,NGN ATI RN Pediatrics Proctored Exam
Advanced Prep: Master Pediatric Nursing
Clinical Judgment & Care
Subject: Pediatric Nursing (NGN ATI RN 2023 Retake) | Subtopic: Pediatric
Clinical Judgment, Safety, and Acute Care
Question 1: A nurse is assessing a 4-year-old child following a tonsillectomy. Which of the
following findings is the highest priority for the nurse to report to the surgeon?
A) The child is requesting an ice pop every 30 minutes.
B) The child has thick, blood-tinged nasal secretions.
C) The child is swallowing frequently while sleeping.
D) The child has a heart rate of 110 beats/min while resting.
Correct Answer: C) The child is swallowing frequently while sleeping.
Explanation: Frequent swallowing in a child who has undergone a tonsillectomy is a hallmark
clinical indicator of postoperative hemorrhage. Because children cannot easily expectorate
blood, they swallow it. The nurse must assess for other signs of bleeding (tachycardia, pallor,
restlessness) and notify the surgeon immediately. Thick, blood-tinged secretions are expected; a
heart rate of 110 is within normal limits for a 4-year-old; and ice pops are encouraged to
promote hydration.
Question 2: A nurse is caring for an infant with suspected intussusception. Which of the
following clinical manifestations should the nurse expect to find?
A) Projectile, non-bilious vomiting.
B) Stool that resembles red currant jelly.
C) Olive-shaped mass in the right upper quadrant.
D) Sharp, localized pain in the right lower quadrant.
Correct Answer: B) Stool that resembles red currant jelly.
,Explanation: Intussusception occurs when a portion of the bowel telescopes into an adjacent
segment, causing obstruction and ischemia. This leads to the classic sign of "currant jelly"
stools—a mixture of blood and mucus. Projectile vomiting and an olive-shaped mass are
indicative of pyloric stenosis. Sharp RLQ pain suggests appendicitis.
Question 3: A nurse is providing discharge teaching for the parents of a child who has a new
prescription for a long-acting beta-agonist (LABA) inhaler. Which of the following statements
by the parents indicates an understanding of the teaching?
A) "We will use this inhaler whenever our child has an acute asthma attack."
B) "We should monitor for decreased heart rate after administration."
C) "We will administer this medication on a set schedule, not for rescue use."
D) "We should increase the dosage if our child starts coughing."
Correct Answer: C) "We will administer this medication on a set schedule, not for rescue
use."
Explanation: LABAs are controllers, not rescue medications. They have a slow onset and long
duration, meaning they are ineffective for acute bronchospasm. Rescue therapy requires a short-
acting beta-agonist (SABA). LABAs can cause tachycardia, not bradycardia, and dosage should
never be adjusted without provider consultation.
Question 4: A nurse is caring for a 6-month-old infant with developmental dysplasia of the hip
(DDH) who is placed in a Pavlik harness. Which of the following nursing actions is appropriate?
A) Remove the harness daily for bathing and infant exercise.
B) Place a diaper underneath the straps of the harness.
C) Ensure the straps are adjusted every 24 hours to accommodate growth.
D) Adjust the harness straps so the hips are held in a position of adduction.
Correct Answer: B) Place a diaper underneath the straps of the harness.
Explanation: Placing the diaper under the harness straps helps keep the harness clean and dry,
preventing skin breakdown. The harness should generally be worn continuously and not removed
for bathing unless directed by the provider. Parents should not adjust the straps, as this can
affect hip alignment. The hips must be maintained in abduction, not adduction, to ensure the
femoral head remains in the acetabulum.
Question 5: A nurse is assessing a child with acute glomerulonephritis (AGN). Which of the
following laboratory findings should the nurse anticipate?
, A) Serum albumin 5.5 g/dL.
B) Positive antistreptolysin O (ASO) titer.
C) Decreased erythrocyte sedimentation rate (ESR).
D) Hemoglobin 14 g/dL.
Correct Answer: B) Positive antistreptolysin O (ASO) titer.
Explanation: AGN is frequently a post-infectious response, commonly following a Group A beta-
hemolytic streptococcal infection. A positive ASO titer confirms the recent streptococcal
infection. AGN typically presents with elevated ESR, normal or slightly low serum albumin
(unlike nephrotic syndrome, which shows significant hypoalbuminemia), and potentially anemia
rather than high hemoglobin.
Question 6: A nurse is caring for a toddler who is in the emergency department with suspected
epiglottitis. Which of the following actions is the priority?
A) Perform a throat culture to identify the causative organism.
B) Obtain a lateral neck radiograph.
C) Keep the child in a supine position to promote comfort.
D) Prepare the child for immediate endotracheal intubation.
Correct Answer: D) Prepare the child for immediate endotracheal intubation.
Explanation: Epiglottitis is a life-threatening airway emergency. The child’s airway can become
completely obstructed at any moment. The nurse must prioritize airway management and be
prepared to assist with intubation. A throat culture or tongue-depressor assessment can trigger a
laryngospasm and total airway obstruction. The child should be kept in a position of comfort
(usually sitting upright), never supine.
Question 7: A nurse is caring for a school-age child who has nephrotic syndrome. Which of the
following findings is the priority to report to the provider?
A) Generalized edema.
B) Serum cholesterol 350 mg/dL.
C) Respiratory rate 28/min.
D) Urine protein 3+.
Advanced Prep: Master Pediatric Nursing
Clinical Judgment & Care
Subject: Pediatric Nursing (NGN ATI RN 2023 Retake) | Subtopic: Pediatric
Clinical Judgment, Safety, and Acute Care
Question 1: A nurse is assessing a 4-year-old child following a tonsillectomy. Which of the
following findings is the highest priority for the nurse to report to the surgeon?
A) The child is requesting an ice pop every 30 minutes.
B) The child has thick, blood-tinged nasal secretions.
C) The child is swallowing frequently while sleeping.
D) The child has a heart rate of 110 beats/min while resting.
Correct Answer: C) The child is swallowing frequently while sleeping.
Explanation: Frequent swallowing in a child who has undergone a tonsillectomy is a hallmark
clinical indicator of postoperative hemorrhage. Because children cannot easily expectorate
blood, they swallow it. The nurse must assess for other signs of bleeding (tachycardia, pallor,
restlessness) and notify the surgeon immediately. Thick, blood-tinged secretions are expected; a
heart rate of 110 is within normal limits for a 4-year-old; and ice pops are encouraged to
promote hydration.
Question 2: A nurse is caring for an infant with suspected intussusception. Which of the
following clinical manifestations should the nurse expect to find?
A) Projectile, non-bilious vomiting.
B) Stool that resembles red currant jelly.
C) Olive-shaped mass in the right upper quadrant.
D) Sharp, localized pain in the right lower quadrant.
Correct Answer: B) Stool that resembles red currant jelly.
,Explanation: Intussusception occurs when a portion of the bowel telescopes into an adjacent
segment, causing obstruction and ischemia. This leads to the classic sign of "currant jelly"
stools—a mixture of blood and mucus. Projectile vomiting and an olive-shaped mass are
indicative of pyloric stenosis. Sharp RLQ pain suggests appendicitis.
Question 3: A nurse is providing discharge teaching for the parents of a child who has a new
prescription for a long-acting beta-agonist (LABA) inhaler. Which of the following statements
by the parents indicates an understanding of the teaching?
A) "We will use this inhaler whenever our child has an acute asthma attack."
B) "We should monitor for decreased heart rate after administration."
C) "We will administer this medication on a set schedule, not for rescue use."
D) "We should increase the dosage if our child starts coughing."
Correct Answer: C) "We will administer this medication on a set schedule, not for rescue
use."
Explanation: LABAs are controllers, not rescue medications. They have a slow onset and long
duration, meaning they are ineffective for acute bronchospasm. Rescue therapy requires a short-
acting beta-agonist (SABA). LABAs can cause tachycardia, not bradycardia, and dosage should
never be adjusted without provider consultation.
Question 4: A nurse is caring for a 6-month-old infant with developmental dysplasia of the hip
(DDH) who is placed in a Pavlik harness. Which of the following nursing actions is appropriate?
A) Remove the harness daily for bathing and infant exercise.
B) Place a diaper underneath the straps of the harness.
C) Ensure the straps are adjusted every 24 hours to accommodate growth.
D) Adjust the harness straps so the hips are held in a position of adduction.
Correct Answer: B) Place a diaper underneath the straps of the harness.
Explanation: Placing the diaper under the harness straps helps keep the harness clean and dry,
preventing skin breakdown. The harness should generally be worn continuously and not removed
for bathing unless directed by the provider. Parents should not adjust the straps, as this can
affect hip alignment. The hips must be maintained in abduction, not adduction, to ensure the
femoral head remains in the acetabulum.
Question 5: A nurse is assessing a child with acute glomerulonephritis (AGN). Which of the
following laboratory findings should the nurse anticipate?
, A) Serum albumin 5.5 g/dL.
B) Positive antistreptolysin O (ASO) titer.
C) Decreased erythrocyte sedimentation rate (ESR).
D) Hemoglobin 14 g/dL.
Correct Answer: B) Positive antistreptolysin O (ASO) titer.
Explanation: AGN is frequently a post-infectious response, commonly following a Group A beta-
hemolytic streptococcal infection. A positive ASO titer confirms the recent streptococcal
infection. AGN typically presents with elevated ESR, normal or slightly low serum albumin
(unlike nephrotic syndrome, which shows significant hypoalbuminemia), and potentially anemia
rather than high hemoglobin.
Question 6: A nurse is caring for a toddler who is in the emergency department with suspected
epiglottitis. Which of the following actions is the priority?
A) Perform a throat culture to identify the causative organism.
B) Obtain a lateral neck radiograph.
C) Keep the child in a supine position to promote comfort.
D) Prepare the child for immediate endotracheal intubation.
Correct Answer: D) Prepare the child for immediate endotracheal intubation.
Explanation: Epiglottitis is a life-threatening airway emergency. The child’s airway can become
completely obstructed at any moment. The nurse must prioritize airway management and be
prepared to assist with intubation. A throat culture or tongue-depressor assessment can trigger a
laryngospasm and total airway obstruction. The child should be kept in a position of comfort
(usually sitting upright), never supine.
Question 7: A nurse is caring for a school-age child who has nephrotic syndrome. Which of the
following findings is the priority to report to the provider?
A) Generalized edema.
B) Serum cholesterol 350 mg/dL.
C) Respiratory rate 28/min.
D) Urine protein 3+.
