ATI PEDIATRIC CMS PROCTORED EXAM 2023
| VERSIONS A & B QUESTIONS, ANSWERS &
RATIONALES
OVERVIEW
• This document contains 200 comprehensive ATI Pediatric CMS Proctored Exam
questions from Versions A & B with detailed rationales—ideal for studying test-
taking strategies, clinical decision-making, and pediatric nursing concepts across
the full exam scope.
• Use this material by completing questions in sets, timing yourself, reviewing
incorrect answers and rationales immediately, and focusing on content areas
where you score below 80%.
1.
A 3-year-old child presents with a barky, seal-like cough and inspiratory
stridor. The child appears anxious and has mild respiratory distress.
Temperature is 38.2°C. Which condition is this child most likely experiencing?
A) Acute epiglottitis
B) Peritonsillar abscess
C) Croup
D) Laryngitis
E) Tracheitis
CORRECT ANSWER: C) Croup
Croup (laryngotracheobronchitis) is characterized by the classic barky, seal-like
cough and inspiratory stridor, most common in children aged 6 months to 3 years.
The condition is typically viral (parainfluenza virus) and occurs with mild fever and
signs of upper respiratory infection. Epiglottitis presents with severe respiratory
distress and drooling; peritonsillar abscess involves throat pain and difficulty
swallowing; laryngitis causes hoarseness but not stridor; tracheitis is bacterial with
high fever and toxic appearance.
,2.
A 6-month-old infant with bronchiolitis is receiving supplemental oxygen and
is admitted to the pediatric unit. Which nursing intervention is most
appropriate for this infant?
A) Restrict fluid intake to prevent pulmonary edema
B) Position supine to facilitate drainage
C) Maintain humidity and provide frequent suctioning as needed
D) Encourage aggressive chest physiotherapy
E) Administer antibiotics prophylactically
CORRECT ANSWER: C) Maintain humidity and provide frequent suctioning as
needed
Bronchiolitis is a viral infection causing inflammation of the bronchioles.
Management focuses on supportive care including humidified oxygen, careful fluid
and electrolyte management, and suctioning to maintain airway patency.
Antibiotics are not indicated for viral bronchiolitis unless bacterial superinfection
occurs. Aggressive chest physiotherapy and positioning supine are not
recommended as they may increase respiratory distress. Fluids are typically
maintained at normal to slightly reduced levels.
3.
A 4-year-old child with asthma is prescribed albuterol via metered-dose
inhaler (MDI) with a spacer. After demonstrating the technique, you observe
the child taking the medication. Which action indicates correct use?
A) The child takes a deep breath before activating the MDI
B) The child activates the MDI, then immediately inhales quickly
C) The child places the spacer in their mouth and activates the MDI simultaneously
,D) The child activates the MDI into the spacer, then takes 5-6 slow, deep breaths
E) The child exhales completely, then activates the MDI without using the spacer
CORRECT ANSWER: D) The child activates the MDI into the spacer, then takes
5-6 slow, deep breaths
Correct MDI technique with a spacer involves: activating the MDI into the spacer
chamber first, then placing the spacer in the mouth and taking 5-6 slow, deep
breaths to ensure medication delivery to the lungs. A spacer reduces the need for
hand-breath coordination and increases medication delivery to the lower airways.
Activating and immediately inhaling is incorrect timing. Deep breaths before
activation are unnecessary. Simultaneous activation and placement is improper
technique.
4.
A 2-year-old child is admitted with moderate dehydration secondary to acute
gastroenteritis. The child weighs 15 kg. Which fluid replacement plan is most
appropriate for the first 4 hours?
A) 50 mL/kg of 0.9% NaCl IV bolus
B) 100 mL/kg of oral rehydration solution (ORS) over 4 hours
C) 25-50 mL/kg of 0.45% NaCl IV over 4 hours
D) Continue NPO status with IV dextrose and water
E) 500 mL of D5W IV over 4 hours
CORRECT ANSWER: C) 25-50 mL/kg of 0.45% NaCl IV over 4 hours
For moderate dehydration in children, IV fluid replacement of 25-50 mL/kg is
appropriate, using a hypotonic solution like 0.45% NaCl (half-normal saline). For a
15 kg child, this would be 375-750 mL over 4 hours. Bolus therapy (50 mL/kg) is
reserved for severe dehydration or shock. Oral rehydration is preferred for mild
dehydration. NPO status is not indicated; the child can resume feeding once
, rehydrated. Dextrose and water solutions are not appropriate for dehydration
replacement as they lack adequate electrolytes.
5.
A 7-year-old child with newly diagnosed type 1 diabetes mellitus receives
insulin injection training. Which statement by the parent indicates they need
further teaching?
A) "We will rotate injection sites to prevent lipohypertrophy"
B) "We should inject insulin at room temperature"
C) "We will store unopened insulin vials in the freezer"
D) "We should use a new needle for each injection"
E) "We will check blood glucose before meals and at bedtime"
CORRECT ANSWER: C) We will store unopened insulin vials in the freezer
Unopened insulin vials should be stored in the refrigerator (2-8°C), not the freezer,
as freezing can damage the insulin. Opened vials may be kept at room temperature
for about 28 days. Rotating injection sites prevents lipohypertrophy. Using room
temperature insulin is correct (cold insulin can be uncomfortable). Using new
needles prevents infection and ensures accurate dosing. Checking blood glucose
before meals and bedtime is part of appropriate diabetes management.
6.
A 9-month-old infant presents with developmental dysplasia of the hip (DDH).
The infant was not diagnosed during newborn screening. Which clinical
finding would the nurse expect to observe?
A) Increased abduction of the affected hip
B) Positive Ortolani and Barlow signs
C) Symmetric abduction bilaterally
| VERSIONS A & B QUESTIONS, ANSWERS &
RATIONALES
OVERVIEW
• This document contains 200 comprehensive ATI Pediatric CMS Proctored Exam
questions from Versions A & B with detailed rationales—ideal for studying test-
taking strategies, clinical decision-making, and pediatric nursing concepts across
the full exam scope.
• Use this material by completing questions in sets, timing yourself, reviewing
incorrect answers and rationales immediately, and focusing on content areas
where you score below 80%.
1.
A 3-year-old child presents with a barky, seal-like cough and inspiratory
stridor. The child appears anxious and has mild respiratory distress.
Temperature is 38.2°C. Which condition is this child most likely experiencing?
A) Acute epiglottitis
B) Peritonsillar abscess
C) Croup
D) Laryngitis
E) Tracheitis
CORRECT ANSWER: C) Croup
Croup (laryngotracheobronchitis) is characterized by the classic barky, seal-like
cough and inspiratory stridor, most common in children aged 6 months to 3 years.
The condition is typically viral (parainfluenza virus) and occurs with mild fever and
signs of upper respiratory infection. Epiglottitis presents with severe respiratory
distress and drooling; peritonsillar abscess involves throat pain and difficulty
swallowing; laryngitis causes hoarseness but not stridor; tracheitis is bacterial with
high fever and toxic appearance.
,2.
A 6-month-old infant with bronchiolitis is receiving supplemental oxygen and
is admitted to the pediatric unit. Which nursing intervention is most
appropriate for this infant?
A) Restrict fluid intake to prevent pulmonary edema
B) Position supine to facilitate drainage
C) Maintain humidity and provide frequent suctioning as needed
D) Encourage aggressive chest physiotherapy
E) Administer antibiotics prophylactically
CORRECT ANSWER: C) Maintain humidity and provide frequent suctioning as
needed
Bronchiolitis is a viral infection causing inflammation of the bronchioles.
Management focuses on supportive care including humidified oxygen, careful fluid
and electrolyte management, and suctioning to maintain airway patency.
Antibiotics are not indicated for viral bronchiolitis unless bacterial superinfection
occurs. Aggressive chest physiotherapy and positioning supine are not
recommended as they may increase respiratory distress. Fluids are typically
maintained at normal to slightly reduced levels.
3.
A 4-year-old child with asthma is prescribed albuterol via metered-dose
inhaler (MDI) with a spacer. After demonstrating the technique, you observe
the child taking the medication. Which action indicates correct use?
A) The child takes a deep breath before activating the MDI
B) The child activates the MDI, then immediately inhales quickly
C) The child places the spacer in their mouth and activates the MDI simultaneously
,D) The child activates the MDI into the spacer, then takes 5-6 slow, deep breaths
E) The child exhales completely, then activates the MDI without using the spacer
CORRECT ANSWER: D) The child activates the MDI into the spacer, then takes
5-6 slow, deep breaths
Correct MDI technique with a spacer involves: activating the MDI into the spacer
chamber first, then placing the spacer in the mouth and taking 5-6 slow, deep
breaths to ensure medication delivery to the lungs. A spacer reduces the need for
hand-breath coordination and increases medication delivery to the lower airways.
Activating and immediately inhaling is incorrect timing. Deep breaths before
activation are unnecessary. Simultaneous activation and placement is improper
technique.
4.
A 2-year-old child is admitted with moderate dehydration secondary to acute
gastroenteritis. The child weighs 15 kg. Which fluid replacement plan is most
appropriate for the first 4 hours?
A) 50 mL/kg of 0.9% NaCl IV bolus
B) 100 mL/kg of oral rehydration solution (ORS) over 4 hours
C) 25-50 mL/kg of 0.45% NaCl IV over 4 hours
D) Continue NPO status with IV dextrose and water
E) 500 mL of D5W IV over 4 hours
CORRECT ANSWER: C) 25-50 mL/kg of 0.45% NaCl IV over 4 hours
For moderate dehydration in children, IV fluid replacement of 25-50 mL/kg is
appropriate, using a hypotonic solution like 0.45% NaCl (half-normal saline). For a
15 kg child, this would be 375-750 mL over 4 hours. Bolus therapy (50 mL/kg) is
reserved for severe dehydration or shock. Oral rehydration is preferred for mild
dehydration. NPO status is not indicated; the child can resume feeding once
, rehydrated. Dextrose and water solutions are not appropriate for dehydration
replacement as they lack adequate electrolytes.
5.
A 7-year-old child with newly diagnosed type 1 diabetes mellitus receives
insulin injection training. Which statement by the parent indicates they need
further teaching?
A) "We will rotate injection sites to prevent lipohypertrophy"
B) "We should inject insulin at room temperature"
C) "We will store unopened insulin vials in the freezer"
D) "We should use a new needle for each injection"
E) "We will check blood glucose before meals and at bedtime"
CORRECT ANSWER: C) We will store unopened insulin vials in the freezer
Unopened insulin vials should be stored in the refrigerator (2-8°C), not the freezer,
as freezing can damage the insulin. Opened vials may be kept at room temperature
for about 28 days. Rotating injection sites prevents lipohypertrophy. Using room
temperature insulin is correct (cold insulin can be uncomfortable). Using new
needles prevents infection and ensures accurate dosing. Checking blood glucose
before meals and bedtime is part of appropriate diabetes management.
6.
A 9-month-old infant presents with developmental dysplasia of the hip (DDH).
The infant was not diagnosed during newborn screening. Which clinical
finding would the nurse expect to observe?
A) Increased abduction of the affected hip
B) Positive Ortolani and Barlow signs
C) Symmetric abduction bilaterally
