ATI-STYLE PRACTICE EXAM: PN PEDIATRIC NURSING
(2026)
Proctored Assessment | NGN Questions & Answers | Level 3 Mastery Preparation
INSTRUCTIONS: This exam contains 25 comprehensive clinical items covering Growth &
Development, Respiratory, Cardiovascular, GI, GU, Endocrine, Neurological, and Mental Health
disorders in pediatric clients. Review rationales carefully to achieve ATI Level 3 proficiency.
Question 1 (Multiple Choice)
A practical nurse (PN) is collecting data on a 12-month-old infant during a well-child routine visit.
Which of the following developmental milestones should the PN expect the infant to have achieved?
A. Walking independently across the room
B. Using two-word simple sentences
C. Building a tower of six blocks
D. Exhibiting a positive Babinski reflex
Correct Answer: A. Walking independently across the room
ATI Clinical Rationale & Level 3 Mastery Guide: By 12 months of age, most infants are able to pull
themselves up to a standing position and walk with one hand held or take independent steps across the
room. Using two-word sentences is expected around 2 years of age. Building a tower of six blocks is a
milestone for a 2-year-old (a 12-month-old can build a tower of two blocks). The Babinski reflex typically
disappears between 12 to 24 months of age, but its presence at 12 months is a transitional finding, not a
newly achieved milestone.
Question 2 (Multiple Response (SATA))
A PN is reinforcing discharge teaching with the parent of a school-age child diagnosed with acute
asthma. Which of the following environmental triggers should the parent be instructed to eliminate
from the home? (Select all that apply.)
A. Feather pillows
B. Hardwood flooring
C. Tobacco smoke
D. Upholstered furniture with dust mites
E. Household pets with fur or feathers
Correct Answer: A, C, D, E
ATI Clinical Rationale & Level 3 Mastery Guide: Feather pillows, tobacco smoke, dust mites in
upholstered furniture, and furry pets are common allergen triggers that provoke bronchospasm in asthmatic
children. Hardwood flooring is recommended over wall-to-wall carpeting because carpet traps dust mites
and pet dander.
, Question 3 (NGN Bowtie Item)
A 4-year-old child is brought to the emergency department with a 3-hour history of high fever,
drooling, severe dysphagia, and sitting in a tripod position with an inspiratory stridor.
Question: Complete the bowtie by selecting the condition to monitor, two nursing actions to take, and
two parameters to assess.
Condition to Monitor: [Epiglottitis] / [Acute Laryngotracheobronchitis] / [Foreign Body Aspiration]
Nursing Actions: [Prepare for emergent intubation] / [Obtain immediate throat culture with tongue
blade] / [Administer humidified oxygen] / [Encourage oral fluid intake]
Parameters to Assess: [Respiratory effort and stridor] / [Serum electrolyte panel] / [Neurological level
of consciousness] / [Oxygen saturation]
Correct Answer: Condition: Epiglottitis | Actions: Prepare for emergent intubation, Administer
humidified oxygen | Parameters: Respiratory effort and stridor, Oxygen saturation
ATI Clinical Rationale & Level 3 Mastery Guide: The clinical presentation (drooling, dysphagia, tripod
positioning, stridor in a preschooler) is classic for acute epiglottitis (Haemophilus influenzae type B).
Epiglottitis is a medical emergency; attempting to examine the throat with a tongue blade can trigger
sudden complete airway obstruction. Emergency intubation equipment must be immediately at hand.
Humidified oxygen and continuous respiratory monitoring are essential. Oral fluids are contraindicated due
to dysphagia and aspiration risk.
Question 4 (Multiple Choice)
A PN is caring for an infant with a congenital heart defect resulting in left-to-right shunt (such as a
ventricular septal defect). Which of the following clinical manifestations should the PN expect to
observe?
A. Severe cyanosis at birth
B. Signs of heart failure and pulmonary congestion
C. Polycythemia and clubbing of the fingers
D. Decreased lower extremity pulses compared to upper extremities
Correct Answer: B. Signs of heart failure and pulmonary congestion
ATI Clinical Rationale & Level 3 Mastery Guide: A left-to-right shunt allows oxygenated blood from the
left side of the heart to flow back into the right side, increasing pulmonary blood flow. This leads to volume
overload in the lungs, resulting in tachypnea, tachycardia, poor weight gain, and signs of heart failure.
Cyanosis, polycythemia, and clubbing are classic for cyanotic defects with right-to-left shunts (e.g.,
Tetralogy of Fallot). Decreased lower extremity pulses are characteristic of coarctation of the aorta.
Question 5 (Multiple Choice)
A PN is caring for a school-age child diagnosed with acute post-streptococcal glomerulonephritis
(APSGN). Which of the following laboratory findings should the PN anticipate?
A. Elevated serum complement levels
B. Decreased blood urea nitrogen (BUN) and creatinine
C. Positive antistreptolysin O (ASO) titer
D. Metabolic alkalosis
(2026)
Proctored Assessment | NGN Questions & Answers | Level 3 Mastery Preparation
INSTRUCTIONS: This exam contains 25 comprehensive clinical items covering Growth &
Development, Respiratory, Cardiovascular, GI, GU, Endocrine, Neurological, and Mental Health
disorders in pediatric clients. Review rationales carefully to achieve ATI Level 3 proficiency.
Question 1 (Multiple Choice)
A practical nurse (PN) is collecting data on a 12-month-old infant during a well-child routine visit.
Which of the following developmental milestones should the PN expect the infant to have achieved?
A. Walking independently across the room
B. Using two-word simple sentences
C. Building a tower of six blocks
D. Exhibiting a positive Babinski reflex
Correct Answer: A. Walking independently across the room
ATI Clinical Rationale & Level 3 Mastery Guide: By 12 months of age, most infants are able to pull
themselves up to a standing position and walk with one hand held or take independent steps across the
room. Using two-word sentences is expected around 2 years of age. Building a tower of six blocks is a
milestone for a 2-year-old (a 12-month-old can build a tower of two blocks). The Babinski reflex typically
disappears between 12 to 24 months of age, but its presence at 12 months is a transitional finding, not a
newly achieved milestone.
Question 2 (Multiple Response (SATA))
A PN is reinforcing discharge teaching with the parent of a school-age child diagnosed with acute
asthma. Which of the following environmental triggers should the parent be instructed to eliminate
from the home? (Select all that apply.)
A. Feather pillows
B. Hardwood flooring
C. Tobacco smoke
D. Upholstered furniture with dust mites
E. Household pets with fur or feathers
Correct Answer: A, C, D, E
ATI Clinical Rationale & Level 3 Mastery Guide: Feather pillows, tobacco smoke, dust mites in
upholstered furniture, and furry pets are common allergen triggers that provoke bronchospasm in asthmatic
children. Hardwood flooring is recommended over wall-to-wall carpeting because carpet traps dust mites
and pet dander.
, Question 3 (NGN Bowtie Item)
A 4-year-old child is brought to the emergency department with a 3-hour history of high fever,
drooling, severe dysphagia, and sitting in a tripod position with an inspiratory stridor.
Question: Complete the bowtie by selecting the condition to monitor, two nursing actions to take, and
two parameters to assess.
Condition to Monitor: [Epiglottitis] / [Acute Laryngotracheobronchitis] / [Foreign Body Aspiration]
Nursing Actions: [Prepare for emergent intubation] / [Obtain immediate throat culture with tongue
blade] / [Administer humidified oxygen] / [Encourage oral fluid intake]
Parameters to Assess: [Respiratory effort and stridor] / [Serum electrolyte panel] / [Neurological level
of consciousness] / [Oxygen saturation]
Correct Answer: Condition: Epiglottitis | Actions: Prepare for emergent intubation, Administer
humidified oxygen | Parameters: Respiratory effort and stridor, Oxygen saturation
ATI Clinical Rationale & Level 3 Mastery Guide: The clinical presentation (drooling, dysphagia, tripod
positioning, stridor in a preschooler) is classic for acute epiglottitis (Haemophilus influenzae type B).
Epiglottitis is a medical emergency; attempting to examine the throat with a tongue blade can trigger
sudden complete airway obstruction. Emergency intubation equipment must be immediately at hand.
Humidified oxygen and continuous respiratory monitoring are essential. Oral fluids are contraindicated due
to dysphagia and aspiration risk.
Question 4 (Multiple Choice)
A PN is caring for an infant with a congenital heart defect resulting in left-to-right shunt (such as a
ventricular septal defect). Which of the following clinical manifestations should the PN expect to
observe?
A. Severe cyanosis at birth
B. Signs of heart failure and pulmonary congestion
C. Polycythemia and clubbing of the fingers
D. Decreased lower extremity pulses compared to upper extremities
Correct Answer: B. Signs of heart failure and pulmonary congestion
ATI Clinical Rationale & Level 3 Mastery Guide: A left-to-right shunt allows oxygenated blood from the
left side of the heart to flow back into the right side, increasing pulmonary blood flow. This leads to volume
overload in the lungs, resulting in tachypnea, tachycardia, poor weight gain, and signs of heart failure.
Cyanosis, polycythemia, and clubbing are classic for cyanotic defects with right-to-left shunts (e.g.,
Tetralogy of Fallot). Decreased lower extremity pulses are characteristic of coarctation of the aorta.
Question 5 (Multiple Choice)
A PN is caring for a school-age child diagnosed with acute post-streptococcal glomerulonephritis
(APSGN). Which of the following laboratory findings should the PN anticipate?
A. Elevated serum complement levels
B. Decreased blood urea nitrogen (BUN) and creatinine
C. Positive antistreptolysin O (ASO) titer
D. Metabolic alkalosis
