ATI Pediatrics Proctored Assessment Original
Practice Questions & Answers | Comprehensive
Pediatric Nursing Study Guide & Assessment
Preparation | Pediatric Growth & Development,
Newborn & Infant Care, Pediatric Assessment,
Respiratory & Cardiovascular Disorders,
Gastrointestinal & Endocrine Conditions,
Neurological & Hematological Disorders,
Immunizations, Communicable Diseases, Pediatric
Emergencies, Medication Safety, Psychosocial Care
& Family-Centered Nursing
Question 1: A 2-day-old newborn is being evaluated for jaundice. The total
serum bilirubin level is 18 mg/dL, and the direct fraction is 1.5 mg/dL. Which
of the following conditions is most likely indicated by this result?
A. Physiologic jaundice
B. Breast milk jaundice
C. Crigler-Najjar syndrome
D. Biliary atresia
CORRECT ANSWER: D. Biliary atresia
Rationale: A direct fraction greater than 1.0 mg/dL or greater than 20% of the total
bilirubin indicates direct hyperbilirubinemia, which is always pathologic. Biliary atresia is
a common cause of direct hyperbilirubinemia in newborns. Physiologic and breast milk
jaundice are typically indirect hyperbilirubinemias. Crigler-Najjar is also an indirect
hyperbilirubinemia.
Question 2: A 4-year-old child presents with a high fever, stridor, and a
"barky" cough that is worse at night. Which of the following is the most
appropriate initial management?
A. Racemic epinephrine nebulization
B. Oral corticosteroids
C. Immediate endotracheal intubation
D. Observation and supportive care
CORRECT ANSWER: B. Oral corticosteroids
Rationale: The presentation is classic for croup (laryngotracheobronchitis). While severe
cases may require racemic epinephrine, the initial mainstay of management for mild to
moderate croup is a single dose of oral corticosteroids (e.g., dexamethasone) to reduce
airway edema. Intubation is reserved for impending respiratory failure, and observation
alone is not sufficient for a child with stridor.
,Question 3: A 6-month-old infant with a history of frequent respiratory
infections is noted to have a harsh, continuous, machine-like murmur at the
left upper sternal border. Which of the following is the most likely diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: A continuous, "machine-like" murmur at the left upper sternal border is a
classic sign of a patent ductus arteriosus (PDA). VSD is a harsh holosystolic murmur at
the left lower sternal border. ASD is a systolic ejection murmur at the left upper border
with a fixed split S2. Tetralogy of Fallot presents with a systolic ejection murmur and
cyanosis.
Question 4: During a well-child visit, a 9-year-old is found to have a BMI in the
97th percentile. Which of the following comorbid conditions is most strongly
associated with this finding?
A. Type 1 diabetes mellitus
B. Iron deficiency anemia
C. Non-alcoholic fatty liver disease
D. Celiac disease
CORRECT ANSWER: C. Non-alcoholic fatty liver disease
Rationale: A BMI at or above the 95th percentile is classified as obesity. Non-alcoholic
fatty liver disease (NAFLD) is one of the most common and significant comorbidities
associated with pediatric obesity. While type 2 diabetes is a risk, type 1 is not associated
with obesity. Iron deficiency anemia is more common in toddlers with excessive milk
intake, and celiac disease is associated with poor weight gain.
Question 5: A 2-week-old infant presents with projectile vomiting after
feedings. The vomitus is non-bilious. On examination, an olive-like mass is
palpable in the right upper quadrant. What is the most appropriate diagnostic
study?
A. Upper GI series
B. Abdominal ultrasound
C. CT scan of the abdomen
D. Serum electrolyte panel
CORRECT ANSWER: B. Abdominal ultrasound
,Rationale: The presentation is classic for pyloric stenosis. An abdominal ultrasound is
the diagnostic test of choice to visualize the thickened pyloric muscle (olive-like mass)
and confirm the diagnosis. An upper GI series can be used if ultrasound is inconclusive
but is not the first line. A CT scan involves unnecessary radiation, and electrolytes are
used to assess for hypokalemic metabolic alkalosis but are not diagnostic.
Question 6: A 15-year-old female presents with secondary amenorrhea and
excessive exercise. She is significantly underweight and has lanugo hair
growth. Which of the following is the most likely underlying diagnosis?
A. Polycystic ovarian syndrome
B. Hypothyroidism
C. Anorexia nervosa
D. Primary ovarian insufficiency
CORRECT ANSWER: C. Anorexia nervosa
Rationale: The triad of amenorrhea, excessive exercise, and lanugo hair in an
underweight adolescent is characteristic of anorexia nervosa. PCOS typically presents
with obesity and hirsutism. Hypothyroidism usually presents with weight gain. Primary
ovarian insufficiency involves elevated FSH levels, but the history here points to an
eating disorder.
Question 7: A 5-year-old child is brought to the emergency department with a
sudden onset of severe wheezing, cough, and stridor. The parent reports the
child was eating peanuts 30 minutes prior. Which of the following is the
priority intervention?
A. Diphenhydramine
B. Albuterol nebulizer
C. Epinephrine IM
D. Corticosteroids
CORRECT ANSWER: C. Epinephrine IM
Rationale: This is anaphylaxis, a life-threatening allergic reaction. Intramuscular
epinephrine is the first-line and priority treatment. While albuterol may help with
bronchospasm and diphenhydramine with histamine release, they do not reverse the
life-threatening cardiovascular and respiratory effects of anaphylaxis. Corticosteroids
work too slowly for acute management.
Question 8: A newborn fails to pass meconium within the first 48 hours of life.
On examination, the abdomen is distended, and a contrast enema reveals a
microcolon. What is the most likely diagnosis?
, A. Hirschsprung disease
B. Imperforate anus
C. Meconium ileus
D. Malrotation with volvulus
CORRECT ANSWER: C. Meconium ileus
Rationale: Meconium ileus is a bowel obstruction in newborns caused by impacted,
thick meconium. It is highly associated with cystic fibrosis. The presence of a
microcolon on contrast enema is a hallmark sign. Hirschsprung disease presents with
delayed meconium passage but usually not a microcolon. Imperforate anus is a physical
finding, and malrotation typically presents with bilious vomiting.
Question 9: A 3-year-old child presents with a temperature of 104°F,
tachycardia, and an erythematous, sandpaper-like rash on the trunk, which
began 24 hours after the onset of a sore throat. Which of the following is the
most appropriate treatment?
A. Amoxicillin
B. Penicillin V
C. Erythromycin
D. Cephalexin
CORRECT ANSWER: B. Penicillin V
Rationale: The presentation is classic for scarlet fever (Group A Streptococcus
pharyngitis). The treatment of choice is Penicillin V. Amoxicillin is often used, but
Penicillin V is the specific recommended therapy to ensure eradication and prevent
rheumatic fever. Erythromycin is a second-line agent for those with penicillin allergy.
Cephalexin is a cephalosporin but not the first line.
Question 10: A 1-month-old infant is irritable and feeding poorly. The anterior
fontanelle is bulging. A lumbar puncture reveals clear cerebrospinal fluid with
300 WBCs (mostly lymphocytes), elevated protein, and low glucose. Which of
the following is the most likely organism?
A. Group B Streptococcus
B. Escherichia coli
C. Listeria monocytogenes
D. Enterovirus
CORRECT ANSWER: D. Enterovirus
Rationale: The CSF profile (lymphocytic pleocytosis, elevated protein, low-normal
glucose) is classic for viral meningitis in a young infant. Enterovirus is the most common
Practice Questions & Answers | Comprehensive
Pediatric Nursing Study Guide & Assessment
Preparation | Pediatric Growth & Development,
Newborn & Infant Care, Pediatric Assessment,
Respiratory & Cardiovascular Disorders,
Gastrointestinal & Endocrine Conditions,
Neurological & Hematological Disorders,
Immunizations, Communicable Diseases, Pediatric
Emergencies, Medication Safety, Psychosocial Care
& Family-Centered Nursing
Question 1: A 2-day-old newborn is being evaluated for jaundice. The total
serum bilirubin level is 18 mg/dL, and the direct fraction is 1.5 mg/dL. Which
of the following conditions is most likely indicated by this result?
A. Physiologic jaundice
B. Breast milk jaundice
C. Crigler-Najjar syndrome
D. Biliary atresia
CORRECT ANSWER: D. Biliary atresia
Rationale: A direct fraction greater than 1.0 mg/dL or greater than 20% of the total
bilirubin indicates direct hyperbilirubinemia, which is always pathologic. Biliary atresia is
a common cause of direct hyperbilirubinemia in newborns. Physiologic and breast milk
jaundice are typically indirect hyperbilirubinemias. Crigler-Najjar is also an indirect
hyperbilirubinemia.
Question 2: A 4-year-old child presents with a high fever, stridor, and a
"barky" cough that is worse at night. Which of the following is the most
appropriate initial management?
A. Racemic epinephrine nebulization
B. Oral corticosteroids
C. Immediate endotracheal intubation
D. Observation and supportive care
CORRECT ANSWER: B. Oral corticosteroids
Rationale: The presentation is classic for croup (laryngotracheobronchitis). While severe
cases may require racemic epinephrine, the initial mainstay of management for mild to
moderate croup is a single dose of oral corticosteroids (e.g., dexamethasone) to reduce
airway edema. Intubation is reserved for impending respiratory failure, and observation
alone is not sufficient for a child with stridor.
,Question 3: A 6-month-old infant with a history of frequent respiratory
infections is noted to have a harsh, continuous, machine-like murmur at the
left upper sternal border. Which of the following is the most likely diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: A continuous, "machine-like" murmur at the left upper sternal border is a
classic sign of a patent ductus arteriosus (PDA). VSD is a harsh holosystolic murmur at
the left lower sternal border. ASD is a systolic ejection murmur at the left upper border
with a fixed split S2. Tetralogy of Fallot presents with a systolic ejection murmur and
cyanosis.
Question 4: During a well-child visit, a 9-year-old is found to have a BMI in the
97th percentile. Which of the following comorbid conditions is most strongly
associated with this finding?
A. Type 1 diabetes mellitus
B. Iron deficiency anemia
C. Non-alcoholic fatty liver disease
D. Celiac disease
CORRECT ANSWER: C. Non-alcoholic fatty liver disease
Rationale: A BMI at or above the 95th percentile is classified as obesity. Non-alcoholic
fatty liver disease (NAFLD) is one of the most common and significant comorbidities
associated with pediatric obesity. While type 2 diabetes is a risk, type 1 is not associated
with obesity. Iron deficiency anemia is more common in toddlers with excessive milk
intake, and celiac disease is associated with poor weight gain.
Question 5: A 2-week-old infant presents with projectile vomiting after
feedings. The vomitus is non-bilious. On examination, an olive-like mass is
palpable in the right upper quadrant. What is the most appropriate diagnostic
study?
A. Upper GI series
B. Abdominal ultrasound
C. CT scan of the abdomen
D. Serum electrolyte panel
CORRECT ANSWER: B. Abdominal ultrasound
,Rationale: The presentation is classic for pyloric stenosis. An abdominal ultrasound is
the diagnostic test of choice to visualize the thickened pyloric muscle (olive-like mass)
and confirm the diagnosis. An upper GI series can be used if ultrasound is inconclusive
but is not the first line. A CT scan involves unnecessary radiation, and electrolytes are
used to assess for hypokalemic metabolic alkalosis but are not diagnostic.
Question 6: A 15-year-old female presents with secondary amenorrhea and
excessive exercise. She is significantly underweight and has lanugo hair
growth. Which of the following is the most likely underlying diagnosis?
A. Polycystic ovarian syndrome
B. Hypothyroidism
C. Anorexia nervosa
D. Primary ovarian insufficiency
CORRECT ANSWER: C. Anorexia nervosa
Rationale: The triad of amenorrhea, excessive exercise, and lanugo hair in an
underweight adolescent is characteristic of anorexia nervosa. PCOS typically presents
with obesity and hirsutism. Hypothyroidism usually presents with weight gain. Primary
ovarian insufficiency involves elevated FSH levels, but the history here points to an
eating disorder.
Question 7: A 5-year-old child is brought to the emergency department with a
sudden onset of severe wheezing, cough, and stridor. The parent reports the
child was eating peanuts 30 minutes prior. Which of the following is the
priority intervention?
A. Diphenhydramine
B. Albuterol nebulizer
C. Epinephrine IM
D. Corticosteroids
CORRECT ANSWER: C. Epinephrine IM
Rationale: This is anaphylaxis, a life-threatening allergic reaction. Intramuscular
epinephrine is the first-line and priority treatment. While albuterol may help with
bronchospasm and diphenhydramine with histamine release, they do not reverse the
life-threatening cardiovascular and respiratory effects of anaphylaxis. Corticosteroids
work too slowly for acute management.
Question 8: A newborn fails to pass meconium within the first 48 hours of life.
On examination, the abdomen is distended, and a contrast enema reveals a
microcolon. What is the most likely diagnosis?
, A. Hirschsprung disease
B. Imperforate anus
C. Meconium ileus
D. Malrotation with volvulus
CORRECT ANSWER: C. Meconium ileus
Rationale: Meconium ileus is a bowel obstruction in newborns caused by impacted,
thick meconium. It is highly associated with cystic fibrosis. The presence of a
microcolon on contrast enema is a hallmark sign. Hirschsprung disease presents with
delayed meconium passage but usually not a microcolon. Imperforate anus is a physical
finding, and malrotation typically presents with bilious vomiting.
Question 9: A 3-year-old child presents with a temperature of 104°F,
tachycardia, and an erythematous, sandpaper-like rash on the trunk, which
began 24 hours after the onset of a sore throat. Which of the following is the
most appropriate treatment?
A. Amoxicillin
B. Penicillin V
C. Erythromycin
D. Cephalexin
CORRECT ANSWER: B. Penicillin V
Rationale: The presentation is classic for scarlet fever (Group A Streptococcus
pharyngitis). The treatment of choice is Penicillin V. Amoxicillin is often used, but
Penicillin V is the specific recommended therapy to ensure eradication and prevent
rheumatic fever. Erythromycin is a second-line agent for those with penicillin allergy.
Cephalexin is a cephalosporin but not the first line.
Question 10: A 1-month-old infant is irritable and feeding poorly. The anterior
fontanelle is bulging. A lumbar puncture reveals clear cerebrospinal fluid with
300 WBCs (mostly lymphocytes), elevated protein, and low glucose. Which of
the following is the most likely organism?
A. Group B Streptococcus
B. Escherichia coli
C. Listeria monocytogenes
D. Enterovirus
CORRECT ANSWER: D. Enterovirus
Rationale: The CSF profile (lymphocytic pleocytosis, elevated protein, low-normal
glucose) is classic for viral meningitis in a young infant. Enterovirus is the most common
