ATI Pediatrics Pediatric Nursing 2026/2027 | ACTUAL-Style
Practice Questions & Answers, ATI RN Pediatrics Exam Prep, Child
Growth and Development, Pediatric Disorders, Medication Safety,
Nursing Interventions, Emergency Care, and Detailed Rationales
Question 1: A nurse is assessing a 6-month-old infant during a well-
child visit. Which finding should the nurse report to the provider
immediately?
A. Closed posterior fontanel
B. Positive Moro reflex
C. Persistent head lag when pulled to sit
D. Heart rate of 130/min
CORRECT ANSWER: C. Persistent head lag when pulled to sit
Rationale: By 4 to 6 months of age, an infant should have sufficient neck
and trunk strength to maintain the head in alignment with the body when
pulled to a sitting position. Persistent head lag beyond 4 to 6 months is a
red flag for delayed neurologic or motor development and warrants
immediate provider notification. A closed posterior fontanel by 6 to 8 weeks
is expected. The Moro reflex normally disappears by 3 to 4 months, so its
presence at 6 months would also be abnormal, but the question asks for
the finding that should be reported immediately; head lag is the most
concerning motor milestone delay. A heart rate of 130/min is within the
expected range of 90 to 160/min for an infant.
Question 2: A nurse is caring for a 2-year-old child who has been
prescribed digoxin for heart failure. Which assessment finding should
the nurse identify as an early sign of digoxin toxicity?
A. Bradycardia
B. Vomiting
C. Visual disturbances
D. Hypotension
CORRECT ANSWER: B. Vomiting
Rationale: In infants and young children, the earliest and most common
signs of digoxin toxicity are gastrointestinal, particularly vomiting and
anorexia. Bradycardia, visual disturbances, and hypotension can occur but
are typically later or less common presentations in the pediatric
population. The nurse should hold the dose and notify the provider if
,vomiting occurs, and should monitor the apical pulse for one full minute
before administration, holding the drug if the heart rate is below the age-
specific threshold.
Question 3: A nurse is preparing to administer immunizations to a 4-
month-old infant. Which immunization schedule is appropriate at this
age according to the CDC recommended schedule?
A. DTaP, IPV, MMR, Varicella
B. DTaP, IPV, Hib, PCV13, Rotavirus
C. DTaP, Hib, MMR, Hepatitis B
D. IPV, MMR, Varicella, Hepatitis A
CORRECT ANSWER: B. DTaP, IPV, Hib, PCV13, Rotavirus
Rationale: At 4 months of age, the recommended immunizations include
the second doses of DTaP, IPV, Hib, PCV13, and rotavirus vaccine. MMR and
varicella are not given until 12 to 15 months of age. Hepatitis B is typically
given at birth, 1 to 2 months, and 6 to 18 months. Hepatitis A is given at 12
to 23 months. Following the correct schedule ensures optimal immunity
and prevents unnecessary or improperly timed vaccinations.
Question 4: A nurse is assessing a neonate 1 hour after birth. Which
finding should the nurse recognize as a sign of respiratory distress?
A. Respiratory rate of 40/min
B. Nasal flaring and intercostal retractions
C. Acrocyanosis of the hands and feet
D. Periodic breathing with pauses of 5 seconds
CORRECT ANSWER: B. Nasal flaring and intercostal retractions
Rationale: Nasal flaring and intercostal retractions are classic signs of
respiratory distress in a neonate, indicating increased work of breathing. A
respiratory rate of 40/min is normal for a newborn (expected 30 to 60/min).
Acrocyanosis is a normal finding in the first few hours after birth. Periodic
breathing with brief pauses of less than 20 seconds is also considered
normal in neonates. The nurse should intervene and notify the provider
when signs of distress such as grunting, retractions, or flaring are present.
Question 5: A nurse is teaching the parents of a child newly diagnosed
with type 1 diabetes mellitus about insulin administration. Which
statement by the parent indicates a need for further teaching?
,A. "I will rotate injection sites to prevent lipohypertrophy."
B. "I will give the insulin at room temperature to reduce discomfort."
C. "I will mix the rapid-acting insulin with the NPH insulin in the same
syringe."
D. "I will store the unopened insulin vials in the freezer to keep them fresh."
CORRECT ANSWER: D. "I will store the unopened insulin vials in the
freezer to keep them fresh."
Rationale: Insulin must never be frozen, as freezing destroys the
medication's effectiveness. Unopened insulin vials should be stored in the
refrigerator at 2 to 8 degrees Celsius, and in-use vials may be kept at room
temperature for up to 28 days. Rotating injection sites prevents
lipohypertrophy. Administering insulin at room temperature reduces
injection discomfort. Mixing rapid-acting insulin with NPH is acceptable
when drawn up in the correct order (rapid-acting first), though some newer
analogs have specific mixing considerations.
Question 6: A nurse is caring for a 5-year-old child who has just
returned from the post-anesthesia care unit following a tonsillectomy.
Which intervention should the nurse implement first?
A. Place the child in a supine position
B. Assess for frequent swallowing and clearing of the throat
C. Offer the child a red popsicle
D. Encourage the child to cough and deep breathe
CORRECT ANSWER: B. Assess for frequent swallowing and clearing of
the throat
Rationale: Frequent swallowing or clearing of the throat after a
tonsillectomy is a classic sign of postoperative bleeding, as blood trickles
down the throat and stimulates swallowing. The nurse must assess for
hemorrhage first, as this is the most life-threatening complication. The
child should be placed in a side-lying or prone position to facilitate
drainage, not supine. Red popsicles and other red-colored items are
avoided because they can mask the appearance of blood in emesis.
Coughing is discouraged because it can dislodge the surgical clot and
precipitate bleeding.
, Question 7: A nurse is assessing a 9-month-old infant for
developmental milestones. Which behavior should the nurse expect to
observe?
A. Using a pincer grasp to pick up a small object
B. Walking independently across the room
C. Speaking in two-word phrases
D. Stacking two blocks
CORRECT ANSWER: A. Using a pincer grasp to pick up a small object
Rationale: The pincer grasp, which involves bringing the thumb and index
finger together to pick up small objects, typically develops between 9 and
12 months of age. Walking independently usually occurs around 12 to 15
months. Speaking in two-word phrases is expected around 18 to 24
months. Stacking two blocks is a fine motor skill usually achieved around
15 months. The nurse should recognize the pincer grasp as an appropriate
milestone for a 9-month-old.
Question 8: A nurse is reviewing the laboratory results of a child with
nephrotic syndrome. Which finding should the nurse expect?
A. Elevated serum albumin
B. Decreased urine protein
C. Hyperlipidemia
D. Hematuria with red blood cell casts
CORRECT ANSWER: C. Hyperlipidemia
Rationale: Nephrotic syndrome is characterized by the classic triad of
proteinuria, hypoalbuminemia, and edema, often accompanied by
hyperlipidemia. The massive loss of protein in the urine leads to decreased
serum albumin, which triggers increased hepatic lipoprotein synthesis and
resulting hyperlipidemia. Hematuria with red blood cell casts is more
characteristic of nephritic syndrome or glomerulonephritis. The nurse
should monitor for edema, weight gain, and signs of infection in these
immunocompromised children.
Question 9: A nurse is administering oxygen to a premature infant in the
neonatal intensive care unit. Which complication should the nurse
monitor for as a result of oxygen therapy?
Practice Questions & Answers, ATI RN Pediatrics Exam Prep, Child
Growth and Development, Pediatric Disorders, Medication Safety,
Nursing Interventions, Emergency Care, and Detailed Rationales
Question 1: A nurse is assessing a 6-month-old infant during a well-
child visit. Which finding should the nurse report to the provider
immediately?
A. Closed posterior fontanel
B. Positive Moro reflex
C. Persistent head lag when pulled to sit
D. Heart rate of 130/min
CORRECT ANSWER: C. Persistent head lag when pulled to sit
Rationale: By 4 to 6 months of age, an infant should have sufficient neck
and trunk strength to maintain the head in alignment with the body when
pulled to a sitting position. Persistent head lag beyond 4 to 6 months is a
red flag for delayed neurologic or motor development and warrants
immediate provider notification. A closed posterior fontanel by 6 to 8 weeks
is expected. The Moro reflex normally disappears by 3 to 4 months, so its
presence at 6 months would also be abnormal, but the question asks for
the finding that should be reported immediately; head lag is the most
concerning motor milestone delay. A heart rate of 130/min is within the
expected range of 90 to 160/min for an infant.
Question 2: A nurse is caring for a 2-year-old child who has been
prescribed digoxin for heart failure. Which assessment finding should
the nurse identify as an early sign of digoxin toxicity?
A. Bradycardia
B. Vomiting
C. Visual disturbances
D. Hypotension
CORRECT ANSWER: B. Vomiting
Rationale: In infants and young children, the earliest and most common
signs of digoxin toxicity are gastrointestinal, particularly vomiting and
anorexia. Bradycardia, visual disturbances, and hypotension can occur but
are typically later or less common presentations in the pediatric
population. The nurse should hold the dose and notify the provider if
,vomiting occurs, and should monitor the apical pulse for one full minute
before administration, holding the drug if the heart rate is below the age-
specific threshold.
Question 3: A nurse is preparing to administer immunizations to a 4-
month-old infant. Which immunization schedule is appropriate at this
age according to the CDC recommended schedule?
A. DTaP, IPV, MMR, Varicella
B. DTaP, IPV, Hib, PCV13, Rotavirus
C. DTaP, Hib, MMR, Hepatitis B
D. IPV, MMR, Varicella, Hepatitis A
CORRECT ANSWER: B. DTaP, IPV, Hib, PCV13, Rotavirus
Rationale: At 4 months of age, the recommended immunizations include
the second doses of DTaP, IPV, Hib, PCV13, and rotavirus vaccine. MMR and
varicella are not given until 12 to 15 months of age. Hepatitis B is typically
given at birth, 1 to 2 months, and 6 to 18 months. Hepatitis A is given at 12
to 23 months. Following the correct schedule ensures optimal immunity
and prevents unnecessary or improperly timed vaccinations.
Question 4: A nurse is assessing a neonate 1 hour after birth. Which
finding should the nurse recognize as a sign of respiratory distress?
A. Respiratory rate of 40/min
B. Nasal flaring and intercostal retractions
C. Acrocyanosis of the hands and feet
D. Periodic breathing with pauses of 5 seconds
CORRECT ANSWER: B. Nasal flaring and intercostal retractions
Rationale: Nasal flaring and intercostal retractions are classic signs of
respiratory distress in a neonate, indicating increased work of breathing. A
respiratory rate of 40/min is normal for a newborn (expected 30 to 60/min).
Acrocyanosis is a normal finding in the first few hours after birth. Periodic
breathing with brief pauses of less than 20 seconds is also considered
normal in neonates. The nurse should intervene and notify the provider
when signs of distress such as grunting, retractions, or flaring are present.
Question 5: A nurse is teaching the parents of a child newly diagnosed
with type 1 diabetes mellitus about insulin administration. Which
statement by the parent indicates a need for further teaching?
,A. "I will rotate injection sites to prevent lipohypertrophy."
B. "I will give the insulin at room temperature to reduce discomfort."
C. "I will mix the rapid-acting insulin with the NPH insulin in the same
syringe."
D. "I will store the unopened insulin vials in the freezer to keep them fresh."
CORRECT ANSWER: D. "I will store the unopened insulin vials in the
freezer to keep them fresh."
Rationale: Insulin must never be frozen, as freezing destroys the
medication's effectiveness. Unopened insulin vials should be stored in the
refrigerator at 2 to 8 degrees Celsius, and in-use vials may be kept at room
temperature for up to 28 days. Rotating injection sites prevents
lipohypertrophy. Administering insulin at room temperature reduces
injection discomfort. Mixing rapid-acting insulin with NPH is acceptable
when drawn up in the correct order (rapid-acting first), though some newer
analogs have specific mixing considerations.
Question 6: A nurse is caring for a 5-year-old child who has just
returned from the post-anesthesia care unit following a tonsillectomy.
Which intervention should the nurse implement first?
A. Place the child in a supine position
B. Assess for frequent swallowing and clearing of the throat
C. Offer the child a red popsicle
D. Encourage the child to cough and deep breathe
CORRECT ANSWER: B. Assess for frequent swallowing and clearing of
the throat
Rationale: Frequent swallowing or clearing of the throat after a
tonsillectomy is a classic sign of postoperative bleeding, as blood trickles
down the throat and stimulates swallowing. The nurse must assess for
hemorrhage first, as this is the most life-threatening complication. The
child should be placed in a side-lying or prone position to facilitate
drainage, not supine. Red popsicles and other red-colored items are
avoided because they can mask the appearance of blood in emesis.
Coughing is discouraged because it can dislodge the surgical clot and
precipitate bleeding.
, Question 7: A nurse is assessing a 9-month-old infant for
developmental milestones. Which behavior should the nurse expect to
observe?
A. Using a pincer grasp to pick up a small object
B. Walking independently across the room
C. Speaking in two-word phrases
D. Stacking two blocks
CORRECT ANSWER: A. Using a pincer grasp to pick up a small object
Rationale: The pincer grasp, which involves bringing the thumb and index
finger together to pick up small objects, typically develops between 9 and
12 months of age. Walking independently usually occurs around 12 to 15
months. Speaking in two-word phrases is expected around 18 to 24
months. Stacking two blocks is a fine motor skill usually achieved around
15 months. The nurse should recognize the pincer grasp as an appropriate
milestone for a 9-month-old.
Question 8: A nurse is reviewing the laboratory results of a child with
nephrotic syndrome. Which finding should the nurse expect?
A. Elevated serum albumin
B. Decreased urine protein
C. Hyperlipidemia
D. Hematuria with red blood cell casts
CORRECT ANSWER: C. Hyperlipidemia
Rationale: Nephrotic syndrome is characterized by the classic triad of
proteinuria, hypoalbuminemia, and edema, often accompanied by
hyperlipidemia. The massive loss of protein in the urine leads to decreased
serum albumin, which triggers increased hepatic lipoprotein synthesis and
resulting hyperlipidemia. Hematuria with red blood cell casts is more
characteristic of nephritic syndrome or glomerulonephritis. The nurse
should monitor for edema, weight gain, and signs of infection in these
immunocompromised children.
Question 9: A nurse is administering oxygen to a premature infant in the
neonatal intensive care unit. Which complication should the nurse
monitor for as a result of oxygen therapy?
