ATI Pediatrics Proctored Exam Updated 2026 | Comprehensive Nursing
Study Guide, Practice Exam Questions and Answers, Exam Prep Test
Bank, Pediatric Growth and Development Milestones, Child Health
Assessment, Common Pediatric Disorders and Diseases, Pediatric
Pharmacology and Medication Safety, Family-Centered Care,
Immunization Guidelines, Clinical Judgment Skills, and Detailed Rationales
for ATI Exam Success
Question 1: A 2-day-old newborn, born at 39 weeks gestation via spontaneous
vaginal delivery, is being evaluated for a heart murmur. The infant is asymptomatic,
with normal peripheral pulses and no respiratory distress. An echocardiogram
reveals a small patent ductus arteriosus (PDA) with left-to-right shunting. Which of
the following is the most appropriate initial management for this infant?
A. Immediate surgical ligation
B. Indomethacin administration
C. Observation and supportive care
D. Cardiac catheterization with coil occlusion
CORRECT ANSWER: C. Observation and supportive care
Rationale: In a full-term, asymptomatic newborn with a small PDA, spontaneous
closure is highly likely within the first 24-72 hours of life. Indomethacin is used for a
hemodynamically significant PDA in premature infants, not asymptomatic full-term
infants. Surgical ligation and catheterization are reserved for patients who fail medical
management or develop complications.
Question 2: A 6-month-old infant is brought to the clinic for a well-child visit. The
mother reports that the infant has been exclusively breastfed since birth and has
not received any vitamin supplements. On physical examination, the infant is
irritable and has frontal bossing and widened wrist joints. Which of the following
laboratory findings is most consistent with the suspected diagnosis?
A. Elevated serum calcium
B. Elevated serum alkaline phosphatase
C. Decreased serum parathyroid hormone
D. Normal serum phosphorus
CORRECT ANSWER: B. Elevated serum alkaline phosphatase
Rationale: The clinical presentation of frontal bossing and widened wrists in a breastfed
infant without vitamin D supplementation is classic for rickets. Vitamin D deficiency
leads to impaired calcium absorption, resulting in secondary hyperparathyroidism,
which causes an elevation in serum alkaline phosphatase (a marker of bone turnover)
and decreased serum phosphorus.
Question 3: A 4-year-old child presents with a 3-day history of fever, cough, and
conjunctivitis. On examination, the nurse notes the presence of small, white, grain-
,like spots on the buccal mucosa opposite the lower molars. Which of the following
immunizations is most effective at preventing the disease associated with this
finding?
A. DTaP
B. MMR
C. Hib
D. Varicella
CORRECT ANSWER: B. MMR
Rationale: The presence of Koplik spots (small white spots on the buccal mucosa) is a
pathognomonic sign of measles (rubeola). The MMR (Measles, Mumps, Rubella)
vaccine is highly effective at preventing measles. The first dose is typically administered
at 12-15 months of age.
Question 4: A 10-year-old child with a history of asthma is brought to the
emergency department with severe respiratory distress. The nurse administers a
bronchodilator via nebulizer. Which of the following findings would indicate a
therapeutic response to this medication?
A. Increased respiratory rate
B. Decreased peak expiratory flow rate
C. Decreased wheezing on auscultation
D. Increased use of accessory muscles
CORRECT ANSWER: C. Decreased wheezing on auscultation
Rationale: Wheezing is caused by air passing through narrowed airways. A therapeutic
response to a bronchodilator (e.g., albuterol) results in bronchodilation, which
decreases airway resistance and reduces wheezing. Increased respiratory rate,
accessory muscle use, and decreased peak flow indicate worsening respiratory status.
Question 5: A 2-week-old infant is being evaluated for persistent vomiting that is
described as forceful and projectile, occurring shortly after feeding. The infant is
visibly hungry and has not gained weight since birth. Which of the following
findings on physical examination would be most suggestive of the underlying
diagnosis?
A. A palpable olive-shaped mass in the right upper quadrant
B. Hyperactive bowel sounds in the lower quadrants
C. A scaphoid abdomen
D. A palpable mass in the left lower quadrant
CORRECT ANSWER: A. A palpable olive-shaped mass in the right upper quadrant
Rationale: The classic presentation of projectile, non-bilious vomiting in a 2-week-old
infant is hypertrophic pyloric stenosis. The hypertrophy of the pyloric muscle creates a
,palpable, firm, mobile mass (olive-shaped) in the right upper quadrant. A scaphoid
abdomen is more associated with diaphragmatic hernia.
Question 6: A 7-year-old child is diagnosed with acute otitis media. The child has a
history of a severe anaphylactic reaction to amoxicillin. Which of the following
medications is the most appropriate alternative for treating this infection?
A. Cephalexin
B. Azithromycin
C. Cefdinir
D. Clindamycin
CORRECT ANSWER: B. Azithromycin
Rationale: In a patient with a severe (anaphylactic) allergy to penicillin, cephalosporins
(like cephalexin and cefdinir) should be avoided due to the risk of cross-reactivity. The
preferred alternative for acute otitis media in this scenario is a macrolide, such as
azithromycin or clarithromycin. Clindamycin is an alternative but is typically reserved
for penicillin-resistant organisms.
Question 7: A nurse is assessing a 15-year-old adolescent who is 2 days post-
operative following a spinal fusion for scoliosis. The patient's vital signs are stable,
but the patient reports severe pain that is not relieved by the prescribed
hydromorphone. The nurse notes a decreased urine output over the last 4 hours.
Which of the following is the priority nursing action?
A. Administer a PRN dose of an antiemetic
B. Increase the IV fluid rate
C. Assess the patient's bladder for distention
D. Notify the provider for a pain medication change
CORRECT ANSWER: C. Assess the patient's bladder for distention
Rationale: This patient is at high risk for urinary retention due to narcotic analgesics
and immobility. A distended bladder can cause significant pain, which may mimic or
exacerbate post-operative pain. The priority is to assess for bladder distention, which is
a reversible cause of pain, before increasing fluids or changing the pain regimen.
Question 8: A 3-year-old child is brought to the emergency department with a
barking cough, stridor, and a hoarse voice. The symptoms are worse at night. The
child's immunization status is up-to-date. Which of the following interventions is
the most appropriate initial treatment?
A. Inhaled racemic epinephrine
B. Intramuscular ceftriaxone
C. Oral amoxicillin
D. Nebulized saline
CORRECT ANSWER: A. Inhaled racemic epinephrine
, Rationale: The presentation of a barking cough, stridor, and hoarseness in a 3-year-old
is classic for croup (laryngotracheobronchitis). The mainstay of treatment for moderate-
to-severe croup is a single dose of oral dexamethasone. Inhaled racemic epinephrine is
indicated for acute, severe distress with stridor at rest to rapidly reduce airway edema.
Nebulized saline is a supportive measure.
Question 9: An 8-year-old child with sickle cell disease presents with fever and
chest pain. A chest X-ray reveals a new infiltrate. Which of the following
complications is this child most likely experiencing?
A. Aplastic crisis
B. Vaso-occlusive crisis
C. Acute chest syndrome
D. Splenic sequestration
CORRECT ANSWER: C. Acute chest syndrome
Rationale: Acute chest syndrome is a leading cause of death in children with sickle cell
disease. It is characterized by fever, chest pain, and a new infiltrate on chest X-ray. It is
often triggered by infection or pulmonary infarction. Vaso-occlusive crises cause severe
bone pain, splenic sequestration causes acute anemia and splenomegaly, and aplastic
crises are characterized by a drop in hemoglobin.
Question 10: A 5-year-old child is brought to the clinic for a routine health
maintenance visit. Which of the following developmental milestones is most
appropriate for a child of this age?
A. Tying shoelaces
B. Copying a square
C. Riding a bicycle
D. Using a fork and knife properly
CORRECT ANSWER: B. Copying a square
Rationale: By age 5, a child is typically able to copy a square and a triangle, print letters,
and draw a person with a body. Tying shoelaces (fine motor) and riding a bicycle (gross
motor) are typically mastered around age 6-7. Using a fork and knife properly is also a
more advanced skill, generally developed by age 7-8.
Question 11: A 16-year-old adolescent is diagnosed with infectious mononucleosis.
The nurse is providing discharge instructions. Which of the following activities
should the nurse emphasize that the adolescent must avoid to prevent a life-
threatening complication?
A. Swimming
B. Contact sports
C. Eating spicy foods
D. Watching television for long periods
Study Guide, Practice Exam Questions and Answers, Exam Prep Test
Bank, Pediatric Growth and Development Milestones, Child Health
Assessment, Common Pediatric Disorders and Diseases, Pediatric
Pharmacology and Medication Safety, Family-Centered Care,
Immunization Guidelines, Clinical Judgment Skills, and Detailed Rationales
for ATI Exam Success
Question 1: A 2-day-old newborn, born at 39 weeks gestation via spontaneous
vaginal delivery, is being evaluated for a heart murmur. The infant is asymptomatic,
with normal peripheral pulses and no respiratory distress. An echocardiogram
reveals a small patent ductus arteriosus (PDA) with left-to-right shunting. Which of
the following is the most appropriate initial management for this infant?
A. Immediate surgical ligation
B. Indomethacin administration
C. Observation and supportive care
D. Cardiac catheterization with coil occlusion
CORRECT ANSWER: C. Observation and supportive care
Rationale: In a full-term, asymptomatic newborn with a small PDA, spontaneous
closure is highly likely within the first 24-72 hours of life. Indomethacin is used for a
hemodynamically significant PDA in premature infants, not asymptomatic full-term
infants. Surgical ligation and catheterization are reserved for patients who fail medical
management or develop complications.
Question 2: A 6-month-old infant is brought to the clinic for a well-child visit. The
mother reports that the infant has been exclusively breastfed since birth and has
not received any vitamin supplements. On physical examination, the infant is
irritable and has frontal bossing and widened wrist joints. Which of the following
laboratory findings is most consistent with the suspected diagnosis?
A. Elevated serum calcium
B. Elevated serum alkaline phosphatase
C. Decreased serum parathyroid hormone
D. Normal serum phosphorus
CORRECT ANSWER: B. Elevated serum alkaline phosphatase
Rationale: The clinical presentation of frontal bossing and widened wrists in a breastfed
infant without vitamin D supplementation is classic for rickets. Vitamin D deficiency
leads to impaired calcium absorption, resulting in secondary hyperparathyroidism,
which causes an elevation in serum alkaline phosphatase (a marker of bone turnover)
and decreased serum phosphorus.
Question 3: A 4-year-old child presents with a 3-day history of fever, cough, and
conjunctivitis. On examination, the nurse notes the presence of small, white, grain-
,like spots on the buccal mucosa opposite the lower molars. Which of the following
immunizations is most effective at preventing the disease associated with this
finding?
A. DTaP
B. MMR
C. Hib
D. Varicella
CORRECT ANSWER: B. MMR
Rationale: The presence of Koplik spots (small white spots on the buccal mucosa) is a
pathognomonic sign of measles (rubeola). The MMR (Measles, Mumps, Rubella)
vaccine is highly effective at preventing measles. The first dose is typically administered
at 12-15 months of age.
Question 4: A 10-year-old child with a history of asthma is brought to the
emergency department with severe respiratory distress. The nurse administers a
bronchodilator via nebulizer. Which of the following findings would indicate a
therapeutic response to this medication?
A. Increased respiratory rate
B. Decreased peak expiratory flow rate
C. Decreased wheezing on auscultation
D. Increased use of accessory muscles
CORRECT ANSWER: C. Decreased wheezing on auscultation
Rationale: Wheezing is caused by air passing through narrowed airways. A therapeutic
response to a bronchodilator (e.g., albuterol) results in bronchodilation, which
decreases airway resistance and reduces wheezing. Increased respiratory rate,
accessory muscle use, and decreased peak flow indicate worsening respiratory status.
Question 5: A 2-week-old infant is being evaluated for persistent vomiting that is
described as forceful and projectile, occurring shortly after feeding. The infant is
visibly hungry and has not gained weight since birth. Which of the following
findings on physical examination would be most suggestive of the underlying
diagnosis?
A. A palpable olive-shaped mass in the right upper quadrant
B. Hyperactive bowel sounds in the lower quadrants
C. A scaphoid abdomen
D. A palpable mass in the left lower quadrant
CORRECT ANSWER: A. A palpable olive-shaped mass in the right upper quadrant
Rationale: The classic presentation of projectile, non-bilious vomiting in a 2-week-old
infant is hypertrophic pyloric stenosis. The hypertrophy of the pyloric muscle creates a
,palpable, firm, mobile mass (olive-shaped) in the right upper quadrant. A scaphoid
abdomen is more associated with diaphragmatic hernia.
Question 6: A 7-year-old child is diagnosed with acute otitis media. The child has a
history of a severe anaphylactic reaction to amoxicillin. Which of the following
medications is the most appropriate alternative for treating this infection?
A. Cephalexin
B. Azithromycin
C. Cefdinir
D. Clindamycin
CORRECT ANSWER: B. Azithromycin
Rationale: In a patient with a severe (anaphylactic) allergy to penicillin, cephalosporins
(like cephalexin and cefdinir) should be avoided due to the risk of cross-reactivity. The
preferred alternative for acute otitis media in this scenario is a macrolide, such as
azithromycin or clarithromycin. Clindamycin is an alternative but is typically reserved
for penicillin-resistant organisms.
Question 7: A nurse is assessing a 15-year-old adolescent who is 2 days post-
operative following a spinal fusion for scoliosis. The patient's vital signs are stable,
but the patient reports severe pain that is not relieved by the prescribed
hydromorphone. The nurse notes a decreased urine output over the last 4 hours.
Which of the following is the priority nursing action?
A. Administer a PRN dose of an antiemetic
B. Increase the IV fluid rate
C. Assess the patient's bladder for distention
D. Notify the provider for a pain medication change
CORRECT ANSWER: C. Assess the patient's bladder for distention
Rationale: This patient is at high risk for urinary retention due to narcotic analgesics
and immobility. A distended bladder can cause significant pain, which may mimic or
exacerbate post-operative pain. The priority is to assess for bladder distention, which is
a reversible cause of pain, before increasing fluids or changing the pain regimen.
Question 8: A 3-year-old child is brought to the emergency department with a
barking cough, stridor, and a hoarse voice. The symptoms are worse at night. The
child's immunization status is up-to-date. Which of the following interventions is
the most appropriate initial treatment?
A. Inhaled racemic epinephrine
B. Intramuscular ceftriaxone
C. Oral amoxicillin
D. Nebulized saline
CORRECT ANSWER: A. Inhaled racemic epinephrine
, Rationale: The presentation of a barking cough, stridor, and hoarseness in a 3-year-old
is classic for croup (laryngotracheobronchitis). The mainstay of treatment for moderate-
to-severe croup is a single dose of oral dexamethasone. Inhaled racemic epinephrine is
indicated for acute, severe distress with stridor at rest to rapidly reduce airway edema.
Nebulized saline is a supportive measure.
Question 9: An 8-year-old child with sickle cell disease presents with fever and
chest pain. A chest X-ray reveals a new infiltrate. Which of the following
complications is this child most likely experiencing?
A. Aplastic crisis
B. Vaso-occlusive crisis
C. Acute chest syndrome
D. Splenic sequestration
CORRECT ANSWER: C. Acute chest syndrome
Rationale: Acute chest syndrome is a leading cause of death in children with sickle cell
disease. It is characterized by fever, chest pain, and a new infiltrate on chest X-ray. It is
often triggered by infection or pulmonary infarction. Vaso-occlusive crises cause severe
bone pain, splenic sequestration causes acute anemia and splenomegaly, and aplastic
crises are characterized by a drop in hemoglobin.
Question 10: A 5-year-old child is brought to the clinic for a routine health
maintenance visit. Which of the following developmental milestones is most
appropriate for a child of this age?
A. Tying shoelaces
B. Copying a square
C. Riding a bicycle
D. Using a fork and knife properly
CORRECT ANSWER: B. Copying a square
Rationale: By age 5, a child is typically able to copy a square and a triangle, print letters,
and draw a person with a body. Tying shoelaces (fine motor) and riding a bicycle (gross
motor) are typically mastered around age 6-7. Using a fork and knife properly is also a
more advanced skill, generally developed by age 7-8.
Question 11: A 16-year-old adolescent is diagnosed with infectious mononucleosis.
The nurse is providing discharge instructions. Which of the following activities
should the nurse emphasize that the adolescent must avoid to prevent a life-
threatening complication?
A. Swimming
B. Contact sports
C. Eating spicy foods
D. Watching television for long periods
