ATI PEDIATRICS PROCTORED FINAL EXAM 2026 –
EXPANDED PRACTICE QUESTIONS & ANSWERS ALSO
ENHANCED WITH SUFFICIENT RATIONALES
Question 1: Respiratory Syncytial Virus (RSV)
A nurse in a pediatric unit is caring for a 4-month-old infant admitted with respiratory syncytial virus (RSV). The
infant has nasal flaring, intercostal retractions, wheezing, and oxygen saturation of 89% on room air. The infant is
irritable, feeding poorly, and has thick nasal secretions. Which nursing intervention is the nurse’s PRIORITY?
Choices
Option Answer Choice
A Encourage oral feedings every 2 hours
B Administer IV antibiotics immediately
C Suction the infant’s airway using bulb suction
D Place the infant in Trendelenburg position
Correct Answer
C. Suction the infant’s airway using bulb suction
Rationale
Infants with RSV commonly develop bronchiolitis with excessive mucus production and airway obstruction.
Maintaining a patent airway is the priority because infants are obligate nose breathers. Suctioning secretions
improves oxygenation and respiratory status.
Question 2: Kawasaki Disease
A 5-year-old child is admitted with Kawasaki disease. Assessment findings include fever for 6 days, strawberry
tongue, cracked lips, cervical lymphadenopathy, and peeling skin on the hands. The provider prescribes aspirin
therapy and IV immunoglobulin (IVIG). Which statement by the parent indicates understanding of the disease
process?
Choices
Option Answer Choice
A “My child will need antibiotics for life.”
B “This disease can affect the coronary arteries.”
C “Aspirin should be stopped when the fever decreases.”
D “Kawasaki disease only affects the skin.”
Correct Answer
, B. “This disease can affect the coronary arteries.”
Rationale
Kawasaki disease is a systemic vasculitis that can lead to coronary artery aneurysms if untreated. IVIG and aspirin
are administered to reduce inflammation and prevent cardiac complications.
Question 3: Diabetic Ketoacidosis (DKA)
A school-age child with type 1 diabetes mellitus is brought to the emergency department with fruity breath odor,
deep rapid respirations, abdominal pain, and blood glucose of 480 mg/dL. The nurse recognizes these findings as
manifestations of diabetic ketoacidosis (DKA). Which prescription should the nurse implement FIRST?
Choices
Option Answer Choice
A Administer IV regular insulin
B Start IV isotonic fluids
C Give oral glucose gel
D Restrict fluid intake
Correct Answer
B. Start IV isotonic fluids
Rationale
The priority treatment for DKA is fluid replacement because severe dehydration occurs due to osmotic diuresis.
After fluids are initiated, insulin therapy and electrolyte monitoring follow.
Question 4: Epiglottitis
A nurse is assessing a child suspected of having epiglottitis. The child is drooling, sitting upright leaning forward,
and has inspiratory stridor. Which nursing action is MOST appropriate?
Choices
Option Answer Choice
A Inspect the throat using a tongue depressor
B Obtain a throat culture immediately
C Prepare for emergency airway management
D Place the child in a supine position
Correct Answer
C. Prepare for emergency airway management
,Rationale
Epiglottitis is a life-threatening emergency because airway obstruction can occur rapidly. The nurse should avoid
upsetting the child and prepare for airway stabilization.
Question 5: Congenital Heart Defect
A nurse is caring for an infant diagnosed with tetralogy of Fallot who suddenly becomes cyanotic and begins crying
uncontrollably during feeding. Which nursing intervention is PRIORITY?
Choices
Option Answer Choice
A Place the infant in knee-chest position
B Increase oral feedings
C Lay the infant flat in bed
D Administer potassium supplements
Correct Answer
A. Place the infant in knee-chest position
Rationale
The knee-chest position increases systemic vascular resistance and improves pulmonary blood flow during a
hypercyanotic spell (“tet spell”). This helps improve oxygenation.
Question 6: Meningitis Precautions
A child admitted with bacterial meningitis is placed on droplet precautions. Which finding requires immediate
nursing intervention?
Choices
Option Answer Choice
A Fever of 38.3°C (101°F)
B Positive Kernig’s sign
C Decreased level of consciousness
D Complaint of headache
Correct Answer
C. Decreased level of consciousness
Rationale
, A decreasing level of consciousness may indicate increased intracranial pressure or neurological deterioration,
which is a medical emergency.
Question 7: Cystic Fibrosis
A nurse is teaching the parents of a child with cystic fibrosis about pancreatic enzyme replacement therapy. Which
statement by the parents indicates understanding?
Choices
Option Answer Choice
A “The enzymes should be taken on an empty stomach.”
B “We will give the enzymes with every meal and snack.”
C “The medication should be crushed into hot foods.”
D “Enzymes are only needed when the child is ill.”
Correct Answer
B. “We will give the enzymes with every meal and snack.”
Rationale
Children with cystic fibrosis require pancreatic enzymes with meals and snacks to aid digestion and nutrient
absorption.
Question 8: Child Abuse Indicators
A nurse in the emergency department suspects physical abuse in a toddler. Which assessment finding is MOST
concerning for abuse?
Choices
Option Answer Choice
A Bruises over the knees
B Multiple bruises in different stages of healing
C Abrasions on the elbows
D Small forehead bruise from learning to walk
Correct Answer
B. Multiple bruises in different stages of healing
Rationale
Bruises in various stages of healing strongly suggest repeated trauma and possible physical abuse.
EXPANDED PRACTICE QUESTIONS & ANSWERS ALSO
ENHANCED WITH SUFFICIENT RATIONALES
Question 1: Respiratory Syncytial Virus (RSV)
A nurse in a pediatric unit is caring for a 4-month-old infant admitted with respiratory syncytial virus (RSV). The
infant has nasal flaring, intercostal retractions, wheezing, and oxygen saturation of 89% on room air. The infant is
irritable, feeding poorly, and has thick nasal secretions. Which nursing intervention is the nurse’s PRIORITY?
Choices
Option Answer Choice
A Encourage oral feedings every 2 hours
B Administer IV antibiotics immediately
C Suction the infant’s airway using bulb suction
D Place the infant in Trendelenburg position
Correct Answer
C. Suction the infant’s airway using bulb suction
Rationale
Infants with RSV commonly develop bronchiolitis with excessive mucus production and airway obstruction.
Maintaining a patent airway is the priority because infants are obligate nose breathers. Suctioning secretions
improves oxygenation and respiratory status.
Question 2: Kawasaki Disease
A 5-year-old child is admitted with Kawasaki disease. Assessment findings include fever for 6 days, strawberry
tongue, cracked lips, cervical lymphadenopathy, and peeling skin on the hands. The provider prescribes aspirin
therapy and IV immunoglobulin (IVIG). Which statement by the parent indicates understanding of the disease
process?
Choices
Option Answer Choice
A “My child will need antibiotics for life.”
B “This disease can affect the coronary arteries.”
C “Aspirin should be stopped when the fever decreases.”
D “Kawasaki disease only affects the skin.”
Correct Answer
, B. “This disease can affect the coronary arteries.”
Rationale
Kawasaki disease is a systemic vasculitis that can lead to coronary artery aneurysms if untreated. IVIG and aspirin
are administered to reduce inflammation and prevent cardiac complications.
Question 3: Diabetic Ketoacidosis (DKA)
A school-age child with type 1 diabetes mellitus is brought to the emergency department with fruity breath odor,
deep rapid respirations, abdominal pain, and blood glucose of 480 mg/dL. The nurse recognizes these findings as
manifestations of diabetic ketoacidosis (DKA). Which prescription should the nurse implement FIRST?
Choices
Option Answer Choice
A Administer IV regular insulin
B Start IV isotonic fluids
C Give oral glucose gel
D Restrict fluid intake
Correct Answer
B. Start IV isotonic fluids
Rationale
The priority treatment for DKA is fluid replacement because severe dehydration occurs due to osmotic diuresis.
After fluids are initiated, insulin therapy and electrolyte monitoring follow.
Question 4: Epiglottitis
A nurse is assessing a child suspected of having epiglottitis. The child is drooling, sitting upright leaning forward,
and has inspiratory stridor. Which nursing action is MOST appropriate?
Choices
Option Answer Choice
A Inspect the throat using a tongue depressor
B Obtain a throat culture immediately
C Prepare for emergency airway management
D Place the child in a supine position
Correct Answer
C. Prepare for emergency airway management
,Rationale
Epiglottitis is a life-threatening emergency because airway obstruction can occur rapidly. The nurse should avoid
upsetting the child and prepare for airway stabilization.
Question 5: Congenital Heart Defect
A nurse is caring for an infant diagnosed with tetralogy of Fallot who suddenly becomes cyanotic and begins crying
uncontrollably during feeding. Which nursing intervention is PRIORITY?
Choices
Option Answer Choice
A Place the infant in knee-chest position
B Increase oral feedings
C Lay the infant flat in bed
D Administer potassium supplements
Correct Answer
A. Place the infant in knee-chest position
Rationale
The knee-chest position increases systemic vascular resistance and improves pulmonary blood flow during a
hypercyanotic spell (“tet spell”). This helps improve oxygenation.
Question 6: Meningitis Precautions
A child admitted with bacterial meningitis is placed on droplet precautions. Which finding requires immediate
nursing intervention?
Choices
Option Answer Choice
A Fever of 38.3°C (101°F)
B Positive Kernig’s sign
C Decreased level of consciousness
D Complaint of headache
Correct Answer
C. Decreased level of consciousness
Rationale
, A decreasing level of consciousness may indicate increased intracranial pressure or neurological deterioration,
which is a medical emergency.
Question 7: Cystic Fibrosis
A nurse is teaching the parents of a child with cystic fibrosis about pancreatic enzyme replacement therapy. Which
statement by the parents indicates understanding?
Choices
Option Answer Choice
A “The enzymes should be taken on an empty stomach.”
B “We will give the enzymes with every meal and snack.”
C “The medication should be crushed into hot foods.”
D “Enzymes are only needed when the child is ill.”
Correct Answer
B. “We will give the enzymes with every meal and snack.”
Rationale
Children with cystic fibrosis require pancreatic enzymes with meals and snacks to aid digestion and nutrient
absorption.
Question 8: Child Abuse Indicators
A nurse in the emergency department suspects physical abuse in a toddler. Which assessment finding is MOST
concerning for abuse?
Choices
Option Answer Choice
A Bruises over the knees
B Multiple bruises in different stages of healing
C Abrasions on the elbows
D Small forehead bruise from learning to walk
Correct Answer
B. Multiple bruises in different stages of healing
Rationale
Bruises in various stages of healing strongly suggest repeated trauma and possible physical abuse.
