ATI RN Comprehensive Predictor 2026 –
Pediatric Nursing Practice Exam | NGN
Clinical Judgment Case Studies, Verified
Answers, & Comprehensive Rationales
1. A nurse is caring for a 4-year-old child with suspected
epiglottitis. Which intervention is the priority?
A. Obtain a throat culture
B. Prepare for emergency airway management
C. Place the child in supine position
D. Encourage oral fluids
Rationale: Epiglottitis is a life-threatening airway obstruction.
Any agitation, throat examination, or positioning that
worsens airway compromise should be avoided. The priority is
maintaining airway patency and preparing for intubation in a
controlled setting. Immediate airway stabilization takes
precedence over diagnostic testing or oral interventions.
2. A 2-year-old with dehydration is prescribed IV fluids.
Which finding indicates improvement?
A. Sunken fontanel remains present
B. Urine specific gravity 1.040
C. Capillary refill of 2 seconds
D. Heart rate remains elevated for age
,Rationale: Improved perfusion is reflected by a capillary refill
of ≤2 seconds. Persistent tachycardia, high urine
concentration, and sunken fontanel indicate ongoing
dehydration.
3. A child with cystic fibrosis is receiving pancreatic enzyme
replacement. When should the nurse administer this
medication?
A. After meals
B. With meals and snacks
C. 1 hour before meals
D. Only at bedtime
Rationale: Pancreatic enzymes must be taken with food to aid
digestion and nutrient absorption. Administering after meals
reduces effectiveness, while giving long before meals does not
coincide with digestion.
4. A nurse is teaching parents of a child with acute otitis
media. Which instruction is appropriate?
A. Place the child flat when sleeping
B. Complete the full course of antibiotics
C. Avoid all analgesics
D. Delay follow-up until symptoms resolve
Rationale: Completing antibiotics ensures eradication of
infection and prevents resistance. Analgesics are appropriate
,for pain, and positioning should be slightly elevated to reduce
pressure.
5. A 6-month-old is diagnosed with iron-deficiency anemia.
Which food should the nurse recommend first?
A. Whole cow’s milk
B. Rice cereal with honey
C. Iron-fortified cereal
D. Apple juice
Rationale: Iron-fortified cereals are the primary dietary source
for infants starting solids. Cow’s milk is contraindicated under
12 months, and honey poses botulism risk.
6. A child is experiencing a tonic-clonic seizure. What is the
nurse’s first action?
A. Insert an oral airway
B. Protect the child from injury
C. Restrain the child
D. Place the child in Trendelenburg position
Rationale: Safety is the priority. The nurse should protect the
airway, pad side rails, and avoid restraining movements.
Airway devices are not inserted during active seizure.
7. A child with nephrotic syndrome is at risk for which
complication?
, A. Hypoglycemia
B. Infection due to loss of immunoglobulins
C. Hypertension crisis only
D. Hypercalcemia
Rationale: Loss of proteins in urine leads to decreased
immunoglobulins, increasing infection risk. Edema and
protein loss are hallmark features.
8. A nurse is assessing a child with suspected appendicitis.
Which finding is most concerning?
A. Rebound tenderness in right lower quadrant
B. Decreased appetite
C. Low-grade fever
D. Sudden relief of abdominal pain
Rationale: Sudden pain relief may indicate rupture of the
appendix, a surgical emergency leading to peritonitis.
9. A 3-year-old is prescribed digoxin. Which finding requires
withholding the medication?
A. Apical pulse 90/min
B. Apical pulse 68/min
C. Blood pressure 100/60 mmHg
D. Respiratory rate 24/min
Rationale: Digoxin should be withheld if apical pulse is below
70 in infants/young children due to risk of bradycardia and
toxicity.
Pediatric Nursing Practice Exam | NGN
Clinical Judgment Case Studies, Verified
Answers, & Comprehensive Rationales
1. A nurse is caring for a 4-year-old child with suspected
epiglottitis. Which intervention is the priority?
A. Obtain a throat culture
B. Prepare for emergency airway management
C. Place the child in supine position
D. Encourage oral fluids
Rationale: Epiglottitis is a life-threatening airway obstruction.
Any agitation, throat examination, or positioning that
worsens airway compromise should be avoided. The priority is
maintaining airway patency and preparing for intubation in a
controlled setting. Immediate airway stabilization takes
precedence over diagnostic testing or oral interventions.
2. A 2-year-old with dehydration is prescribed IV fluids.
Which finding indicates improvement?
A. Sunken fontanel remains present
B. Urine specific gravity 1.040
C. Capillary refill of 2 seconds
D. Heart rate remains elevated for age
,Rationale: Improved perfusion is reflected by a capillary refill
of ≤2 seconds. Persistent tachycardia, high urine
concentration, and sunken fontanel indicate ongoing
dehydration.
3. A child with cystic fibrosis is receiving pancreatic enzyme
replacement. When should the nurse administer this
medication?
A. After meals
B. With meals and snacks
C. 1 hour before meals
D. Only at bedtime
Rationale: Pancreatic enzymes must be taken with food to aid
digestion and nutrient absorption. Administering after meals
reduces effectiveness, while giving long before meals does not
coincide with digestion.
4. A nurse is teaching parents of a child with acute otitis
media. Which instruction is appropriate?
A. Place the child flat when sleeping
B. Complete the full course of antibiotics
C. Avoid all analgesics
D. Delay follow-up until symptoms resolve
Rationale: Completing antibiotics ensures eradication of
infection and prevents resistance. Analgesics are appropriate
,for pain, and positioning should be slightly elevated to reduce
pressure.
5. A 6-month-old is diagnosed with iron-deficiency anemia.
Which food should the nurse recommend first?
A. Whole cow’s milk
B. Rice cereal with honey
C. Iron-fortified cereal
D. Apple juice
Rationale: Iron-fortified cereals are the primary dietary source
for infants starting solids. Cow’s milk is contraindicated under
12 months, and honey poses botulism risk.
6. A child is experiencing a tonic-clonic seizure. What is the
nurse’s first action?
A. Insert an oral airway
B. Protect the child from injury
C. Restrain the child
D. Place the child in Trendelenburg position
Rationale: Safety is the priority. The nurse should protect the
airway, pad side rails, and avoid restraining movements.
Airway devices are not inserted during active seizure.
7. A child with nephrotic syndrome is at risk for which
complication?
, A. Hypoglycemia
B. Infection due to loss of immunoglobulins
C. Hypertension crisis only
D. Hypercalcemia
Rationale: Loss of proteins in urine leads to decreased
immunoglobulins, increasing infection risk. Edema and
protein loss are hallmark features.
8. A nurse is assessing a child with suspected appendicitis.
Which finding is most concerning?
A. Rebound tenderness in right lower quadrant
B. Decreased appetite
C. Low-grade fever
D. Sudden relief of abdominal pain
Rationale: Sudden pain relief may indicate rupture of the
appendix, a surgical emergency leading to peritonitis.
9. A 3-year-old is prescribed digoxin. Which finding requires
withholding the medication?
A. Apical pulse 90/min
B. Apical pulse 68/min
C. Blood pressure 100/60 mmHg
D. Respiratory rate 24/min
Rationale: Digoxin should be withheld if apical pulse is below
70 in infants/young children due to risk of bradycardia and
toxicity.
