ATI RN PEDIATRIC NURSING (PEDS) 2026
PROCTORED EXAM ASSESSMENT | NGN-STYLE INCLUDED
Comprehensive Level 3 Mastery Test Bank & Detailed Rationales
EXAM METRICS & ASSESSMENT OVERVIEW
• Benchmark Level: Level 3 Advanced Benchmark Mastery (Target Pass Rate > 90%)
• Assessment Content: Pediatric Growth & Development, Congenital Heart Defects, Respiratory Distress, Pediatric
Pharmacotherapy, Infectious Diseases, Safety & Emergency Nursing, Next-Generation NCLEX (NGN) Clinical Judgment
Scenarios.
• Format: Standard Multiple-Choice, Select All That Apply (SATA), Visual Exhibit/Screenshot Items, and NGN Case
Studies.
QUESTION 1 [Standard Multiple-Choice | Cardiovascular & Congenital Heart Defects]
A nurse in a pediatric clinic is assessing an infant with Tetralogy of Fallot who suddenly becomes acutely
cyanotic and hyperpneic ('tet' spell) during a blood draw. Which of the following actions should the nurse take
immediately?
A. Administer high-flow intravenous fluids.
B. Place the infant in the knee-chest position.
C. Prepare the infant for immediate endotracheal intubation.
D. Administer sublingual nitroglycerin.
CORRECT ANSWER: B. Place the infant in the knee-chest position.
ATI LEVEL 3 CLINICAL RATIONALE: Hypercyanotic spells ('tet' spells) are caused by acute pulmonary infundibular spasm
leading to increased right-to-left shunting. Placing the infant in the knee-chest position increases systemic vascular resistance
(SVR), which decreases the right-to-left shunt and improves pulmonary blood flow and arterial oxygen saturation.
QUESTION 2 [Select All That Apply (SATA) | Infectious Diseases & Public Health]
A nurse is providing discharge instruction to the parents of a school-age child diagnosed with acute rheumatic
fever. Which of the following statements by the parent indicate understanding of the instructions? (Select all that
apply.)
A. 'Our child will need continuous prophylactic antibiotic therapy for several years.'
B. 'We will encourage vigorous contact sports once the fever subsides.'
C. 'We should monitor for involuntary, sudden muscle movements.'
D. 'Gentle joint anti-inflammatory medications like ibuprofen can be given for joint pain.'
E. 'A monthly blood test will be required for the rest of their life.'
CORRECT ANSWER: A, C, D
ATI LEVEL 3 CLINICAL RATIONALE: Rheumatic fever requires long-term prophylactic penicillin/antibiotic treatment to
prevent recurrent Group A Streptococcus infections and carditis (A). Sydenham chorea (involuntary, jerky movements) is a
major manifestation of rheumatic fever (C). Anti-inflammatory agents are used for polyarthritis (D). Strenuous exercise is
restricted during the acute phase to reduce cardiac workload, making B incorrect.
, QUESTION 3 [NGN Clinical Judgment Scenario - Visual Exhibit / Screenshot Item | Gastrointestinal & Surgical
Nursing]
[SCREENSHOT EXHIBIT: PEDIATRIC ABDOMINAL ULTRASOUND & VITAL SIGNS LOG]
Examine the exhibit below regarding a 6-month-old infant presenting to the Emergency Department:
- Clinical Manifestations: Sudden onset of episodic severe abdominal pain, screaming with knees drawn up to
chest, intermittent red currant jelly-like stools, and palpable sausage-shaped abdominal mass in RUQ.
- Vital Signs: HR 148/min, BP 88/54 mmHg, Temp 38.1°C (100.6°F).
Based on the visual exhibit and clinical presentation, which diagnostic/therapeutic intervention should the nurse
anticipate as the primary treatment of choice?
A. Emergency surgical pyloromyotomy
B. Administration of a high-protein, low-residue oral feed
C. Hydrostatic barium or air/contrast enema
D. Immediate insertion of a permanent gastrostomy tube
CORRECT ANSWER: C. Hydrostatic barium or air/contrast enema
ATI LEVEL 3 CLINICAL RATIONALE: The presentation (currant jelly stool, sausage-shaped RUQ mass, episodic colicky pain)
is classic for intussusception. An air or contrast/barium enema serves as both the definitive diagnostic tool and primary non-
surgical therapeutic reduction method, exerting hydrostatic pressure to unfold the telescoped bowel.
QUESTION 4 [Pharmacotherapy & Dosage Calculations | Pediatric Safety & Calculations]
A pediatric nurse is preparing to administer IV acetaminophen to a toddler weighing 12 kg. The prescribed
dosage is 15 mg/kg per dose. The medication available is 10 mg/mL. How many mL should the nurse
administer per dose? (Round to the nearest tenth.)
A. 12 mL
B. 18 mL
C. 15 mL
D. 20 mL
CORRECT ANSWER: B. 18 mL
ATI LEVEL 3 CLINICAL RATIONALE: Calculation: Desired dose = 12 kg x 15 mg/kg = 180 mg. Volume to administer = 180
mg / (10 mg/mL) = 18 mL. Wait: 12 * 15 = 180. = 18 mL. Correct answer is 18 mL (B).
QUESTION 5 [Standard Multiple-Choice | Growth & Development]
A nurse is evaluating the developmental milestones of an 18-month-old toddler during a well-child exam. Which
of the following findings requires further developmental evaluation?
A. The child builds a tower of 3 to 4 blocks.
B. The child speaks in 4- to 5-word complete sentences.
C. The child cannot run or kick a ball forward.
D. The child uses a spoon with frequent spilling.
CORRECT ANSWER: C. The child cannot run or kick a ball forward.
ATI LEVEL 3 CLINICAL RATIONALE: By 18 to 24 months, gross motor skill benchmarks include running well and kicking a
ball forward without falling. Inability to perform gross motor skills like walking or running independently by 18 months
warrants immediate pediatric neurological or developmental assessment. Complete 4-5 word sentences (B) are expected at
age 3-4, so lack of 4-5 word sentences is normal, but gross motor deficit in running/kicking at 18 months is a red flag.
PROCTORED EXAM ASSESSMENT | NGN-STYLE INCLUDED
Comprehensive Level 3 Mastery Test Bank & Detailed Rationales
EXAM METRICS & ASSESSMENT OVERVIEW
• Benchmark Level: Level 3 Advanced Benchmark Mastery (Target Pass Rate > 90%)
• Assessment Content: Pediatric Growth & Development, Congenital Heart Defects, Respiratory Distress, Pediatric
Pharmacotherapy, Infectious Diseases, Safety & Emergency Nursing, Next-Generation NCLEX (NGN) Clinical Judgment
Scenarios.
• Format: Standard Multiple-Choice, Select All That Apply (SATA), Visual Exhibit/Screenshot Items, and NGN Case
Studies.
QUESTION 1 [Standard Multiple-Choice | Cardiovascular & Congenital Heart Defects]
A nurse in a pediatric clinic is assessing an infant with Tetralogy of Fallot who suddenly becomes acutely
cyanotic and hyperpneic ('tet' spell) during a blood draw. Which of the following actions should the nurse take
immediately?
A. Administer high-flow intravenous fluids.
B. Place the infant in the knee-chest position.
C. Prepare the infant for immediate endotracheal intubation.
D. Administer sublingual nitroglycerin.
CORRECT ANSWER: B. Place the infant in the knee-chest position.
ATI LEVEL 3 CLINICAL RATIONALE: Hypercyanotic spells ('tet' spells) are caused by acute pulmonary infundibular spasm
leading to increased right-to-left shunting. Placing the infant in the knee-chest position increases systemic vascular resistance
(SVR), which decreases the right-to-left shunt and improves pulmonary blood flow and arterial oxygen saturation.
QUESTION 2 [Select All That Apply (SATA) | Infectious Diseases & Public Health]
A nurse is providing discharge instruction to the parents of a school-age child diagnosed with acute rheumatic
fever. Which of the following statements by the parent indicate understanding of the instructions? (Select all that
apply.)
A. 'Our child will need continuous prophylactic antibiotic therapy for several years.'
B. 'We will encourage vigorous contact sports once the fever subsides.'
C. 'We should monitor for involuntary, sudden muscle movements.'
D. 'Gentle joint anti-inflammatory medications like ibuprofen can be given for joint pain.'
E. 'A monthly blood test will be required for the rest of their life.'
CORRECT ANSWER: A, C, D
ATI LEVEL 3 CLINICAL RATIONALE: Rheumatic fever requires long-term prophylactic penicillin/antibiotic treatment to
prevent recurrent Group A Streptococcus infections and carditis (A). Sydenham chorea (involuntary, jerky movements) is a
major manifestation of rheumatic fever (C). Anti-inflammatory agents are used for polyarthritis (D). Strenuous exercise is
restricted during the acute phase to reduce cardiac workload, making B incorrect.
, QUESTION 3 [NGN Clinical Judgment Scenario - Visual Exhibit / Screenshot Item | Gastrointestinal & Surgical
Nursing]
[SCREENSHOT EXHIBIT: PEDIATRIC ABDOMINAL ULTRASOUND & VITAL SIGNS LOG]
Examine the exhibit below regarding a 6-month-old infant presenting to the Emergency Department:
- Clinical Manifestations: Sudden onset of episodic severe abdominal pain, screaming with knees drawn up to
chest, intermittent red currant jelly-like stools, and palpable sausage-shaped abdominal mass in RUQ.
- Vital Signs: HR 148/min, BP 88/54 mmHg, Temp 38.1°C (100.6°F).
Based on the visual exhibit and clinical presentation, which diagnostic/therapeutic intervention should the nurse
anticipate as the primary treatment of choice?
A. Emergency surgical pyloromyotomy
B. Administration of a high-protein, low-residue oral feed
C. Hydrostatic barium or air/contrast enema
D. Immediate insertion of a permanent gastrostomy tube
CORRECT ANSWER: C. Hydrostatic barium or air/contrast enema
ATI LEVEL 3 CLINICAL RATIONALE: The presentation (currant jelly stool, sausage-shaped RUQ mass, episodic colicky pain)
is classic for intussusception. An air or contrast/barium enema serves as both the definitive diagnostic tool and primary non-
surgical therapeutic reduction method, exerting hydrostatic pressure to unfold the telescoped bowel.
QUESTION 4 [Pharmacotherapy & Dosage Calculations | Pediatric Safety & Calculations]
A pediatric nurse is preparing to administer IV acetaminophen to a toddler weighing 12 kg. The prescribed
dosage is 15 mg/kg per dose. The medication available is 10 mg/mL. How many mL should the nurse
administer per dose? (Round to the nearest tenth.)
A. 12 mL
B. 18 mL
C. 15 mL
D. 20 mL
CORRECT ANSWER: B. 18 mL
ATI LEVEL 3 CLINICAL RATIONALE: Calculation: Desired dose = 12 kg x 15 mg/kg = 180 mg. Volume to administer = 180
mg / (10 mg/mL) = 18 mL. Wait: 12 * 15 = 180. = 18 mL. Correct answer is 18 mL (B).
QUESTION 5 [Standard Multiple-Choice | Growth & Development]
A nurse is evaluating the developmental milestones of an 18-month-old toddler during a well-child exam. Which
of the following findings requires further developmental evaluation?
A. The child builds a tower of 3 to 4 blocks.
B. The child speaks in 4- to 5-word complete sentences.
C. The child cannot run or kick a ball forward.
D. The child uses a spoon with frequent spilling.
CORRECT ANSWER: C. The child cannot run or kick a ball forward.
ATI LEVEL 3 CLINICAL RATIONALE: By 18 to 24 months, gross motor skill benchmarks include running well and kicking a
ball forward without falling. Inability to perform gross motor skills like walking or running independently by 18 months
warrants immediate pediatric neurological or developmental assessment. Complete 4-5 word sentences (B) are expected at
age 3-4, so lack of 4-5 word sentences is normal, but gross motor deficit in running/kicking at 18 months is a red flag.
