**ATI RN PEDIATRIC PROCTORED EXAM 2023**
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**1.** A nurse is assessing a 4-month-old infant. Which finding should the nurse report to the provider?
A) Unable to roll over
B) Birth weight doubled
C) Anterior fontanel open
D) Moro reflex present
💡 RATIONALE – Moro reflex should disappear by 3-4 months; persistence at 4 months may indicate
neurologic impairment. Rolling over is a 5-6 month milestone. Birth weight doubles by 6 months.
✔️ **ANSWER – D) Moro reflex present**
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**2.** A 2-year-old is hospitalized. The parent must leave for work. The child screams "Don't go!" and
then becomes quiet and withdrawn. This behavior indicates:
A) Protest phase
B) Despair phase
C) Detachment phase
D) Regression
💡 RATIONALE – Despair phase: withdrawn, quiet, sad, no longer crying. Protest phase is initial
screaming/clinging.
✔️ **ANSWER – B) Despair phase**
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,**3.** A child with cystic fibrosis is being discharged. Which statement by the parent indicates
understanding of pancreatic enzyme administration?
A) "I will give the enzymes if my child has abdominal pain."
B) "I will give the enzymes with meals and snacks."
C) "I will crush the beads and mix in a full bottle of formula."
D) "I will stop enzymes if my child has diarrhea."
💡 RATIONALE – Pancreatic enzymes must be given with all meals and snacks to digest fats. Do not crush
enteric-coated beads.
✔️ **ANSWER – B) "I will give the enzymes with meals and snacks."**
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**4.** A 5-year-old with a Wilms tumor (nephroblastoma) is admitted. Which nursing action is
contraindicated?
A) Monitoring blood pressure
B) Palpating the abdomen
C) Checking urine for blood
D) Measuring abdominal girth
💡 RATIONALE – Do NOT palpate abdomen – may rupture tumor and cause seeding. Wilms tumor is
fragile.
✔️ **ANSWER – B) Palpating the abdomen**
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**5.** A 10-year-old with asthma has a peak flow reading of 55% of personal best. What action should
the nurse take first?
A) Administer rescue inhaler (albuterol)
,B) Call the provider
C) Send child to emergency room
D) Repeat reading in 30 minutes
💡 RATIONALE – Yellow zone (50-80%) requires rescue inhaler; reassess after 15-20 minutes.
✔️ **ANSWER – A) Administer rescue inhaler (albuterol)**
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**6.** A 3-month-old is brought to the clinic with fever and poor feeding. The nurse notes a bulging
anterior fontanel. What is the priority?
A) Administer acetaminophen
B) Notify the provider immediately
C) Encourage oral fluids
D) Obtain a urine specimen
💡 RATIONALE – Bulging fontanel + fever = meningitis until proven otherwise; immediate provider
notification.
✔️ **ANSWER – B) Notify the provider immediately**
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**7.** A 7-year-old with sickle cell anemia has a fever of 38.9°C (102°F). The nurse should advise the
parent to:
A) Give acetaminophen and fluids at home
B) Go to the emergency department immediately
C) Call the pediatrician in the morning
D) Wait 24 hours to see if fever resolves
, 💡 RATIONALE – Fever in sickle cell child is a medical emergency due to risk of sepsis from encapsulated
organisms.
✔️ **ANSWER – B) Go to the emergency department immediately**
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**8.** A newborn is noted to have a continuous "machinery" murmur, bounding pulses, and wide pulse
pressure. The nurse suspects:
A) Ventricular septal defect (VSD)
B) Atrial septal defect (ASD)
C) Patent ductus arteriosus (PDA)
D) Tetralogy of Fallot (TOF)
💡 RATIONALE – PDA: continuous murmur (systolic & diastolic), bounding pulses, wide pulse pressure.
✔️ **ANSWER – C) Patent ductus arteriosus (PDA)**
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**9.** A 4-year-old with croup has stridor at rest and nasal flaring. The nurse should prepare for:
A) Racemic epinephrine nebulizer
B) Discharge home
C) Oral dexamethasone only
D) Heliox therapy
💡 RATIONALE – Stridor at rest = moderate to severe croup; racemic epinephrine + dexamethasone.
✔️ **ANSWER – A) Racemic epinephrine nebulizer**
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**1.** A nurse is assessing a 4-month-old infant. Which finding should the nurse report to the provider?
A) Unable to roll over
B) Birth weight doubled
C) Anterior fontanel open
D) Moro reflex present
💡 RATIONALE – Moro reflex should disappear by 3-4 months; persistence at 4 months may indicate
neurologic impairment. Rolling over is a 5-6 month milestone. Birth weight doubles by 6 months.
✔️ **ANSWER – D) Moro reflex present**
---
**2.** A 2-year-old is hospitalized. The parent must leave for work. The child screams "Don't go!" and
then becomes quiet and withdrawn. This behavior indicates:
A) Protest phase
B) Despair phase
C) Detachment phase
D) Regression
💡 RATIONALE – Despair phase: withdrawn, quiet, sad, no longer crying. Protest phase is initial
screaming/clinging.
✔️ **ANSWER – B) Despair phase**
---
,**3.** A child with cystic fibrosis is being discharged. Which statement by the parent indicates
understanding of pancreatic enzyme administration?
A) "I will give the enzymes if my child has abdominal pain."
B) "I will give the enzymes with meals and snacks."
C) "I will crush the beads and mix in a full bottle of formula."
D) "I will stop enzymes if my child has diarrhea."
💡 RATIONALE – Pancreatic enzymes must be given with all meals and snacks to digest fats. Do not crush
enteric-coated beads.
✔️ **ANSWER – B) "I will give the enzymes with meals and snacks."**
---
**4.** A 5-year-old with a Wilms tumor (nephroblastoma) is admitted. Which nursing action is
contraindicated?
A) Monitoring blood pressure
B) Palpating the abdomen
C) Checking urine for blood
D) Measuring abdominal girth
💡 RATIONALE – Do NOT palpate abdomen – may rupture tumor and cause seeding. Wilms tumor is
fragile.
✔️ **ANSWER – B) Palpating the abdomen**
---
**5.** A 10-year-old with asthma has a peak flow reading of 55% of personal best. What action should
the nurse take first?
A) Administer rescue inhaler (albuterol)
,B) Call the provider
C) Send child to emergency room
D) Repeat reading in 30 minutes
💡 RATIONALE – Yellow zone (50-80%) requires rescue inhaler; reassess after 15-20 minutes.
✔️ **ANSWER – A) Administer rescue inhaler (albuterol)**
---
**6.** A 3-month-old is brought to the clinic with fever and poor feeding. The nurse notes a bulging
anterior fontanel. What is the priority?
A) Administer acetaminophen
B) Notify the provider immediately
C) Encourage oral fluids
D) Obtain a urine specimen
💡 RATIONALE – Bulging fontanel + fever = meningitis until proven otherwise; immediate provider
notification.
✔️ **ANSWER – B) Notify the provider immediately**
---
**7.** A 7-year-old with sickle cell anemia has a fever of 38.9°C (102°F). The nurse should advise the
parent to:
A) Give acetaminophen and fluids at home
B) Go to the emergency department immediately
C) Call the pediatrician in the morning
D) Wait 24 hours to see if fever resolves
, 💡 RATIONALE – Fever in sickle cell child is a medical emergency due to risk of sepsis from encapsulated
organisms.
✔️ **ANSWER – B) Go to the emergency department immediately**
---
**8.** A newborn is noted to have a continuous "machinery" murmur, bounding pulses, and wide pulse
pressure. The nurse suspects:
A) Ventricular septal defect (VSD)
B) Atrial septal defect (ASD)
C) Patent ductus arteriosus (PDA)
D) Tetralogy of Fallot (TOF)
💡 RATIONALE – PDA: continuous murmur (systolic & diastolic), bounding pulses, wide pulse pressure.
✔️ **ANSWER – C) Patent ductus arteriosus (PDA)**
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**9.** A 4-year-old with croup has stridor at rest and nasal flaring. The nurse should prepare for:
A) Racemic epinephrine nebulizer
B) Discharge home
C) Oral dexamethasone only
D) Heliox therapy
💡 RATIONALE – Stridor at rest = moderate to severe croup; racemic epinephrine + dexamethasone.
✔️ **ANSWER – A) Racemic epinephrine nebulizer**
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