2026 ATI RN Pediatric Proctored Exam: Comprehensive
NGN-Style Practice Questions, Verified Answers &
Clinical Rationales
EXAM TOPICS COVERED & QUESTION DISTRIBUTION
Topic Area # Questions
1. Growth & Developmental Milestones (Infancy through Adolescence) 18
2. Health Promotion, Immunizations & Preventive Care 12
3. Pediatric Assessment & Physical Examination 15
4. Pediatric Respiratory Disorders 12
5. Pediatric Cardiovascular Disorders 12
6. Pediatric Neurological Disorders 8
7. Pediatric Infectious Diseases 8
8. Pediatric Gastrointestinal Disorders 10
9. Pediatric Genitourinary Disorders 6
10. Pediatric Hematological & Oncological Disorders 10
11. Pediatric Endocrine Disorders 8
,Topic Area # Questions
12. Pediatric Musculoskeletal Disorders 6
13. Pediatric Integumentary Disorders 6
14. Pediatric Medication Administration & Dosage Calculations 10
15. Pediatric Emergency & Critical Care 10
16. Child Maltreatment & Abuse 6
17. Family-Centered Care & Psychosocial Development 8
18. NGN-Style Case Scenarios & Clinical Judgment (Integrated) 25
TOTAL 200
SECTION 1: GROWTH & DEVELOPMENTAL MILESTONES (Questions 1-18)
Question 1 (NGN-Style: Single Best Answer)
A nurse is performing a developmental screening on a 12-month-old infant during a well-child
visit. Which of the following fine motor milestones should the nurse expect the infant to have
achieved?
A) Building a tower of two blocks
B) Using a pincer grasp to pick up small objects
C) Scribbling spontaneously with a crayon
D) Using a spoon without spilling
CORRECT ANSWER: B) Using a pincer grasp to pick up small objects
,Explanation: By 12 months of age, infants have typically developed the pincer grasp—the ability
to pick up small objects using the thumb and forefinger. This fine motor skill emerges around 9-
10 months and is well-established by 12 months . Building a tower of two blocks is generally
expected at approximately 15 months of age. Scribbling spontaneously is a milestone that
appears around 18 months. Using a spoon without spilling is typically achieved between 18 and
24 months. The pincer grasp is a critical developmental marker because it indicates maturation
of the neuromuscular control needed for self-feeding and exploration.
Question 2 (NGN-Style: Single Best Answer)
A nurse is assessing a 4-year-old child during a well-child visit. According to Erikson's theory of
psychosocial development, which developmental task should the nurse expect the child to be
actively working on?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
CORRECT ANSWER: C) Initiative vs. Guilt
Explanation: According to Erikson's theory of psychosocial development, preschoolers aged 3 to
5 years are in the initiative vs. guilt stage. During this stage, children begin to assert control and
power over their environment by initiating activities, planning games, and asking questions .
They develop a sense of purpose when their initiatives are encouraged. However, if they are
criticized or controlled excessively, they may develop feelings of guilt about their desires and
actions. Trust vs. Mistrust is the stage for infants (birth to 1 year). Autonomy vs. Shame and
Doubt is characteristic of toddlers (1 to 3 years). Industry vs. Inferiority is the task for school-age
children (6 to 12 years).
Question 3 (NGN-Style: Single Best Answer)
A nurse is assessing a 3-year-old child who is 1 day postoperative following a tonsillectomy.
Which of the following methods should the nurse use to most effectively determine if the child
is experiencing pain?
A) Ask the parents to rate the child's pain
B) Use the FACES pain rating scale
, C) Use a numeric rating scale from 0 to 10
D) Check the child's temperature and heart rate
CORRECT ANSWER: B) Use the FACES pain rating scale
Explanation: The FACES pain rating scale (Wong-Baker Faces) is an appropriate and validated
pain assessment tool for children aged 3 years and older because it uses visual cues that young
children can understand and relate to . Preschoolers are generally unable to conceptualize
numbers or abstract pain ratings, making the numeric rating scale (0-10) inappropriate for this
age group. While parental input and physiologic parameters like temperature and heart rate can
provide supplementary information, they are not reliable primary indicators of pain intensity.
The FACES scale allows the child to point to the face that best represents their current pain
level, making it a developmentally appropriate, patient-centered approach to pain assessment.
Question 4 (NGN-Style: Single Best Answer)
A nurse is caring for a toddler and is preparing to administer 0.9% sodium chloride 100 mL IV to
infuse 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 the answer to the nearest whole
number.)
A) 15 gtt/min
B) 20 gtt/min
C) 25 gtt/min
D) 30 gtt/min
CORRECT ANSWER: C) 25 gtt/min
Explanation: To calculate the IV drip rate, use the formula: gtt/min = (Volume in mL × Drop
Factor) ÷ Time in minutes . First, convert hours to minutes: 4 hours × 60 minutes = 240 minutes.
Then calculate: (100 mL × 60 gtt/mL) ÷ 240 minutes = 6000 ÷ 240 = 25 gtt/min. Therefore, the
nurse should set the IV infusion to deliver 25 drops per minute. This dosage calculation is a
common pediatric nursing competency tested on the ATI exam and requires careful attention to
the drop factor (60 gtt/mL is microdrip tubing, which is standard for pediatric IV infusions). The
answer should be rounded to the nearest whole number as instructed.
Question 5 (NGN-Style: Single Best Answer)
NGN-Style Practice Questions, Verified Answers &
Clinical Rationales
EXAM TOPICS COVERED & QUESTION DISTRIBUTION
Topic Area # Questions
1. Growth & Developmental Milestones (Infancy through Adolescence) 18
2. Health Promotion, Immunizations & Preventive Care 12
3. Pediatric Assessment & Physical Examination 15
4. Pediatric Respiratory Disorders 12
5. Pediatric Cardiovascular Disorders 12
6. Pediatric Neurological Disorders 8
7. Pediatric Infectious Diseases 8
8. Pediatric Gastrointestinal Disorders 10
9. Pediatric Genitourinary Disorders 6
10. Pediatric Hematological & Oncological Disorders 10
11. Pediatric Endocrine Disorders 8
,Topic Area # Questions
12. Pediatric Musculoskeletal Disorders 6
13. Pediatric Integumentary Disorders 6
14. Pediatric Medication Administration & Dosage Calculations 10
15. Pediatric Emergency & Critical Care 10
16. Child Maltreatment & Abuse 6
17. Family-Centered Care & Psychosocial Development 8
18. NGN-Style Case Scenarios & Clinical Judgment (Integrated) 25
TOTAL 200
SECTION 1: GROWTH & DEVELOPMENTAL MILESTONES (Questions 1-18)
Question 1 (NGN-Style: Single Best Answer)
A nurse is performing a developmental screening on a 12-month-old infant during a well-child
visit. Which of the following fine motor milestones should the nurse expect the infant to have
achieved?
A) Building a tower of two blocks
B) Using a pincer grasp to pick up small objects
C) Scribbling spontaneously with a crayon
D) Using a spoon without spilling
CORRECT ANSWER: B) Using a pincer grasp to pick up small objects
,Explanation: By 12 months of age, infants have typically developed the pincer grasp—the ability
to pick up small objects using the thumb and forefinger. This fine motor skill emerges around 9-
10 months and is well-established by 12 months . Building a tower of two blocks is generally
expected at approximately 15 months of age. Scribbling spontaneously is a milestone that
appears around 18 months. Using a spoon without spilling is typically achieved between 18 and
24 months. The pincer grasp is a critical developmental marker because it indicates maturation
of the neuromuscular control needed for self-feeding and exploration.
Question 2 (NGN-Style: Single Best Answer)
A nurse is assessing a 4-year-old child during a well-child visit. According to Erikson's theory of
psychosocial development, which developmental task should the nurse expect the child to be
actively working on?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
CORRECT ANSWER: C) Initiative vs. Guilt
Explanation: According to Erikson's theory of psychosocial development, preschoolers aged 3 to
5 years are in the initiative vs. guilt stage. During this stage, children begin to assert control and
power over their environment by initiating activities, planning games, and asking questions .
They develop a sense of purpose when their initiatives are encouraged. However, if they are
criticized or controlled excessively, they may develop feelings of guilt about their desires and
actions. Trust vs. Mistrust is the stage for infants (birth to 1 year). Autonomy vs. Shame and
Doubt is characteristic of toddlers (1 to 3 years). Industry vs. Inferiority is the task for school-age
children (6 to 12 years).
Question 3 (NGN-Style: Single Best Answer)
A nurse is assessing a 3-year-old child who is 1 day postoperative following a tonsillectomy.
Which of the following methods should the nurse use to most effectively determine if the child
is experiencing pain?
A) Ask the parents to rate the child's pain
B) Use the FACES pain rating scale
, C) Use a numeric rating scale from 0 to 10
D) Check the child's temperature and heart rate
CORRECT ANSWER: B) Use the FACES pain rating scale
Explanation: The FACES pain rating scale (Wong-Baker Faces) is an appropriate and validated
pain assessment tool for children aged 3 years and older because it uses visual cues that young
children can understand and relate to . Preschoolers are generally unable to conceptualize
numbers or abstract pain ratings, making the numeric rating scale (0-10) inappropriate for this
age group. While parental input and physiologic parameters like temperature and heart rate can
provide supplementary information, they are not reliable primary indicators of pain intensity.
The FACES scale allows the child to point to the face that best represents their current pain
level, making it a developmentally appropriate, patient-centered approach to pain assessment.
Question 4 (NGN-Style: Single Best Answer)
A nurse is caring for a toddler and is preparing to administer 0.9% sodium chloride 100 mL IV to
infuse 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 the answer to the nearest whole
number.)
A) 15 gtt/min
B) 20 gtt/min
C) 25 gtt/min
D) 30 gtt/min
CORRECT ANSWER: C) 25 gtt/min
Explanation: To calculate the IV drip rate, use the formula: gtt/min = (Volume in mL × Drop
Factor) ÷ Time in minutes . First, convert hours to minutes: 4 hours × 60 minutes = 240 minutes.
Then calculate: (100 mL × 60 gtt/mL) ÷ 240 minutes = 6000 ÷ 240 = 25 gtt/min. Therefore, the
nurse should set the IV infusion to deliver 25 drops per minute. This dosage calculation is a
common pediatric nursing competency tested on the ATI exam and requires careful attention to
the drop factor (60 gtt/mL is microdrip tubing, which is standard for pediatric IV infusions). The
answer should be rounded to the nearest whole number as instructed.
Question 5 (NGN-Style: Single Best Answer)
