardia is an early compensatory sign of hypovolemic shock in infants. A heart
rate of 170 bpm is significantly elevated, indicating the infant is struggling to maintain cardiac
output due to severe volume depletion. While skin turgor and fontanels are important assessment
data for dehydration, the cardiovascular response (tachycardia) signifies an imminent threat to
systemic perfusion.
Question 6: A nurse is preparing to administer an immunization to a 4-year-old child. Which
action is most appropriate to minimize the child's pain?
A) Place the child in a prone position for the injection.
B) Request that the caregiver leave the room to reduce the child's anxiety.
C) Administer the immunization using a 24-gauge needle.
D) Aspirate for 3 seconds before injecting the medication.
Correct Answer: C) Administer the immunization using a 24-gauge needle.
Explanation: Using the smallest appropriate gauge needle (24-gauge) minimizes tissue trauma
and pain for the pediatric client. The caregiver should be encouraged to stay to provide comfort
(distancing them increases anxiety). Prone positioning is not standard, and aspiration is no
longer recommended for routine IM immunizations as it increases pain without clinical benefit.
Question 7: A nurse is caring for a toddler who has a concussion and an episode of forceful
vomiting. Which action should the nurse take first?
A) Administer an antiemetic medication.
B) Assess the child’s pupillary response.
C) Notify the provider of increased intracranial pressure (ICP) signs.
D) Elevate the head of the bed to 30 degrees.
Correct Answer: B) Assess the child’s pupillary response.
Prep: Master Pediatric Clinical Judgment &
Nursing Practice Questions
Subject: Pediatric Nursing | Subtopic: Comprehensive Clinical Judgment,
Growth & Development, and Pediatric Pathophysiology
Question 1: A nurse is caring for a 4-year-old child diagnosed with acute glomerulonephritis
(AGN). Which assessment finding is the priority for the nurse to report to the provider?
A) Serum potassium level of 5.8 mEq/L
B) Periorbital edema upon waking
C) Blood pressure of 115/78 mmHg
D) Tea-colored urine output
Correct Answer: A) Serum potassium level of 5.8 mEq/L
Explanation: In AGN, decreased glomerular filtration rate (GFR) leads to sodium and water
retention, and in severe cases, impaired potassium excretion. While periorbital edema,
hypertension, and hematuria (tea-colored urine) are classic clinical manifestations of AGN,
hyperkalemia (5.8 mEq/L) is a life-threatening complication that can cause fatal cardiac
arrhythmias. The nurse must prioritize electrolyte stabilization over the expected symptomatic
findings of the disease process.
Question 2: A nurse is assessing an 18-month-old toddler during a routine well-child visit.
Which finding should the nurse identify as a potential developmental delay requiring further
evaluation?
A) The toddler uses 10–15 words.
B) The toddler is unable to walk independently.
C) The toddler engages in parallel play with peers.
D) The toddler builds a tower of two blocks.
Correct Answer: B) The toddler is unable to walk independently.
Explanation: Most toddlers achieve independent walking by 12–15 months of age. An 18-month-
old who cannot walk independently indicates a significant motor developmental delay. Using
,10–15 words is within normal limits for an 18-month-old (who typically has a vocabulary of at
least 10 words). Parallel play and building a two-block tower are age-appropriate
developmental milestones for a toddler.
Question 3: A nurse is providing discharge teaching to the parents of a school-age child with
juvenile idiopathic arthritis (JIA). Which of the following instructions should the nurse include?
A) "Limit the movement of the child’s large joints to prevent further inflammation."
B) "Encourage the child to perform independent self-care activities."
C) "Provide the child with a soft mattress to cushion aching joints."
D) "Schedule a 2-hour daily nap in the afternoon to prevent fatigue."
Correct Answer: B) Encourage the child to perform independent self-care.
Explanation: Encouraging self-care is essential in JIA to promote independence and maintain
range of motion. Limiting movement (Option A) leads to joint contractures and muscle atrophy.
A firm mattress (Option C) is generally recommended to provide support. While rest is
important, a 2-hour daily nap (Option D) may interfere with the child’s school and social
development; rest should be balanced with activity.
Question 4: A nurse is caring for a child experiencing an anaphylactic reaction in the emergency
department. Which action is the nurse’s priority?
A) Elevate the head of the bed to facilitate breathing.
B) Insert a large-bore IV catheter for fluid resuscitation.
C) Administer intramuscular (IM) epinephrine.
D) Determine the allergen that caused the reaction.
Correct Answer: C) Administer intramuscular (IM) epinephrine.
Explanation: In an anaphylactic reaction, systemic histamine release causes vasodilation and
bronchoconstriction, which can lead to shock and airway obstruction. Epinephrine is the life-
saving priority as it acts as both a bronchodilator and a vasoconstrictor to reverse these effects.
While obtaining IV access is important, it must not delay the administration of epinephrine.
Question 5: A nurse is caring for a 6-month-old infant who is receiving treatment for severe
dehydration. Which finding is the most critical priority to report to the provider?
A) Heart rate of 170 bpm
, B) WBC count of 12,000/mm³
C) Decreased skin turgor
D) Sunken fontanel
Correct Answer: A) Heart rate of 170 bpm
Explanation: Tachycardia is an early compensatory sign of hypovolemic shock in infants. A heart
rate of 170 bpm is significantly elevated, indicating the infant is struggling to maintain cardiac
output due to severe volume depletion. While skin turgor and fontanels are important assessment
data for dehydration, the cardiovascular response (tachycardia) signifies an imminent threat to
systemic perfusion.
Question 6: A nurse is preparing to administer an immunization to a 4-year-old child. Which
action is most appropriate to minimize the child's pain?
A) Place the child in a prone position for the injection.
B) Request that the caregiver leave the room to reduce the child's anxiety.
C) Administer the immunization using a 24-gauge needle.
D) Aspirate for 3 seconds before injecting the medication.
Correct Answer: C) Administer the immunization using a 24-gauge needle.
Explanation: Using the smallest appropriate gauge needle (24-gauge) minimizes tissue trauma
and pain for the pediatric client. The caregiver should be encouraged to stay to provide comfort
(distancing them increases anxiety). Prone positioning is not standard, and aspiration is no
longer recommended for routine IM immunizations as it increases pain without clinical benefit.
Question 7: A nurse is caring for a toddler who has a concussion and an episode of forceful
vomiting. Which action should the nurse take first?
A) Administer an antiemetic medication.
B) Assess the child’s pupillary response.
C) Notify the provider of increased intracranial pressure (ICP) signs.
D) Elevate the head of the bed to 30 degrees.
Correct Answer: B) Assess the child’s pupillary response.
