2026 ATI RN Nursing Care of Children
Practice Exam Questions with Answers
and Detailed Rationales
1. A nurse is assessing a 4-month-old infant who has a
suspected bacterial meningitis infection. Which finding
requires the nurse to intervene immediately?
A. Temperature of 38.2°C (100.8°F)
B. Irritability when held
C. Bulging anterior fontanelle with a high-pitched cry
D. Decreased appetite for one feeding
Rationale: A bulging fontanelle combined with a high-pitched
cry suggests increased intracranial pressure and possible
meningitis. This is an emergency requiring immediate
assessment and intervention. Fever and irritability are
common with infection, while a single missed feeding is less
immediately concerning.
2. A nurse is caring for a child with epiglottitis. Which action
should the nurse take?
A. Obtain a throat culture using a tongue depressor
B. Place the child in a supine position
C. Prepare for emergency airway management
D. Encourage the child to drink cold fluids
,Rationale: Epiglottitis can cause rapid airway obstruction. The
nurse should avoid manipulating the throat because this can
precipitate complete obstruction. The child should remain
calm and upright while emergency airway equipment and
personnel are prepared.
3. A 2-year-old child is admitted with severe dehydration
secondary to gastroenteritis. Which assessment finding is
most concerning?
A. Dry mucous membranes
B. Capillary refill of 3 seconds
C. Decreased urine output
D. Lethargy and weak peripheral pulses
Rationale: Lethargy and weak peripheral pulses indicate
severe dehydration with compromised circulatory status and
possible hypovolemic shock. These findings require immediate
fluid resuscitation and close monitoring.
4. A nurse is teaching the parents of a child with cystic
fibrosis about pancreatic enzyme replacement. Which
instruction is appropriate?
A. Administer enzymes once daily at bedtime
B. Give pancreatic enzymes with all meals and snacks
C. Mix the enzymes with hot food
D. Give the enzymes only when abdominal pain occurs
,Rationale: Children with cystic fibrosis may have pancreatic
insufficiency and require enzymes with meals and snacks to
promote digestion and nutrient absorption. Enzymes should
not be mixed with hot foods because heat can reduce their
effectiveness.
5. A child with nephrotic syndrome is receiving
corticosteroid therapy. Which finding should the nurse
report immediately?
A. Increased appetite
B. Facial edema
C. Temperature of 38.5°C (101.3°F)
D. Weight gain of 0.5 kg over 1 week
Rationale: Children with nephrotic syndrome are at increased
risk for infection because of urinary protein losses and
immunosuppressive therapy. Fever may indicate a serious
infection requiring prompt evaluation.
6. A nurse is caring for a child experiencing a generalized
tonic-clonic seizure. Which intervention is appropriate?
A. Insert a padded tongue blade
B. Restrain the child's extremities
C. Turn the child to the side and protect the airway
D. Administer oral fluids immediately
Rationale: During a seizure, the nurse should protect the child
from injury and maintain airway patency by positioning the
, child on the side when possible. Nothing should be placed in
the mouth, and restraints should not be used.
7. A 6-year-old child with sickle cell disease reports severe
generalized pain. Which intervention is the priority?
A. Restrict oral fluids
B. Apply cold packs to painful joints
C. Administer prescribed analgesics and promote hydration
D. Encourage strenuous exercise
Rationale: A vaso-occlusive crisis causes tissue ischemia and
severe pain. Management includes adequate analgesia,
hydration, oxygen if hypoxemia is present, and treatment of
the underlying trigger. Cold exposure and dehydration can
worsen sickling.
8. A nurse is caring for a child with bacterial pneumonia.
Which finding indicates worsening respiratory distress?
A. Respiratory rate of 28/min
B. Productive cough
C. Temperature of 38°C (100.4°F)
D. Grunting and intercostal retractions
Rationale: Grunting and retractions indicate increased work
of breathing and significant respiratory compromise. The
nurse should immediately assess oxygenation and prepare for
escalation of respiratory support.
Practice Exam Questions with Answers
and Detailed Rationales
1. A nurse is assessing a 4-month-old infant who has a
suspected bacterial meningitis infection. Which finding
requires the nurse to intervene immediately?
A. Temperature of 38.2°C (100.8°F)
B. Irritability when held
C. Bulging anterior fontanelle with a high-pitched cry
D. Decreased appetite for one feeding
Rationale: A bulging fontanelle combined with a high-pitched
cry suggests increased intracranial pressure and possible
meningitis. This is an emergency requiring immediate
assessment and intervention. Fever and irritability are
common with infection, while a single missed feeding is less
immediately concerning.
2. A nurse is caring for a child with epiglottitis. Which action
should the nurse take?
A. Obtain a throat culture using a tongue depressor
B. Place the child in a supine position
C. Prepare for emergency airway management
D. Encourage the child to drink cold fluids
,Rationale: Epiglottitis can cause rapid airway obstruction. The
nurse should avoid manipulating the throat because this can
precipitate complete obstruction. The child should remain
calm and upright while emergency airway equipment and
personnel are prepared.
3. A 2-year-old child is admitted with severe dehydration
secondary to gastroenteritis. Which assessment finding is
most concerning?
A. Dry mucous membranes
B. Capillary refill of 3 seconds
C. Decreased urine output
D. Lethargy and weak peripheral pulses
Rationale: Lethargy and weak peripheral pulses indicate
severe dehydration with compromised circulatory status and
possible hypovolemic shock. These findings require immediate
fluid resuscitation and close monitoring.
4. A nurse is teaching the parents of a child with cystic
fibrosis about pancreatic enzyme replacement. Which
instruction is appropriate?
A. Administer enzymes once daily at bedtime
B. Give pancreatic enzymes with all meals and snacks
C. Mix the enzymes with hot food
D. Give the enzymes only when abdominal pain occurs
,Rationale: Children with cystic fibrosis may have pancreatic
insufficiency and require enzymes with meals and snacks to
promote digestion and nutrient absorption. Enzymes should
not be mixed with hot foods because heat can reduce their
effectiveness.
5. A child with nephrotic syndrome is receiving
corticosteroid therapy. Which finding should the nurse
report immediately?
A. Increased appetite
B. Facial edema
C. Temperature of 38.5°C (101.3°F)
D. Weight gain of 0.5 kg over 1 week
Rationale: Children with nephrotic syndrome are at increased
risk for infection because of urinary protein losses and
immunosuppressive therapy. Fever may indicate a serious
infection requiring prompt evaluation.
6. A nurse is caring for a child experiencing a generalized
tonic-clonic seizure. Which intervention is appropriate?
A. Insert a padded tongue blade
B. Restrain the child's extremities
C. Turn the child to the side and protect the airway
D. Administer oral fluids immediately
Rationale: During a seizure, the nurse should protect the child
from injury and maintain airway patency by positioning the
, child on the side when possible. Nothing should be placed in
the mouth, and restraints should not be used.
7. A 6-year-old child with sickle cell disease reports severe
generalized pain. Which intervention is the priority?
A. Restrict oral fluids
B. Apply cold packs to painful joints
C. Administer prescribed analgesics and promote hydration
D. Encourage strenuous exercise
Rationale: A vaso-occlusive crisis causes tissue ischemia and
severe pain. Management includes adequate analgesia,
hydration, oxygen if hypoxemia is present, and treatment of
the underlying trigger. Cold exposure and dehydration can
worsen sickling.
8. A nurse is caring for a child with bacterial pneumonia.
Which finding indicates worsening respiratory distress?
A. Respiratory rate of 28/min
B. Productive cough
C. Temperature of 38°C (100.4°F)
D. Grunting and intercostal retractions
Rationale: Grunting and retractions indicate increased work
of breathing and significant respiratory compromise. The
nurse should immediately assess oxygenation and prepare for
escalation of respiratory support.
