2023 ATI CMS
PEDIATRIC
EXAM QUESTIONS
(3 FULL SET EXAMS)
(NGN-STYLE QUESTIONS & CASE SCENARIOS)
GET A LEVEL 2 OR HIGHER
What You’ll Get:
• 450 PEDIATRIC nursing questions
• Detailed answer rationales for each question
Not affiliated with ATI, VATI or NCLEX. For study purposes only.
,PREVIEW QUESTIONS BELOW
GET THE COMPLETE PDF
AFTER PURCHASE
“ If you require further clarification
or in need of any study resources,
feel free to Message me.
”
,Table of Contents
ATI PEDIATRIC PROCTOR EXAM (V1) ................................... 2
ATI PEDIATRIC PROCTOR EXAM (V2) ................................ 49
ATI PEDIATRIC PROCTOR EXAM (V3) ................................ 89
(BONUS) ATI PEDIATRIC 200+ QS ......................................125
ATI PEDIATRIC PROCTOR EXAM (V1)
SCENARIO 1: ANTEPARTUM CLIENT WITH PRETERM LABOR RISK
1. A nurse is assisting with the care for a client in an antepartum unit. After
reviewing the History and Physical, Nurses' Notes, and Vital Signs, which findings
from the client's medical record are risk factors (indications) for preterm labor?
(Select all that apply)
A. History of 2 preterm births at 30 and 34 weeks of gestation
B. Current gestational age of 34 4/7 weeks with twin pregnancy
C. Late prenatal care
D. BMI > 30
E. Periodontal disease
F. Client reports smoking 4 cigarettes per day
Correct Answers: A, B, C, E, F
Rationales:
• A. CORRECT – Previous preterm birth is the strongest predictor of subsequent
preterm labor. History of 2 preterm births significantly increases risk.
• B. CORRECT – Multiple gestation (twins) and current gestational age in late preterm
period (34 weeks) are both risk factors for preterm delivery.
, • C. CORRECT – Late or no prenatal care is associated with increased risk of preterm
labor due to lack of monitoring and intervention.
• D. INCORRECT – While obesity can complicate pregnancy, it is not a primary risk
factor for preterm labor specifically.
• E. CORRECT – Periodontal disease has been linked to increased risk of preterm birth
due to inflammatory mediators.
• F. CORRECT – Smoking during pregnancy is a major modifiable risk factor for
preterm labor, low birth weight, and placental complications.
2. Which of the following findings from the client's medical record should the nurse
report to the client's primary nurse? (Select all that apply)
A. Vaginal examination showing cervical dilation of 4 cm
B. Pain rate of 8/10
C. Uterine contraction pattern every 2-3 minutes, lasting 60-90 seconds
Correct Answers: A, B, C
Rationales:
• A. CORRECT – Cervical dilation of 4 cm indicates active preterm labor and requires
immediate intervention for tocolysis or delivery preparation.
• B. CORRECT – Pain rate of 8/10 indicates significant discomfort that may affect
maternal hemodynamics and fetal status; requires assessment and intervention.
• C. CORRECT – Regular, frequent contractions (every 2-3 minutes) with adequate
duration indicate progressive labor pattern requiring immediate provider
notification.
3. Complete the following sentence: The greatest risk to the fetus is ______________ due
to the maternal contraction pattern.
Options: A. Respiratory distress syndrome
B. Intraventricular hemorrhage
,C. Necrotizing enterocolitis
D. Retinopathy of prematurity
Correct Answer: A. Respiratory distress syndrome
Rationale: The greatest risk to a fetus at 34 weeks gestation with preterm labor is
respiratory distress syndrome (RDS). At this gestational age, fetal surfactant production
may be inadequate, leading to alveolar collapse and respiratory failure after delivery. The
maternal contraction pattern indicates imminent delivery, making RDS the most immediate
life-threatening complication. While B, C, and D are complications of prematurity, RDS is the
most immediate threat requiring surfactant administration and respiratory support.
4. Drag 1 condition and 1 client finding to fill in each blank: The nurse should
anticipate a provider prescription for ______________ due to the client's ______________.
Options for First Blank (Medication): A. Magnesium sulfate
B. Terbutaline
C. Nifedipine
D. Betamethasone
Options for Second Blank (Finding): A. Labor progression
B. Cervical change
C. Contractions every 5 minutes
D. Fetal heart rate decelerations
Correct Answer: Magnesium sulfate + Labor progression
Rationale: Magnesium sulfate is the antenatal neuroprotective agent of choice when
preterm delivery is imminent (typically <32 weeks, though often used up to 34 weeks). It
reduces the risk of cerebral palsy in preterm infants. The nurse should anticipate this
prescription due to labor progression (active cervical change and regular contractions),
which indicates delivery is likely within 24 hours. Magnesium sulfate is administered for
neuroprotection when delivery is anticipated, not as a tocolytic (though it has some
tocolytic properties, its primary use here is fetal neuroprotection).
5. The nurse is collaborating with the client's primary nurse to make
recommendations of interventions for implementation to the client's plan of care.
,Which of the following interventions should the nurse recommend? (Select 5
interventions)
A. Position client on their side
B. Monitor deep tendon reflexes
C. Ensure the client maintains a urinary output of at least 25-30 mL/hr
D. Monitor the client for hypotension
E. Limit client's oral fluid intake
F. Maintain continuous fetal monitoring
G. Assess cervical dilation every 4 hours
H. Administer corticosteroids for fetal lung maturity
Correct Answers: A, B, C, D, F (or appropriate combination based on scenario context)
Rationales:
• A. CORRECT – Side-lying position improves uteroplacental perfusion and reduces
supine hypotensive syndrome.
• B. CORRECT – If magnesium sulfate is administered, deep tendon reflexes must be
monitored to detect hypermagnesemia/toxicity (loss of reflexes indicates levels >10
mg/dL).
• C. CORRECT – Urinary output of 25-30 mL/hr indicates adequate renal perfusion
and helps assess for magnesium toxicity (decreased urine output increases risk of
toxicity).
• D. CORRECT – Magnesium sulfate causes vasodilation and can lead to hypotension;
cardiovascular monitoring is essential.
• E. INCORRECT – Fluid restriction is contraindicated; adequate hydration is
necessary to prevent magnesium toxicity and maintain perfusion.
• F. CORRECT – Continuous fetal monitoring is essential during preterm labor to
detect fetal heart rate changes indicating compromise.
• G. INCORRECT – Excessive vaginal examinations increase risk of infection
(chorioamnionitis); examinations should be minimized.
• H. INCORRECT – While corticosteroids may be indicated, at 34 weeks the benefit is
less clear than at earlier gestations; this would be provider-specific.
,6. The nurse is assisting with evaluating the client following administration of
prescribed magnesium sulfate. For each client finding, specify if the prescribed
therapy was effective or ineffective:
Table
Client Finding Effective Ineffective
Fetal monitoring strip showing late decelerations ☐ ☒
Deep tendon reflexes 2+ ☒ ☐
Maternal blood pressure 140/90 mmHg ☐ ☒
Uterine contraction pattern decreased to every 10-15 minutes ☒ ☐
Pain rate decreased to 3/10 ☒ ☐
Rationales:
• Late decelerations = INEFFECTIVE – Late decelerations indicate uteroplacental
insufficiency and fetal compromise; magnesium sulfate has not resolved underlying
perfusion issues.
• DTR 2+ = EFFECTIVE – Normal deep tendon reflexes (2+) indicate therapeutic
magnesium levels (4-7 mEq/L) without toxicity.
• BP 140/90 = INEFFECTIVE – Persistent hypertension indicates magnesium has not
achieved desired cardiovascular effect; may indicate developing preeclampsia.
• Decreased contraction frequency = EFFECTIVE – Magnesium sulfate has tocolytic
effect, reducing contraction frequency and intensity.
, • Decreased pain = EFFECTIVE – Reduced pain correlates with decreased uterine
activity, indicating therapeutic response.
SCENARIO 2: SPINAL CORD INJURY CLIENT
7. A nurse is assisting with the care of a client who had a spinal cord injury and has
autonomic dysreflexia. Complete the following sentence: The nurse should first
address the client's ______________ followed by the client's ______________.
Options for First Priority: A. Oxygen saturation
B. Blood pressure
C. Pain level
D. Bladder distension
Options for Second Priority: A. Calf circumference
B. Temperature
C. Blood pressure
D. Source of noxious stimulus
Correct Answer: Oxygen saturation + Calf circumference (or appropriate alternative
based on context)
Rationale: In spinal cord injury above T6, autonomic dysreflexia is a life-threatening
emergency. However, if the scenario indicates respiratory compromise (high cervical
injury), oxygen saturation is the first priority (ABCs). The second priority addresses calf
circumference to assess for deep vein thrombosis, a common complication of immobility
in spinal cord injury. Alternatively, if autonomic dysreflexia is present, blood pressure
would be first priority, followed by identifying and removing the noxious stimulus (usually
bladder or bowel distension).
8. A nurse is assisting with the care of a client in a provider's office. Complete the
diagram by dragging choices to specify: Condition, 2 Actions to Take, and 2
Parameters to Monitor.
Potential Condition: A. Osteoporosis
B. Osteoarthritis
C. Osteomyelitis
D. Osteopenia
,Actions to Take: A. Encourage weight-bearing exercises
B. Reinforce nutritional education
C. Initiate bed rest
D. Administer IV antibiotics
Parameters to Monitor: A. Dietary intake
B. Bone mineral density
C. White blood cell count
D. Erythrocyte sedimentation rate
Correct Answer: Osteoporosis + Weight-bearing exercises + Nutritional education +
Dietary intake + Bone mineral density
Rationales:
• Osteoporosis is the likely condition for an office-based client requiring lifestyle
interventions.
• Weight-bearing exercises stimulate osteoblast activity and help maintain bone
density.
• Nutritional education addresses calcium and vitamin D intake essential for bone
health.
• Dietary intake monitoring ensures adequate calcium (1,200 mg/day) and vitamin
D (800-1,000 IU/day) consumption.
• Bone mineral density (DEXA scan) is the gold standard for monitoring
osteoporosis progression and treatment effectiveness.
SCENARIO 3: NEWBORN WITH HEMOLYTIC DISEASE
9. A nurse is assisting with the care for a newborn who is 1 hour following birth in
the nursery. Which of the following findings from the prenatal record should the
nurse recognize as a potential risk for the newborn? (Select all that apply)
A. Maternal blood type O negative
B. Indirect Coombs test result positive (1:16 titer)
C. Maternal history of previous Rh-sensitized pregnancy
D. Maternal rubella immunity
E. Maternal hepatitis B surface antigen negative
, Correct Answers: A, B, C
Rationales:
• A. CORRECT – Maternal Rh-negative status with unknown or Rh-positive father
creates risk for hemolytic disease of the newborn if fetus is Rh-positive.
• B. CORRECT – Positive indirect Coombs test indicates maternal antibodies against
fetal RBC antigens; 1:16 titer indicates significant sensitization risk for hemolytic
disease.
• C. CORRECT – Previous Rh-sensitized pregnancy increases risk and severity of
hemolytic disease in subsequent pregnancies due to amplified antibody response.
• D. INCORRECT – Rubella immunity is protective and poses no risk to newborn.
• E. INCORRECT – Negative hepatitis B surface antigen indicates no active infection;
this is not a risk factor.
10. The nurse is reviewing the newborn's data collection findings in their electronic
medical record. Complete the following sentence: The nurse should report the
newborn's ______________ and ______________ to the provider.
Options: A. Direct Coombs test result
B. Indirect Coombs test result
C. Axillary temperature
D. Blood glucose level
E. Heart rate
F. Respiratory rate
Correct Answer: Direct Coombs + Axillary temperature
Rationale: The direct Coombs test detects antibody-coated fetal RBCs and confirms
hemolytic disease in the newborn. A positive result requires immediate intervention
(phototherapy, possible exchange transfusion). Axillary temperature outside normal
range (36.5-37.5°C) indicates instability and potential sepsis or environmental stress,
requiring immediate provider notification in a newborn at risk for hemolytic disease.
PEDIATRIC
EXAM QUESTIONS
(3 FULL SET EXAMS)
(NGN-STYLE QUESTIONS & CASE SCENARIOS)
GET A LEVEL 2 OR HIGHER
What You’ll Get:
• 450 PEDIATRIC nursing questions
• Detailed answer rationales for each question
Not affiliated with ATI, VATI or NCLEX. For study purposes only.
,PREVIEW QUESTIONS BELOW
GET THE COMPLETE PDF
AFTER PURCHASE
“ If you require further clarification
or in need of any study resources,
feel free to Message me.
”
,Table of Contents
ATI PEDIATRIC PROCTOR EXAM (V1) ................................... 2
ATI PEDIATRIC PROCTOR EXAM (V2) ................................ 49
ATI PEDIATRIC PROCTOR EXAM (V3) ................................ 89
(BONUS) ATI PEDIATRIC 200+ QS ......................................125
ATI PEDIATRIC PROCTOR EXAM (V1)
SCENARIO 1: ANTEPARTUM CLIENT WITH PRETERM LABOR RISK
1. A nurse is assisting with the care for a client in an antepartum unit. After
reviewing the History and Physical, Nurses' Notes, and Vital Signs, which findings
from the client's medical record are risk factors (indications) for preterm labor?
(Select all that apply)
A. History of 2 preterm births at 30 and 34 weeks of gestation
B. Current gestational age of 34 4/7 weeks with twin pregnancy
C. Late prenatal care
D. BMI > 30
E. Periodontal disease
F. Client reports smoking 4 cigarettes per day
Correct Answers: A, B, C, E, F
Rationales:
• A. CORRECT – Previous preterm birth is the strongest predictor of subsequent
preterm labor. History of 2 preterm births significantly increases risk.
• B. CORRECT – Multiple gestation (twins) and current gestational age in late preterm
period (34 weeks) are both risk factors for preterm delivery.
, • C. CORRECT – Late or no prenatal care is associated with increased risk of preterm
labor due to lack of monitoring and intervention.
• D. INCORRECT – While obesity can complicate pregnancy, it is not a primary risk
factor for preterm labor specifically.
• E. CORRECT – Periodontal disease has been linked to increased risk of preterm birth
due to inflammatory mediators.
• F. CORRECT – Smoking during pregnancy is a major modifiable risk factor for
preterm labor, low birth weight, and placental complications.
2. Which of the following findings from the client's medical record should the nurse
report to the client's primary nurse? (Select all that apply)
A. Vaginal examination showing cervical dilation of 4 cm
B. Pain rate of 8/10
C. Uterine contraction pattern every 2-3 minutes, lasting 60-90 seconds
Correct Answers: A, B, C
Rationales:
• A. CORRECT – Cervical dilation of 4 cm indicates active preterm labor and requires
immediate intervention for tocolysis or delivery preparation.
• B. CORRECT – Pain rate of 8/10 indicates significant discomfort that may affect
maternal hemodynamics and fetal status; requires assessment and intervention.
• C. CORRECT – Regular, frequent contractions (every 2-3 minutes) with adequate
duration indicate progressive labor pattern requiring immediate provider
notification.
3. Complete the following sentence: The greatest risk to the fetus is ______________ due
to the maternal contraction pattern.
Options: A. Respiratory distress syndrome
B. Intraventricular hemorrhage
,C. Necrotizing enterocolitis
D. Retinopathy of prematurity
Correct Answer: A. Respiratory distress syndrome
Rationale: The greatest risk to a fetus at 34 weeks gestation with preterm labor is
respiratory distress syndrome (RDS). At this gestational age, fetal surfactant production
may be inadequate, leading to alveolar collapse and respiratory failure after delivery. The
maternal contraction pattern indicates imminent delivery, making RDS the most immediate
life-threatening complication. While B, C, and D are complications of prematurity, RDS is the
most immediate threat requiring surfactant administration and respiratory support.
4. Drag 1 condition and 1 client finding to fill in each blank: The nurse should
anticipate a provider prescription for ______________ due to the client's ______________.
Options for First Blank (Medication): A. Magnesium sulfate
B. Terbutaline
C. Nifedipine
D. Betamethasone
Options for Second Blank (Finding): A. Labor progression
B. Cervical change
C. Contractions every 5 minutes
D. Fetal heart rate decelerations
Correct Answer: Magnesium sulfate + Labor progression
Rationale: Magnesium sulfate is the antenatal neuroprotective agent of choice when
preterm delivery is imminent (typically <32 weeks, though often used up to 34 weeks). It
reduces the risk of cerebral palsy in preterm infants. The nurse should anticipate this
prescription due to labor progression (active cervical change and regular contractions),
which indicates delivery is likely within 24 hours. Magnesium sulfate is administered for
neuroprotection when delivery is anticipated, not as a tocolytic (though it has some
tocolytic properties, its primary use here is fetal neuroprotection).
5. The nurse is collaborating with the client's primary nurse to make
recommendations of interventions for implementation to the client's plan of care.
,Which of the following interventions should the nurse recommend? (Select 5
interventions)
A. Position client on their side
B. Monitor deep tendon reflexes
C. Ensure the client maintains a urinary output of at least 25-30 mL/hr
D. Monitor the client for hypotension
E. Limit client's oral fluid intake
F. Maintain continuous fetal monitoring
G. Assess cervical dilation every 4 hours
H. Administer corticosteroids for fetal lung maturity
Correct Answers: A, B, C, D, F (or appropriate combination based on scenario context)
Rationales:
• A. CORRECT – Side-lying position improves uteroplacental perfusion and reduces
supine hypotensive syndrome.
• B. CORRECT – If magnesium sulfate is administered, deep tendon reflexes must be
monitored to detect hypermagnesemia/toxicity (loss of reflexes indicates levels >10
mg/dL).
• C. CORRECT – Urinary output of 25-30 mL/hr indicates adequate renal perfusion
and helps assess for magnesium toxicity (decreased urine output increases risk of
toxicity).
• D. CORRECT – Magnesium sulfate causes vasodilation and can lead to hypotension;
cardiovascular monitoring is essential.
• E. INCORRECT – Fluid restriction is contraindicated; adequate hydration is
necessary to prevent magnesium toxicity and maintain perfusion.
• F. CORRECT – Continuous fetal monitoring is essential during preterm labor to
detect fetal heart rate changes indicating compromise.
• G. INCORRECT – Excessive vaginal examinations increase risk of infection
(chorioamnionitis); examinations should be minimized.
• H. INCORRECT – While corticosteroids may be indicated, at 34 weeks the benefit is
less clear than at earlier gestations; this would be provider-specific.
,6. The nurse is assisting with evaluating the client following administration of
prescribed magnesium sulfate. For each client finding, specify if the prescribed
therapy was effective or ineffective:
Table
Client Finding Effective Ineffective
Fetal monitoring strip showing late decelerations ☐ ☒
Deep tendon reflexes 2+ ☒ ☐
Maternal blood pressure 140/90 mmHg ☐ ☒
Uterine contraction pattern decreased to every 10-15 minutes ☒ ☐
Pain rate decreased to 3/10 ☒ ☐
Rationales:
• Late decelerations = INEFFECTIVE – Late decelerations indicate uteroplacental
insufficiency and fetal compromise; magnesium sulfate has not resolved underlying
perfusion issues.
• DTR 2+ = EFFECTIVE – Normal deep tendon reflexes (2+) indicate therapeutic
magnesium levels (4-7 mEq/L) without toxicity.
• BP 140/90 = INEFFECTIVE – Persistent hypertension indicates magnesium has not
achieved desired cardiovascular effect; may indicate developing preeclampsia.
• Decreased contraction frequency = EFFECTIVE – Magnesium sulfate has tocolytic
effect, reducing contraction frequency and intensity.
, • Decreased pain = EFFECTIVE – Reduced pain correlates with decreased uterine
activity, indicating therapeutic response.
SCENARIO 2: SPINAL CORD INJURY CLIENT
7. A nurse is assisting with the care of a client who had a spinal cord injury and has
autonomic dysreflexia. Complete the following sentence: The nurse should first
address the client's ______________ followed by the client's ______________.
Options for First Priority: A. Oxygen saturation
B. Blood pressure
C. Pain level
D. Bladder distension
Options for Second Priority: A. Calf circumference
B. Temperature
C. Blood pressure
D. Source of noxious stimulus
Correct Answer: Oxygen saturation + Calf circumference (or appropriate alternative
based on context)
Rationale: In spinal cord injury above T6, autonomic dysreflexia is a life-threatening
emergency. However, if the scenario indicates respiratory compromise (high cervical
injury), oxygen saturation is the first priority (ABCs). The second priority addresses calf
circumference to assess for deep vein thrombosis, a common complication of immobility
in spinal cord injury. Alternatively, if autonomic dysreflexia is present, blood pressure
would be first priority, followed by identifying and removing the noxious stimulus (usually
bladder or bowel distension).
8. A nurse is assisting with the care of a client in a provider's office. Complete the
diagram by dragging choices to specify: Condition, 2 Actions to Take, and 2
Parameters to Monitor.
Potential Condition: A. Osteoporosis
B. Osteoarthritis
C. Osteomyelitis
D. Osteopenia
,Actions to Take: A. Encourage weight-bearing exercises
B. Reinforce nutritional education
C. Initiate bed rest
D. Administer IV antibiotics
Parameters to Monitor: A. Dietary intake
B. Bone mineral density
C. White blood cell count
D. Erythrocyte sedimentation rate
Correct Answer: Osteoporosis + Weight-bearing exercises + Nutritional education +
Dietary intake + Bone mineral density
Rationales:
• Osteoporosis is the likely condition for an office-based client requiring lifestyle
interventions.
• Weight-bearing exercises stimulate osteoblast activity and help maintain bone
density.
• Nutritional education addresses calcium and vitamin D intake essential for bone
health.
• Dietary intake monitoring ensures adequate calcium (1,200 mg/day) and vitamin
D (800-1,000 IU/day) consumption.
• Bone mineral density (DEXA scan) is the gold standard for monitoring
osteoporosis progression and treatment effectiveness.
SCENARIO 3: NEWBORN WITH HEMOLYTIC DISEASE
9. A nurse is assisting with the care for a newborn who is 1 hour following birth in
the nursery. Which of the following findings from the prenatal record should the
nurse recognize as a potential risk for the newborn? (Select all that apply)
A. Maternal blood type O negative
B. Indirect Coombs test result positive (1:16 titer)
C. Maternal history of previous Rh-sensitized pregnancy
D. Maternal rubella immunity
E. Maternal hepatitis B surface antigen negative
, Correct Answers: A, B, C
Rationales:
• A. CORRECT – Maternal Rh-negative status with unknown or Rh-positive father
creates risk for hemolytic disease of the newborn if fetus is Rh-positive.
• B. CORRECT – Positive indirect Coombs test indicates maternal antibodies against
fetal RBC antigens; 1:16 titer indicates significant sensitization risk for hemolytic
disease.
• C. CORRECT – Previous Rh-sensitized pregnancy increases risk and severity of
hemolytic disease in subsequent pregnancies due to amplified antibody response.
• D. INCORRECT – Rubella immunity is protective and poses no risk to newborn.
• E. INCORRECT – Negative hepatitis B surface antigen indicates no active infection;
this is not a risk factor.
10. The nurse is reviewing the newborn's data collection findings in their electronic
medical record. Complete the following sentence: The nurse should report the
newborn's ______________ and ______________ to the provider.
Options: A. Direct Coombs test result
B. Indirect Coombs test result
C. Axillary temperature
D. Blood glucose level
E. Heart rate
F. Respiratory rate
Correct Answer: Direct Coombs + Axillary temperature
Rationale: The direct Coombs test detects antibody-coated fetal RBCs and confirms
hemolytic disease in the newborn. A positive result requires immediate intervention
(phototherapy, possible exchange transfusion). Axillary temperature outside normal
range (36.5-37.5°C) indicates instability and potential sepsis or environmental stress,
requiring immediate provider notification in a newborn at risk for hemolytic disease.
