ATI PEDIATRIC PROCTORED NEWEST EXAM PEDIATRIC ATI PROCTORED EXAM
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES (DETAILED ANSWERS)
COMPLETE EXAM |AGRADE
Question 1
A nurse is assessing a 3-year-old child who has high fever, is drooling, and is sitting in a "tripod"
position. Which of the following actions should the nurse take first?
A) Obtain a throat culture to identify the causative organism.
B) Assess the child’s throat using a tongue blade.
C) Administer an antipyretic for the fever.
D) Notify the provider and prepare for emergency intubation.
E) Encourage the child to lie down and rest.
Correct Answer: D) Notify the provider and prepare for emergency intubation.
Rationale: The child is exhibiting classic signs of epiglottitis, a life-threatening medical
emergency. Drooling and a tripod position (sitting upright and leaning forward) indicate
severe airway obstruction. The nurse's priority is to protect the airway. Any attempt to
visualize the throat or obtain a culture (Options A and B) can trigger a laryngospasm and
cause complete airway obstruction. The child should not be forced to lie down (Option E)
as this could also lead to immediate respiratory arrest. Antipyretics (Option C) are
secondary to airway stabilization.
Question 2
A nurse is teaching the parents of a 6-month-old infant about the introduction of solid foods.
Which of the following instructions should the nurse include?
A) Start with fruit juices to provide vitamin C.
B) Introduce iron-fortified rice cereal as the first solid food.
C) Introduce four new foods at a time to check for preferences.
D) Give the infant cow’s milk if they are still hungry after solids.
E) Mix cereal in the bottle with formula to encourage intake.
Correct Answer: B) Introduce iron-fortified rice cereal as the first solid food.
Rationale: Iron-fortified rice cereal is the recommended first solid food because it is easily
digested and has a low allergenic potential. By 6 months, an infant’s prenatal iron stores
begin to deplete, making iron supplementation via cereal necessary. Foods should be
, 2
introduced one at a time (Option C), usually 5 to 7 days apart, to identify potential food
allergies. Cow’s milk (Option D) should not be given until 1 year of age because it can cause
GI bleeding and is difficult for the kidneys to process. Cereal should not be put in a bottle
(Option E) due to the risk of choking and overfeeding, unless specifically indicated for
reflux.
Question 3
A nurse is assessing a 4-year-old child during a well-child visit. Which of the following
developmental milestones should the nurse expect the child to have achieved?
A) Tying shoelaces in a bow.
B) Cutting with scissors to follow a line.
C) Using a cursive script for writing their name.
D) Walking down stairs with alternating feet.
E) Building a tower of 2 cubes.
Correct Answer: D) Walking down stairs with alternating feet.
Rationale: By age 4, gross motor development allows a child to walk up and down stairs
using alternating feet. Tying shoelaces (Option A) and following lines with scissors (Option
B) are typically 5-year-old milestones. Cursive writing (Option C) occurs much later in
school-age years. Building a tower of 2 cubes (Option E) is a milestone achieved around 15
months of age. A 4-year-old is also expected to catch a bounced ball and hop on one foot.
Question 4
A nurse is caring for a child who has cystic fibrosis (CF). Which of the following interventions
should the nurse include in the plan of care?
A) Administer pancreatic enzymes 2 hours after each meal.
B) Restrict physical activity to prevent lung irritation.
C) Provide a high-protein, high-calorie diet.
D) Limit fluid intake to reduce mucus volume.
E) Administer water-soluble vitamins only.
Correct Answer: C) Provide a high-protein, high-calorie diet.
Rationale: Children with CF require a high-protein, high-calorie diet (often 150% of the
, 3
RDA) due to malabsorption and the increased energy required for breathing. Pancreatic
enzymes (Option A) must be taken with every meal and snack to facilitate digestion.
Physical activity (Option B) is encouraged because it helps loosen secretions. Fluids (Option
D) should be encouraged to thin the thick mucus characteristic of CF. Because CF causes
fat malabsorption, the child requires fat-soluble vitamins (A, D, E, and K) in a water-
miscible form (Option E is incorrect).
Question 5
A nurse is teaching the parents of a toddler who has a new diagnosis of celiac disease. Which of
the following food choices should the nurse recommend?
A) Rye crackers with cheese.
B) Whole wheat bread.
C) Barley soup.
/D) Corn tortillas with beans.
E) Oatmeal cookies.
Correct Answer: D) Corn tortillas with beans.
Rationale: Celiac disease is an autoimmune disorder where the ingestion of gluten leads to
damage in the small intestine. The diet must exclude "BROW" foods: Barley, Rye, Oats,
and Wheat. Corn and beans are naturally gluten-free and safe for the child to consume.
Rye (Option A), Wheat (Option B), Barley (Option C), and Oats (Option E) all contain or
are frequently contaminated with gluten and will cause an exacerbation of symptoms
(steatorrhea and malnutrition).
Question 6
A nurse is assessing a 6-week-old infant who has a history of projectile vomiting after feedings.
The nurse notes a small, olive-shaped mass in the right upper quadrant of the abdomen. Which of
the following conditions should the nurse suspect?
A) Intussusception
B) Hirschsprung’s disease
C) Hypertrophic pyloric stenosis
, 4
D) Gastroesophageal reflux
E) Meckel’s diverticulum
Correct Answer: C) Hypertrophic pyloric stenosis.
Rationale: Hypertrophic pyloric stenosis is the thickening of the pyloric sphincter, which
creates an obstruction. The hallmark signs are non-bile-stained projectile vomiting and a
palpable olive-shaped mass in the epigastrium just to the right of the umbilicus.
Intussusception (Option A) is characterized by "currant jelly" stools and a sausage-shaped
mass. Hirschsprung’s (Option B) involves a lack of ganglionic cells in the colon, leading to
constipation and ribbon-like stools.
Question 7
A nurse is caring for an infant who has intussusception. Which of the following findings should
the nurse expect?
A) Ribbon-like, foul-smelling stools.
B) Stools that contain blood and mucus ("currant jelly").
C) Projectile vomiting after every meal.
D) A sunken abdomen with visible peristalsis.
E) Constant crying with no periods of relief.
Correct Answer: B) Stools that contain blood and mucus ("currant jelly").
Rationale: Intussusception occurs when one portion of the intestine "telescopes" into
another, causing inflammation, edema, and decreased blood flow. The leaking of blood and
mucus into the intestinal lumen creates the characteristic "currant jelly" stool. The infant
typically experiences sudden, episodic abdominal pain (Option E is incorrect because it is
intermittent, not constant). Projectile vomiting (Option C) is pyloric stenosis. Ribbon-like
stools (Option A) indicate Hirschsprung's disease.
Question 8
A nurse is assessing a school-age child who has nephrotic syndrome. Which of the following
findings should the nurse expect?
A) Gross hematuria and hypertension.
B) Severe periorbital and facial edema.
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES (DETAILED ANSWERS)
COMPLETE EXAM |AGRADE
Question 1
A nurse is assessing a 3-year-old child who has high fever, is drooling, and is sitting in a "tripod"
position. Which of the following actions should the nurse take first?
A) Obtain a throat culture to identify the causative organism.
B) Assess the child’s throat using a tongue blade.
C) Administer an antipyretic for the fever.
D) Notify the provider and prepare for emergency intubation.
E) Encourage the child to lie down and rest.
Correct Answer: D) Notify the provider and prepare for emergency intubation.
Rationale: The child is exhibiting classic signs of epiglottitis, a life-threatening medical
emergency. Drooling and a tripod position (sitting upright and leaning forward) indicate
severe airway obstruction. The nurse's priority is to protect the airway. Any attempt to
visualize the throat or obtain a culture (Options A and B) can trigger a laryngospasm and
cause complete airway obstruction. The child should not be forced to lie down (Option E)
as this could also lead to immediate respiratory arrest. Antipyretics (Option C) are
secondary to airway stabilization.
Question 2
A nurse is teaching the parents of a 6-month-old infant about the introduction of solid foods.
Which of the following instructions should the nurse include?
A) Start with fruit juices to provide vitamin C.
B) Introduce iron-fortified rice cereal as the first solid food.
C) Introduce four new foods at a time to check for preferences.
D) Give the infant cow’s milk if they are still hungry after solids.
E) Mix cereal in the bottle with formula to encourage intake.
Correct Answer: B) Introduce iron-fortified rice cereal as the first solid food.
Rationale: Iron-fortified rice cereal is the recommended first solid food because it is easily
digested and has a low allergenic potential. By 6 months, an infant’s prenatal iron stores
begin to deplete, making iron supplementation via cereal necessary. Foods should be
, 2
introduced one at a time (Option C), usually 5 to 7 days apart, to identify potential food
allergies. Cow’s milk (Option D) should not be given until 1 year of age because it can cause
GI bleeding and is difficult for the kidneys to process. Cereal should not be put in a bottle
(Option E) due to the risk of choking and overfeeding, unless specifically indicated for
reflux.
Question 3
A nurse is assessing a 4-year-old child during a well-child visit. Which of the following
developmental milestones should the nurse expect the child to have achieved?
A) Tying shoelaces in a bow.
B) Cutting with scissors to follow a line.
C) Using a cursive script for writing their name.
D) Walking down stairs with alternating feet.
E) Building a tower of 2 cubes.
Correct Answer: D) Walking down stairs with alternating feet.
Rationale: By age 4, gross motor development allows a child to walk up and down stairs
using alternating feet. Tying shoelaces (Option A) and following lines with scissors (Option
B) are typically 5-year-old milestones. Cursive writing (Option C) occurs much later in
school-age years. Building a tower of 2 cubes (Option E) is a milestone achieved around 15
months of age. A 4-year-old is also expected to catch a bounced ball and hop on one foot.
Question 4
A nurse is caring for a child who has cystic fibrosis (CF). Which of the following interventions
should the nurse include in the plan of care?
A) Administer pancreatic enzymes 2 hours after each meal.
B) Restrict physical activity to prevent lung irritation.
C) Provide a high-protein, high-calorie diet.
D) Limit fluid intake to reduce mucus volume.
E) Administer water-soluble vitamins only.
Correct Answer: C) Provide a high-protein, high-calorie diet.
Rationale: Children with CF require a high-protein, high-calorie diet (often 150% of the
, 3
RDA) due to malabsorption and the increased energy required for breathing. Pancreatic
enzymes (Option A) must be taken with every meal and snack to facilitate digestion.
Physical activity (Option B) is encouraged because it helps loosen secretions. Fluids (Option
D) should be encouraged to thin the thick mucus characteristic of CF. Because CF causes
fat malabsorption, the child requires fat-soluble vitamins (A, D, E, and K) in a water-
miscible form (Option E is incorrect).
Question 5
A nurse is teaching the parents of a toddler who has a new diagnosis of celiac disease. Which of
the following food choices should the nurse recommend?
A) Rye crackers with cheese.
B) Whole wheat bread.
C) Barley soup.
/D) Corn tortillas with beans.
E) Oatmeal cookies.
Correct Answer: D) Corn tortillas with beans.
Rationale: Celiac disease is an autoimmune disorder where the ingestion of gluten leads to
damage in the small intestine. The diet must exclude "BROW" foods: Barley, Rye, Oats,
and Wheat. Corn and beans are naturally gluten-free and safe for the child to consume.
Rye (Option A), Wheat (Option B), Barley (Option C), and Oats (Option E) all contain or
are frequently contaminated with gluten and will cause an exacerbation of symptoms
(steatorrhea and malnutrition).
Question 6
A nurse is assessing a 6-week-old infant who has a history of projectile vomiting after feedings.
The nurse notes a small, olive-shaped mass in the right upper quadrant of the abdomen. Which of
the following conditions should the nurse suspect?
A) Intussusception
B) Hirschsprung’s disease
C) Hypertrophic pyloric stenosis
, 4
D) Gastroesophageal reflux
E) Meckel’s diverticulum
Correct Answer: C) Hypertrophic pyloric stenosis.
Rationale: Hypertrophic pyloric stenosis is the thickening of the pyloric sphincter, which
creates an obstruction. The hallmark signs are non-bile-stained projectile vomiting and a
palpable olive-shaped mass in the epigastrium just to the right of the umbilicus.
Intussusception (Option A) is characterized by "currant jelly" stools and a sausage-shaped
mass. Hirschsprung’s (Option B) involves a lack of ganglionic cells in the colon, leading to
constipation and ribbon-like stools.
Question 7
A nurse is caring for an infant who has intussusception. Which of the following findings should
the nurse expect?
A) Ribbon-like, foul-smelling stools.
B) Stools that contain blood and mucus ("currant jelly").
C) Projectile vomiting after every meal.
D) A sunken abdomen with visible peristalsis.
E) Constant crying with no periods of relief.
Correct Answer: B) Stools that contain blood and mucus ("currant jelly").
Rationale: Intussusception occurs when one portion of the intestine "telescopes" into
another, causing inflammation, edema, and decreased blood flow. The leaking of blood and
mucus into the intestinal lumen creates the characteristic "currant jelly" stool. The infant
typically experiences sudden, episodic abdominal pain (Option E is incorrect because it is
intermittent, not constant). Projectile vomiting (Option C) is pyloric stenosis. Ribbon-like
stools (Option A) indicate Hirschsprung's disease.
Question 8
A nurse is assessing a school-age child who has nephrotic syndrome. Which of the following
findings should the nurse expect?
A) Gross hematuria and hypertension.
B) Severe periorbital and facial edema.
