1
ATI PEDS 2025-2026 PROCTORED EXAM /ATI PEDIATRIC
PROCTORED EXAM 2025 NEWEST 3 VERSIONS WITH REFERENCES
AND RATIONAILE
1) Epiglottitis — priority action (Multiple choice)
Stem: A 3-year-old previously healthy child arrives at triage with a 12-hour history
of high fever (39.8°C / 103.6°F), severe sore throat, muffled voice, drooling, and
worse respiratory distress since arrival. The child is sitting upright, appears
anxious, and will not lie flat. On auscultation there are inspiratory stridor and
suprasternal retractions. The parent reports a rapid deterioration over the last hour.
The child is febrile and tachypneic, but cooperative only in sitting position. Which
action should the nurse prioritize immediately?
A. Obtain a throat culture and send for Gram stain.
B. Prepare for controlled airway management (call anesthesiology/ENT, prepare
for possible intubation).
C. Administer IV ceftriaxone and start antipyretics.
D. Attempt oral suctioning and inspect the throat with a tongue depressor.
Answer: B. Prepare for controlled airway management (call
anesthesiology/ENT, prepare for intubation).
Rationale (detailed): Pediatric epiglottitis is an emergency due to the risk of
sudden airway obstruction. The priority is airway stabilization — ideally in a
,2
controlled setting with experienced personnel (anesthesia/ENT) ready for
intubation or surgical airway if needed. Diagnostic procedures (throat inspection,
culture) or delaying airway management for antibiotics or tests can precipitate
complete upper-airway obstruction. Avoid procedures that may frighten the child
(e.g., unnecessary throat inspection) and avoid upsetting the child or forcing a
supine position. Oxygen can be given gently while arranging airway support. This
approach is supported by current pediatric emergency reviews and clinical
summaries. NCBIPMC
2) Kawasaki disease — initial treatment and rationale (Multiple choice)
Stem: A 4-year-old boy presents with 5 days of high fever, conjunctival injection
without exudate, cracked red lips, a polymorphous rash over trunk and extremities,
cervical lymphadenopathy (1.8 cm), and swollen, erythematous hands and feet.
Laboratory studies show elevated CRP and platelet count trending upward on day
7. Which is the best initial treatment to reduce the most serious complication of
Kawasaki disease?
A. High-dose aspirin alone.
B. Intravenous immunoglobulin (IVIG) plus high-dose aspirin.
C. Oral prednisone only.
D. Broad-spectrum antibiotics (e.g., ceftriaxone) while awaiting cultures.
Answer: B. Intravenous immunoglobulin (IVIG) plus high-dose aspirin.
Rationale (detailed): Kawasaki disease is an acute vasculitis that, untreated,
carries a risk of coronary artery aneurysms. The evidence-based initial therapy is
timely IVIG (single infusion, typically 2 g/kg) plus aspirin (high-dose for anti-
inflammatory effect in the acute phase, then lower dose for antiplatelet effect).
,3
Early IVIG (within the first 10 days, ideally as early as diagnosis) markedly
reduces coronary artery complications. Corticosteroids or additional therapies are
used in IVIG-resistant cases per specialty guidance, but IVIG + aspirin is first-line.
Antibiotics are not indicated unless a clear bacterial infection is present. Follow-up
echocardiography is required to monitor coronary arteries. Kawasaki Disease
FoundationAHA Journals
3) Pediatric maintenance fluids — calculation (Calculation / Multiple choice)
Stem: Using the 4-2-1 rule (hourly maintenance), calculate the appropriate hourly
maintenance IV fluid rate for an 28-kg child who requires maintenance fluids.
Which hourly rate is correct?
A. 50 mL/hr
B. 68 mL/hr
C. 84 mL/hr
D. 100 mL/hr
Answer: B. 68 mL/hr
Rationale (detailed and arithmetic shown):
The 4-2-1 rule gives:
4 mL/kg/hr for the first 10 kg = 4 × 10 = 40 mL/hr
2 mL/kg/hr for the next 10 kg = 2 × 10 = 20 mL/hr
1 mL/kg/hr for remaining kg (28 − 20 = 8 kg) = 1 × 8 = 8 mL/hr
Total hourly = 40 + 20 + 8 = 68 mL/hr. Daily total = 68 × 24 = 1,632
mL/day. This rule is a commonly used quick nursing calculation for
maintenance fluids; clinical judgment and the child’s clinical status (e.g.,
, 4
dehydration, renal function) influence exact prescriptions.
impactems.comChildren's Hospital of Philadelphia
4) Simple vs complex febrile seizure — appropriate ED evaluation (Multiple
choice)
Stem: A previously healthy 18-month-old boy has a generalized tonic-clonic
seizure lasting 90 seconds that resolved spontaneously at home. Post-ictal he is
sleepy but arousable. Parents report a rectal temperature of 39.5°C preceding the
seizure. There is no focal neurologic deficit on exam and the child returns to
baseline within an hour. According to pediatric practice guidelines, which is the
most appropriate next step regarding neurodiagnostic evaluation?
A. Immediate CT scan of the head and full EEG before discharge.
B. Lumbar puncture and head CT for every first febrile seizure.
C. No routine neuroimaging, EEG, or extensive lab work is required for a simple
febrile seizure in a well-appearing child; observe and provide education.
D. Admit for continuous EEG monitoring for 24 hours.
Answer: C. No routine neuroimaging, EEG, or extensive labs are required for
a simple febrile seizure in a well-appearing child; observe and provide
education.
Rationale (detailed):
This child meets criteria for a simple febrile seizure: generalized, <15 minutes (this
one is 90 seconds), single seizure in 24 hours, and full neurological recovery. AAP
practice guidelines recommend against routine neuroimaging, EEG, blood tests, or
lumbar puncture for neurologically well children with simple febrile seizures —
these investigations are reserved for atypical/complex cases (focal features,
ATI PEDS 2025-2026 PROCTORED EXAM /ATI PEDIATRIC
PROCTORED EXAM 2025 NEWEST 3 VERSIONS WITH REFERENCES
AND RATIONAILE
1) Epiglottitis — priority action (Multiple choice)
Stem: A 3-year-old previously healthy child arrives at triage with a 12-hour history
of high fever (39.8°C / 103.6°F), severe sore throat, muffled voice, drooling, and
worse respiratory distress since arrival. The child is sitting upright, appears
anxious, and will not lie flat. On auscultation there are inspiratory stridor and
suprasternal retractions. The parent reports a rapid deterioration over the last hour.
The child is febrile and tachypneic, but cooperative only in sitting position. Which
action should the nurse prioritize immediately?
A. Obtain a throat culture and send for Gram stain.
B. Prepare for controlled airway management (call anesthesiology/ENT, prepare
for possible intubation).
C. Administer IV ceftriaxone and start antipyretics.
D. Attempt oral suctioning and inspect the throat with a tongue depressor.
Answer: B. Prepare for controlled airway management (call
anesthesiology/ENT, prepare for intubation).
Rationale (detailed): Pediatric epiglottitis is an emergency due to the risk of
sudden airway obstruction. The priority is airway stabilization — ideally in a
,2
controlled setting with experienced personnel (anesthesia/ENT) ready for
intubation or surgical airway if needed. Diagnostic procedures (throat inspection,
culture) or delaying airway management for antibiotics or tests can precipitate
complete upper-airway obstruction. Avoid procedures that may frighten the child
(e.g., unnecessary throat inspection) and avoid upsetting the child or forcing a
supine position. Oxygen can be given gently while arranging airway support. This
approach is supported by current pediatric emergency reviews and clinical
summaries. NCBIPMC
2) Kawasaki disease — initial treatment and rationale (Multiple choice)
Stem: A 4-year-old boy presents with 5 days of high fever, conjunctival injection
without exudate, cracked red lips, a polymorphous rash over trunk and extremities,
cervical lymphadenopathy (1.8 cm), and swollen, erythematous hands and feet.
Laboratory studies show elevated CRP and platelet count trending upward on day
7. Which is the best initial treatment to reduce the most serious complication of
Kawasaki disease?
A. High-dose aspirin alone.
B. Intravenous immunoglobulin (IVIG) plus high-dose aspirin.
C. Oral prednisone only.
D. Broad-spectrum antibiotics (e.g., ceftriaxone) while awaiting cultures.
Answer: B. Intravenous immunoglobulin (IVIG) plus high-dose aspirin.
Rationale (detailed): Kawasaki disease is an acute vasculitis that, untreated,
carries a risk of coronary artery aneurysms. The evidence-based initial therapy is
timely IVIG (single infusion, typically 2 g/kg) plus aspirin (high-dose for anti-
inflammatory effect in the acute phase, then lower dose for antiplatelet effect).
,3
Early IVIG (within the first 10 days, ideally as early as diagnosis) markedly
reduces coronary artery complications. Corticosteroids or additional therapies are
used in IVIG-resistant cases per specialty guidance, but IVIG + aspirin is first-line.
Antibiotics are not indicated unless a clear bacterial infection is present. Follow-up
echocardiography is required to monitor coronary arteries. Kawasaki Disease
FoundationAHA Journals
3) Pediatric maintenance fluids — calculation (Calculation / Multiple choice)
Stem: Using the 4-2-1 rule (hourly maintenance), calculate the appropriate hourly
maintenance IV fluid rate for an 28-kg child who requires maintenance fluids.
Which hourly rate is correct?
A. 50 mL/hr
B. 68 mL/hr
C. 84 mL/hr
D. 100 mL/hr
Answer: B. 68 mL/hr
Rationale (detailed and arithmetic shown):
The 4-2-1 rule gives:
4 mL/kg/hr for the first 10 kg = 4 × 10 = 40 mL/hr
2 mL/kg/hr for the next 10 kg = 2 × 10 = 20 mL/hr
1 mL/kg/hr for remaining kg (28 − 20 = 8 kg) = 1 × 8 = 8 mL/hr
Total hourly = 40 + 20 + 8 = 68 mL/hr. Daily total = 68 × 24 = 1,632
mL/day. This rule is a commonly used quick nursing calculation for
maintenance fluids; clinical judgment and the child’s clinical status (e.g.,
, 4
dehydration, renal function) influence exact prescriptions.
impactems.comChildren's Hospital of Philadelphia
4) Simple vs complex febrile seizure — appropriate ED evaluation (Multiple
choice)
Stem: A previously healthy 18-month-old boy has a generalized tonic-clonic
seizure lasting 90 seconds that resolved spontaneously at home. Post-ictal he is
sleepy but arousable. Parents report a rectal temperature of 39.5°C preceding the
seizure. There is no focal neurologic deficit on exam and the child returns to
baseline within an hour. According to pediatric practice guidelines, which is the
most appropriate next step regarding neurodiagnostic evaluation?
A. Immediate CT scan of the head and full EEG before discharge.
B. Lumbar puncture and head CT for every first febrile seizure.
C. No routine neuroimaging, EEG, or extensive lab work is required for a simple
febrile seizure in a well-appearing child; observe and provide education.
D. Admit for continuous EEG monitoring for 24 hours.
Answer: C. No routine neuroimaging, EEG, or extensive labs are required for
a simple febrile seizure in a well-appearing child; observe and provide
education.
Rationale (detailed):
This child meets criteria for a simple febrile seizure: generalized, <15 minutes (this
one is 90 seconds), single seizure in 24 hours, and full neurological recovery. AAP
practice guidelines recommend against routine neuroimaging, EEG, blood tests, or
lumbar puncture for neurologically well children with simple febrile seizures —
these investigations are reserved for atypical/complex cases (focal features,
