ATI RN NURSING CARE OF CHILDREN
PROCTORED EXAM — PRACTICE QUESTIONS 2026/2027
Comprehensive Pediatric Nursing Competency Assessment
60 Multiple-Choice 90 Minutes Passing: 75–80% NCSBN CJMM
Questions Aligned
Domain Coverage
Domain Questions
Growth & Development 1–7
Pediatric Assessment & Family-Centered Care 8–13
Respiratory & Cardiovascular 14–20
Gastrointestinal & Renal 21–28
Neurologic & Hematologic/Oncologic 29–35
Infectious Diseases & Immunizations 36–40
Medication Admin & Safety 41–45
Emergency & Critical Care 46–50
Mental Health & Psychosocial 51–55
Scenario-Based Integration 56–60
,Growth & Development Principles (Q1–Q7)
1. A 6-month-old infant is admitted to the pediatric unit for failure to thrive. The
infant's parent has been inconsistent with feeding schedules and has frequently left the
infant with different caregivers. The infant appears withdrawn, avoids eye contact, and
cries weakly when approached by the nurse. The nurse should identify that this infant is
at risk for failing to achieve which Erikson developmental task?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: A. Trust vs. Mistrust
Rationale: Infants in the first 18 months of life are in Erikson's trust vs. mistrust stage. Trust
develops when caregivers consistently meet the infant's basic needs for nourishment, comfort, and
nurturing. Inconsistent caregiving, frequent caregiver changes, and unmet needs place the infant at
risk for developing mistrust, which may manifest as withdrawal, poor feeding, and difficulty
bonding. Autonomy vs. shame and doubt (B) is the toddler stage, initiative vs. guilt (C) is the
preschool stage, and industry vs. inferiority (D) is the school-age stage.
2. A nurse is caring for a 2-year-old toddler who is recovering from surgery. The toddler
insists on choosing which pajamas to wear and becomes upset and throws clothing on
the floor when the nurse attempts to dress the child without offering choices. Which
response by the nurse is most appropriate based on the child's developmental stage?
A. "You must wear the hospital gown because I said so."
B. "I need to dress you quickly so we can finish your care on time."
C. "Would you like to wear the blue pajamas or the yellow pajamas today?"
D. "Your mother can dress you when she arrives later this afternoon."
Correct Answer: C. "Would you like to wear the blue pajamas or the yellow pajamas
today?"
Rationale: Toddlers (ages 1-3 years) are in Erikson's autonomy vs. shame and doubt stage and
have a strong need for independence and control. Offering limited, structured choices supports the
toddler's developing autonomy while maintaining safety and adherence to the care plan. Imposing
decisions without choices (A, B) can lead to shame and doubt. Deferring care unnecessarily (D)
disregards the child's need for participation and delays needed interventions.
3. A 15-year-old adolescent with a chronic illness tells the nurse, "I don't want to take
my medication anymore. None of my friends have to deal with this, and I just want to be
normal like everyone else." The nurse should recognize that this behavior is most
closely related to which Erikson developmental task?
A. Industry vs. Inferiority
B. Identity vs. Role Confusion
C. Initiative vs. Guilt
D. Intimacy vs. Isolation
Correct Answer: B. Identity vs. Role Confusion
Rationale: Adolescents (ages 12-18 years) are in Erikson's identity vs. role confusion stage, during
which they seek to develop a coherent sense of self and establish personal values. A chronic illness
can threaten the adolescent's emerging identity and their desire for peer acceptance. Nonadherence
in this context often reflects difficulty integrating the illness into their self-concept rather than
defiance. Industry vs. inferiority (A) is the school-age stage, initiative vs. guilt (C) is preschool, and
intimacy vs. isolation (D) is young adulthood.
4. A nurse is preparing a 4-year-old child for an outpatient surgical procedure. The
child's parent asks the nurse how to explain the procedure in a way the child will
understand. Based on Piaget's theory of cognitive development, which response by the
nurse is most appropriate?
A. "Provide a detailed explanation of the surgical anatomy and each step of the procedure."
ATI Pediatric Nursing Practice Exam 2026/2027 — Page 1
, B. "Use simple words and tell your child that the doctor will fix the 'owie' and give 'magic
medicine' to help them sleep during the procedure."
C. "Show your child a video explaining the pharmacological effects of general anesthesia."
D. "Give your child a pamphlet with written postoperative instructions to read independently."
Correct Answer: B. "Use simple words and tell your child that the doctor will fix the
'owie' and give 'magic medicine' to help them sleep during the procedure."
Rationale: The 4-year-old is in Piaget's preoperational stage (ages 2-7), characterized by
egocentrism, magical thinking, animism, and the use of symbolic thought but limited ability for
abstract reasoning. Explanations should be simple, concrete, and use familiar terms the child can
understand. Detailed anatomical explanations (A), pharmacology discussions (C), and written self-
study materials (D) require formal operational thinking and are developmentally inappropriate for
a preschooler.
5. A nurse is teaching a 9-year-old child with asthma how to use a peak flow meter and
interpret the results. Which teaching strategy best aligns with the child's Piaget
cognitive developmental stage?
A. Tell the child that the peak flow meter is a 'magic wand' that tells whether breathing is OK.
B. Show the child how to read a color-coded peak flow zone chart and practice using the meter
with real-time feedback.
C. Give the child a detailed lecture on the pathophysiology of airway resistance and
bronchoconstriction.
D. Ask the child to visualize the airway opening and closing through guided imagery techniques.
Correct Answer: B. Show the child how to read a color-coded peak flow zone chart and
practice using the meter with real-time feedback.
Rationale: School-age children (ages 7-11 years) are in Piaget's concrete operations stage,
characterized by logical thought about concrete objects and events, the ability to understand cause-
and-effect relationships, and the capacity for classification and seriation. Color-coded charts and
hands-on practice with immediate feedback are developmentally appropriate. Magical explanations
(A) are suited for younger children in the preoperational stage. Abstract pathophysiology (C) and
guided imagery (D) require formal operational thought, which develops in adolescence.
6. A nurse is performing a Denver II developmental screening on an 18-month-old
toddler during a well-child visit. The toddler cannot stack two blocks, does not speak
any two-word phrases, and is not yet walking independently. Which interpretation by
the nurse is most accurate?
A. These findings are within normal limits for an 18-month-old.
B. The findings suggest a possible developmental delay requiring further evaluation.
C. The child has a confirmed diagnosis of autism spectrum disorder.
D. The Denver II is not valid for children younger than 24 months of age.
Correct Answer: B. The findings suggest a possible developmental delay requiring
further evaluation.
Rationale: By 18 months, a child should be able to stack 2-3 blocks, use at least 3-6 words and
begin combining two-word phrases, and walk independently. Delays across multiple developmental
domains (fine motor, language, gross motor) on the Denver II screening warrant a referral for
comprehensive developmental evaluation. The Denver II is a screening tool, not a diagnostic
instrument (C), and is validated for use from birth through 6 years of age (D).
7. A nurse is providing anticipatory guidance to the parents of a 4-year-old child during
a well-child visit. Which statement by the nurse is most appropriate for this
developmental stage?
A. "Your child should be able to prepare simple meals independently by this age."
B. "It is normal for your child to have an imaginary friend and to exhibit magical thinking about
illness and injury."
C. "Your child should be reading chapter books independently at this developmental level."
D. "You should restrict all physical play activities to prevent injury at all times."
Correct Answer: B. "It is normal for your child to have an imaginary friend and to
exhibit magical thinking about illness and injury."
ATI Pediatric Nursing Practice Exam 2026/2027 — Page 2
PROCTORED EXAM — PRACTICE QUESTIONS 2026/2027
Comprehensive Pediatric Nursing Competency Assessment
60 Multiple-Choice 90 Minutes Passing: 75–80% NCSBN CJMM
Questions Aligned
Domain Coverage
Domain Questions
Growth & Development 1–7
Pediatric Assessment & Family-Centered Care 8–13
Respiratory & Cardiovascular 14–20
Gastrointestinal & Renal 21–28
Neurologic & Hematologic/Oncologic 29–35
Infectious Diseases & Immunizations 36–40
Medication Admin & Safety 41–45
Emergency & Critical Care 46–50
Mental Health & Psychosocial 51–55
Scenario-Based Integration 56–60
,Growth & Development Principles (Q1–Q7)
1. A 6-month-old infant is admitted to the pediatric unit for failure to thrive. The
infant's parent has been inconsistent with feeding schedules and has frequently left the
infant with different caregivers. The infant appears withdrawn, avoids eye contact, and
cries weakly when approached by the nurse. The nurse should identify that this infant is
at risk for failing to achieve which Erikson developmental task?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: A. Trust vs. Mistrust
Rationale: Infants in the first 18 months of life are in Erikson's trust vs. mistrust stage. Trust
develops when caregivers consistently meet the infant's basic needs for nourishment, comfort, and
nurturing. Inconsistent caregiving, frequent caregiver changes, and unmet needs place the infant at
risk for developing mistrust, which may manifest as withdrawal, poor feeding, and difficulty
bonding. Autonomy vs. shame and doubt (B) is the toddler stage, initiative vs. guilt (C) is the
preschool stage, and industry vs. inferiority (D) is the school-age stage.
2. A nurse is caring for a 2-year-old toddler who is recovering from surgery. The toddler
insists on choosing which pajamas to wear and becomes upset and throws clothing on
the floor when the nurse attempts to dress the child without offering choices. Which
response by the nurse is most appropriate based on the child's developmental stage?
A. "You must wear the hospital gown because I said so."
B. "I need to dress you quickly so we can finish your care on time."
C. "Would you like to wear the blue pajamas or the yellow pajamas today?"
D. "Your mother can dress you when she arrives later this afternoon."
Correct Answer: C. "Would you like to wear the blue pajamas or the yellow pajamas
today?"
Rationale: Toddlers (ages 1-3 years) are in Erikson's autonomy vs. shame and doubt stage and
have a strong need for independence and control. Offering limited, structured choices supports the
toddler's developing autonomy while maintaining safety and adherence to the care plan. Imposing
decisions without choices (A, B) can lead to shame and doubt. Deferring care unnecessarily (D)
disregards the child's need for participation and delays needed interventions.
3. A 15-year-old adolescent with a chronic illness tells the nurse, "I don't want to take
my medication anymore. None of my friends have to deal with this, and I just want to be
normal like everyone else." The nurse should recognize that this behavior is most
closely related to which Erikson developmental task?
A. Industry vs. Inferiority
B. Identity vs. Role Confusion
C. Initiative vs. Guilt
D. Intimacy vs. Isolation
Correct Answer: B. Identity vs. Role Confusion
Rationale: Adolescents (ages 12-18 years) are in Erikson's identity vs. role confusion stage, during
which they seek to develop a coherent sense of self and establish personal values. A chronic illness
can threaten the adolescent's emerging identity and their desire for peer acceptance. Nonadherence
in this context often reflects difficulty integrating the illness into their self-concept rather than
defiance. Industry vs. inferiority (A) is the school-age stage, initiative vs. guilt (C) is preschool, and
intimacy vs. isolation (D) is young adulthood.
4. A nurse is preparing a 4-year-old child for an outpatient surgical procedure. The
child's parent asks the nurse how to explain the procedure in a way the child will
understand. Based on Piaget's theory of cognitive development, which response by the
nurse is most appropriate?
A. "Provide a detailed explanation of the surgical anatomy and each step of the procedure."
ATI Pediatric Nursing Practice Exam 2026/2027 — Page 1
, B. "Use simple words and tell your child that the doctor will fix the 'owie' and give 'magic
medicine' to help them sleep during the procedure."
C. "Show your child a video explaining the pharmacological effects of general anesthesia."
D. "Give your child a pamphlet with written postoperative instructions to read independently."
Correct Answer: B. "Use simple words and tell your child that the doctor will fix the
'owie' and give 'magic medicine' to help them sleep during the procedure."
Rationale: The 4-year-old is in Piaget's preoperational stage (ages 2-7), characterized by
egocentrism, magical thinking, animism, and the use of symbolic thought but limited ability for
abstract reasoning. Explanations should be simple, concrete, and use familiar terms the child can
understand. Detailed anatomical explanations (A), pharmacology discussions (C), and written self-
study materials (D) require formal operational thinking and are developmentally inappropriate for
a preschooler.
5. A nurse is teaching a 9-year-old child with asthma how to use a peak flow meter and
interpret the results. Which teaching strategy best aligns with the child's Piaget
cognitive developmental stage?
A. Tell the child that the peak flow meter is a 'magic wand' that tells whether breathing is OK.
B. Show the child how to read a color-coded peak flow zone chart and practice using the meter
with real-time feedback.
C. Give the child a detailed lecture on the pathophysiology of airway resistance and
bronchoconstriction.
D. Ask the child to visualize the airway opening and closing through guided imagery techniques.
Correct Answer: B. Show the child how to read a color-coded peak flow zone chart and
practice using the meter with real-time feedback.
Rationale: School-age children (ages 7-11 years) are in Piaget's concrete operations stage,
characterized by logical thought about concrete objects and events, the ability to understand cause-
and-effect relationships, and the capacity for classification and seriation. Color-coded charts and
hands-on practice with immediate feedback are developmentally appropriate. Magical explanations
(A) are suited for younger children in the preoperational stage. Abstract pathophysiology (C) and
guided imagery (D) require formal operational thought, which develops in adolescence.
6. A nurse is performing a Denver II developmental screening on an 18-month-old
toddler during a well-child visit. The toddler cannot stack two blocks, does not speak
any two-word phrases, and is not yet walking independently. Which interpretation by
the nurse is most accurate?
A. These findings are within normal limits for an 18-month-old.
B. The findings suggest a possible developmental delay requiring further evaluation.
C. The child has a confirmed diagnosis of autism spectrum disorder.
D. The Denver II is not valid for children younger than 24 months of age.
Correct Answer: B. The findings suggest a possible developmental delay requiring
further evaluation.
Rationale: By 18 months, a child should be able to stack 2-3 blocks, use at least 3-6 words and
begin combining two-word phrases, and walk independently. Delays across multiple developmental
domains (fine motor, language, gross motor) on the Denver II screening warrant a referral for
comprehensive developmental evaluation. The Denver II is a screening tool, not a diagnostic
instrument (C), and is validated for use from birth through 6 years of age (D).
7. A nurse is providing anticipatory guidance to the parents of a 4-year-old child during
a well-child visit. Which statement by the nurse is most appropriate for this
developmental stage?
A. "Your child should be able to prepare simple meals independently by this age."
B. "It is normal for your child to have an imaginary friend and to exhibit magical thinking about
illness and injury."
C. "Your child should be reading chapter books independently at this developmental level."
D. "You should restrict all physical play activities to prevent injury at all times."
Correct Answer: B. "It is normal for your child to have an imaginary friend and to
exhibit magical thinking about illness and injury."
ATI Pediatric Nursing Practice Exam 2026/2027 — Page 2
