Actual ATI RN Pediatric Nursing
2023/2026 Proctored NGN Questions
and Answers.
1. A 7-year-old with fever, cough, and tachypnea has focal crackles and
decreased breath sounds on exam. Which initial outpatient antibiotic is most
appropriate if bacterial pneumonia is suspected and immunizations are up to
date?
• Azithromycin
• Ceftriaxone IM
• High-dose amoxicillin
• Oseltamivir Rationale:>> In children >3 months, Streptococcus pneumoniae
is most common; first-line is high-dose amoxicillin when typical bacterial
pneumonia is suspected
2. A 2-month-old infant with suspected bacterial pneumonia requires empiric
inpatient therapy. Which regimen is most appropriate?
• Ampicillin plus an aminoglycoside
• Ceftriaxone monotherapy
• High-dose amoxicillin
• Doxycycline Rationale:>> Neonates/young infants should receive
ampicillin plus an aminoglycoside or a third-generation cephalosporin (not
ceftriaxone in neonates due to bilirubin displacement risk) [1]1[2]2.
3. A 5-year-old presents with cough and fever. Which finding combination
most increases the likelihood of radiographic pneumonia?
• Wheeze + normal breath sounds
• Fever + tachypnea + focal crackles + decreased breath sounds
,• Isolated nasal flaring
• Dry cough alone Rationale:>> No single sign is diagnostic; combined fever,
tachypnea, focal crackles, and decreased breath sounds increase sensitivity
for pneumonia on chest x-ray, though diagnosis is clinical
4. For a 4-year-old with mild community-acquired pneumonia (CAP), which
statement about imaging is correct?
• Always obtain chest x-ray in all suspected CAP
• Ultrasound replaces x-ray in all cases
• Limit chest x-ray to toxic appearance, prolonged/recurrent course,
infants 0–3 months with fever, suspected foreign body, or complications
• Repeat daily chest x-rays to track improvement Rationale:>> Routine
imaging is not required in mild disease; use x-ray selectively to reduce
radiation, cost, and false negatives leading to unnecessary antibiotics
5. A toddler ingested a button battery. Priority nursing action?
• Give milk and observe
• Induce vomiting
• Keep NPO, secure airway/oxygen as needed, obtain urgent imaging,
prepare for emergent endoscopic removal
• Discharge with return precautions Rationale:>> Foreign body ingestion
management prioritizes airway, oxygen, NPO status, imaging for location,
and urgent endoscopy for high-risk objects like button batteries
6. A 3-year-old with opioid exposure is somnolent with shallow respirations
and oxygen saturation 86%. Best initial naloxone dose?
• 2 mg IV bolus
• 0.01 mg/kg IV, repeat every 2–3 min as needed
• 0.4 mg IV once then observe
, • 0.5 mg/kg IM once Rationale:>> Pediatric starting dose is 0.01 mg/kg IV;
may escalate to 0.1 mg/kg if inadequate response. Duration of opioids may
exceed naloxone; monitor and redose as needed
7. A 6-year-old with suspected bacterial CAP is stable for outpatient care. Best
first-line antibiotic?
• Azithromycin
• Cefdinir
• Amoxicillin (high-dose)
• Levofloxacin Rationale:>> For school-aged outpatients, amoxicillin
targeting Streptococcus pneumoniae is first-line; typical course ≤7 days
8. A 9-month-old with mild CAP and no hypoxemia. Chest x-ray?
• Always obtain before treatment
• Daily films for follow-up
• Not routinely—reserve for uncertainty, hypoxemia, significant distress,
or no improvement at 48–72 h
• CT chest is preferred Rationale:>> Routine imaging is unnecessary in mild
cases; obtain if diagnosis uncertain or not improving in 48–72 h
9. An infant <3 months with fever and suspected pneumonia. Disposition?
• Discharge with oral antibiotics
• Outpatient with close follow-up
• Hospitalize for treatment and monitoring
• Telehealth follow-up only Rationale:>> Neonates/young infants should be
hospitalized for suspected bacterial pneumonia
10.Neonate with suspected bacterial pneumonia. Best empiric regimen?
• Ampicillin + aminoglycoside
2023/2026 Proctored NGN Questions
and Answers.
1. A 7-year-old with fever, cough, and tachypnea has focal crackles and
decreased breath sounds on exam. Which initial outpatient antibiotic is most
appropriate if bacterial pneumonia is suspected and immunizations are up to
date?
• Azithromycin
• Ceftriaxone IM
• High-dose amoxicillin
• Oseltamivir Rationale:>> In children >3 months, Streptococcus pneumoniae
is most common; first-line is high-dose amoxicillin when typical bacterial
pneumonia is suspected
2. A 2-month-old infant with suspected bacterial pneumonia requires empiric
inpatient therapy. Which regimen is most appropriate?
• Ampicillin plus an aminoglycoside
• Ceftriaxone monotherapy
• High-dose amoxicillin
• Doxycycline Rationale:>> Neonates/young infants should receive
ampicillin plus an aminoglycoside or a third-generation cephalosporin (not
ceftriaxone in neonates due to bilirubin displacement risk) [1]1[2]2.
3. A 5-year-old presents with cough and fever. Which finding combination
most increases the likelihood of radiographic pneumonia?
• Wheeze + normal breath sounds
• Fever + tachypnea + focal crackles + decreased breath sounds
,• Isolated nasal flaring
• Dry cough alone Rationale:>> No single sign is diagnostic; combined fever,
tachypnea, focal crackles, and decreased breath sounds increase sensitivity
for pneumonia on chest x-ray, though diagnosis is clinical
4. For a 4-year-old with mild community-acquired pneumonia (CAP), which
statement about imaging is correct?
• Always obtain chest x-ray in all suspected CAP
• Ultrasound replaces x-ray in all cases
• Limit chest x-ray to toxic appearance, prolonged/recurrent course,
infants 0–3 months with fever, suspected foreign body, or complications
• Repeat daily chest x-rays to track improvement Rationale:>> Routine
imaging is not required in mild disease; use x-ray selectively to reduce
radiation, cost, and false negatives leading to unnecessary antibiotics
5. A toddler ingested a button battery. Priority nursing action?
• Give milk and observe
• Induce vomiting
• Keep NPO, secure airway/oxygen as needed, obtain urgent imaging,
prepare for emergent endoscopic removal
• Discharge with return precautions Rationale:>> Foreign body ingestion
management prioritizes airway, oxygen, NPO status, imaging for location,
and urgent endoscopy for high-risk objects like button batteries
6. A 3-year-old with opioid exposure is somnolent with shallow respirations
and oxygen saturation 86%. Best initial naloxone dose?
• 2 mg IV bolus
• 0.01 mg/kg IV, repeat every 2–3 min as needed
• 0.4 mg IV once then observe
, • 0.5 mg/kg IM once Rationale:>> Pediatric starting dose is 0.01 mg/kg IV;
may escalate to 0.1 mg/kg if inadequate response. Duration of opioids may
exceed naloxone; monitor and redose as needed
7. A 6-year-old with suspected bacterial CAP is stable for outpatient care. Best
first-line antibiotic?
• Azithromycin
• Cefdinir
• Amoxicillin (high-dose)
• Levofloxacin Rationale:>> For school-aged outpatients, amoxicillin
targeting Streptococcus pneumoniae is first-line; typical course ≤7 days
8. A 9-month-old with mild CAP and no hypoxemia. Chest x-ray?
• Always obtain before treatment
• Daily films for follow-up
• Not routinely—reserve for uncertainty, hypoxemia, significant distress,
or no improvement at 48–72 h
• CT chest is preferred Rationale:>> Routine imaging is unnecessary in mild
cases; obtain if diagnosis uncertain or not improving in 48–72 h
9. An infant <3 months with fever and suspected pneumonia. Disposition?
• Discharge with oral antibiotics
• Outpatient with close follow-up
• Hospitalize for treatment and monitoring
• Telehealth follow-up only Rationale:>> Neonates/young infants should be
hospitalized for suspected bacterial pneumonia
10.Neonate with suspected bacterial pneumonia. Best empiric regimen?
• Ampicillin + aminoglycoside
