ATI RN Pediatric Proctored Exam 2026 Practice
Questions with NGN-Style Format
Verified Answers & Detailed Rationales
Secure your Level 3 proficiency with the definitive 2026 preparation guide for the
ATI RN Pediatric CMS Proctored Exam, featuring Next Generation NCLEX (NGN)
style items. This comprehensive study resource delivers realistic, high-yield
practice questions, multi-stage matrix items, and detailed developmental
rationales covering pediatric immunization schedules, acute congenital disorders,
and emergency interventions. Master pediatric fluid balance, drug dosage
calculations, and critical prioritization rules to pass your proctored evaluation on
the first attempt.
QUESTION 1
A nurse in the emergency department is caring for a 2-year-old child who was found by
his parents crying and holding a container of toilet bowl cleaner. The child's lips are
edematous and inflamed, and he is drooling. Which of the following is the priority
action by the nurse?
A) Remove the child's contaminated clothing
B) Check the child's respiratory status
C) Administer an antidote to the child
D) Establish IV access for the child
Rationale: The nurse should apply the ABC priority-setting framework. Airway is the
priority. Edematous, inflamed lips and drooling indicate potential airway compromise from
caustic ingestion. Respiratory status must be assessed first before any other intervention .
QUESTION 2
A nurse is teaching a parent of a 12-month-old child about development during the
toddler years. Which of the following statements should the nurse include?
,A) "Your child should be referring to himself using the appropriate pronoun by 18
months of age."
B) "A toddler's interest in looking at pictures occurs at 20 months of age."
C) "A toddler should have daytime control of his bowel and bladder by 24 months of
age."
D) "Your child should be able to scribble spontaneously using a crayon at the age
of 15 months."
Rationale: A 15-month-old toddler should be able to scribble spontaneously using a
crayon. This is an expected fine motor developmental milestone. Pronoun use and
bowel/bladder control develop later .
QUESTION 3
A nurse is caring for a toddler and is preparing to administer 25 mL over 4 hours. The
drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV
infusion to deliver how many gtt/min? (Round to the nearest whole number.)
A) 4 gtt/min
B) 6 gtt/min
C) 8 gtt/min
D) 10 gtt/min
Rationale: Using the formula: (Volume × Drop factor) / Time in minutes = (25 mL × 60
gtt/mL) / 240 min = 1500/240 = 6.25 gtt/min, rounded to 6 gtt/min .
QUESTION 4
A nurse in a pediatric clinic is assessing a toddler at a well-child visit. Which of the
following actions should the nurse take?
A) Perform the assessment in a head-to-toe sequence
B) Minimize physical contact with the child initially
C) Explain procedures using medical terminology
D) Stop the assessment if the child becomes uncooperative
,Rationale: Minimizing physical contact initially helps the toddler feel less threatened and
builds trust. The nurse should observe from a distance first before touching. Stopping the
assessment entirely is not appropriate .
QUESTION 5
A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and
is planning to attend college. The nurse should inform the client that he should receive
which of the following immunizations prior to moving into a campus dormitory?
A) Pneumococcal polysaccharide
B) Meningococcal polysaccharide
C) Varicella
D) Herpes zoster
Rationale: Meningococcal vaccine is recommended for adolescents entering college,
especially those living in dormitories, due to increased risk of meningococcal disease in
close quarters .
QUESTION 6
A charge nurse in an emergency department is preparing an in-service for a group of
newly licensed nurses on the clinical manifestations of child maltreatment. Which of the
following clinical manifestations should the charge nurse include as suggestive of
potential physical abuse?
A) Recurrent urinary tract infections
B) Symmetric burns of the lower extremities
C) Growth failure
D) Lack of subcutaneous fat
Rationale: Symmetric burns of the lower extremities are a suggestive clinical
manifestation of physical abuse. The patterns are usually characteristic of the method or
object used, such as cigar or cigarette burns, or burns in the shape of an iron .
, QUESTION 7
A nurse at an urgent care clinic is assessing an adolescent client who has an upper
respiratory tract infection. Which of the following findings should the nurse recognize as
a manifestation of pertussis?
A) Inflamed throat with exudate
B) Purulent eye drainage
C) Dry, hacking cough
D) Koplik spots on buccal mucosa
Rationale: The nurse should recognize that a dry, hacking cough is a manifestation of
pertussis. This disease usually begins with indications of an upper respiratory tract
infection, which includes a dry, hacking cough that is sometimes more severe at night .
QUESTION 8
A nurse in an Emergency Department is assessing a three-month-old infant who has
rotavirus and is experiencing acute vomiting and diarrhea. Which of the following
manifestations should the nurse identify as an indication that the infant has moderate to
severe dehydration?
A) Heart rate 124/minute
B) Increase tear production
C) Sunken anterior fontanel
D) Capillary refill 2 seconds
Rationale: The nurse should recognize that a sunken anterior fontanel is an indication of
moderate to severe dehydration due to the acute loss of fluid. Tachycardia (not
normocardia), decreased tears, and prolonged capillary refill are also signs .
QUESTION 9
A nurse in an emergency department is caring for a school-age child who is
experiencing an anaphylactic reaction. Which of the following is the priority action by
the nurse?
A) Elevate the head of the child's bed
B) Insert a large-bore IV catheter for the child
Questions with NGN-Style Format
Verified Answers & Detailed Rationales
Secure your Level 3 proficiency with the definitive 2026 preparation guide for the
ATI RN Pediatric CMS Proctored Exam, featuring Next Generation NCLEX (NGN)
style items. This comprehensive study resource delivers realistic, high-yield
practice questions, multi-stage matrix items, and detailed developmental
rationales covering pediatric immunization schedules, acute congenital disorders,
and emergency interventions. Master pediatric fluid balance, drug dosage
calculations, and critical prioritization rules to pass your proctored evaluation on
the first attempt.
QUESTION 1
A nurse in the emergency department is caring for a 2-year-old child who was found by
his parents crying and holding a container of toilet bowl cleaner. The child's lips are
edematous and inflamed, and he is drooling. Which of the following is the priority
action by the nurse?
A) Remove the child's contaminated clothing
B) Check the child's respiratory status
C) Administer an antidote to the child
D) Establish IV access for the child
Rationale: The nurse should apply the ABC priority-setting framework. Airway is the
priority. Edematous, inflamed lips and drooling indicate potential airway compromise from
caustic ingestion. Respiratory status must be assessed first before any other intervention .
QUESTION 2
A nurse is teaching a parent of a 12-month-old child about development during the
toddler years. Which of the following statements should the nurse include?
,A) "Your child should be referring to himself using the appropriate pronoun by 18
months of age."
B) "A toddler's interest in looking at pictures occurs at 20 months of age."
C) "A toddler should have daytime control of his bowel and bladder by 24 months of
age."
D) "Your child should be able to scribble spontaneously using a crayon at the age
of 15 months."
Rationale: A 15-month-old toddler should be able to scribble spontaneously using a
crayon. This is an expected fine motor developmental milestone. Pronoun use and
bowel/bladder control develop later .
QUESTION 3
A nurse is caring for a toddler and is preparing to administer 25 mL over 4 hours. The
drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV
infusion to deliver how many gtt/min? (Round to the nearest whole number.)
A) 4 gtt/min
B) 6 gtt/min
C) 8 gtt/min
D) 10 gtt/min
Rationale: Using the formula: (Volume × Drop factor) / Time in minutes = (25 mL × 60
gtt/mL) / 240 min = 1500/240 = 6.25 gtt/min, rounded to 6 gtt/min .
QUESTION 4
A nurse in a pediatric clinic is assessing a toddler at a well-child visit. Which of the
following actions should the nurse take?
A) Perform the assessment in a head-to-toe sequence
B) Minimize physical contact with the child initially
C) Explain procedures using medical terminology
D) Stop the assessment if the child becomes uncooperative
,Rationale: Minimizing physical contact initially helps the toddler feel less threatened and
builds trust. The nurse should observe from a distance first before touching. Stopping the
assessment entirely is not appropriate .
QUESTION 5
A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and
is planning to attend college. The nurse should inform the client that he should receive
which of the following immunizations prior to moving into a campus dormitory?
A) Pneumococcal polysaccharide
B) Meningococcal polysaccharide
C) Varicella
D) Herpes zoster
Rationale: Meningococcal vaccine is recommended for adolescents entering college,
especially those living in dormitories, due to increased risk of meningococcal disease in
close quarters .
QUESTION 6
A charge nurse in an emergency department is preparing an in-service for a group of
newly licensed nurses on the clinical manifestations of child maltreatment. Which of the
following clinical manifestations should the charge nurse include as suggestive of
potential physical abuse?
A) Recurrent urinary tract infections
B) Symmetric burns of the lower extremities
C) Growth failure
D) Lack of subcutaneous fat
Rationale: Symmetric burns of the lower extremities are a suggestive clinical
manifestation of physical abuse. The patterns are usually characteristic of the method or
object used, such as cigar or cigarette burns, or burns in the shape of an iron .
, QUESTION 7
A nurse at an urgent care clinic is assessing an adolescent client who has an upper
respiratory tract infection. Which of the following findings should the nurse recognize as
a manifestation of pertussis?
A) Inflamed throat with exudate
B) Purulent eye drainage
C) Dry, hacking cough
D) Koplik spots on buccal mucosa
Rationale: The nurse should recognize that a dry, hacking cough is a manifestation of
pertussis. This disease usually begins with indications of an upper respiratory tract
infection, which includes a dry, hacking cough that is sometimes more severe at night .
QUESTION 8
A nurse in an Emergency Department is assessing a three-month-old infant who has
rotavirus and is experiencing acute vomiting and diarrhea. Which of the following
manifestations should the nurse identify as an indication that the infant has moderate to
severe dehydration?
A) Heart rate 124/minute
B) Increase tear production
C) Sunken anterior fontanel
D) Capillary refill 2 seconds
Rationale: The nurse should recognize that a sunken anterior fontanel is an indication of
moderate to severe dehydration due to the acute loss of fluid. Tachycardia (not
normocardia), decreased tears, and prolonged capillary refill are also signs .
QUESTION 9
A nurse in an emergency department is caring for a school-age child who is
experiencing an anaphylactic reaction. Which of the following is the priority action by
the nurse?
A) Elevate the head of the child's bed
B) Insert a large-bore IV catheter for the child
