ATI Pediatrics Proctored Exam 2023 RN Nursing
Comprehensive Test Bank 2025/ 2026
1. A pediatric patient with sickle cell disease presents with acute chest syndrome. The nurse notes a
hemoglobin level of 6.2 g/dL, reticulocyte count of 12%, and a chest X-ray showing a left lower
lobe infiltrate. The patient has a history of two prior vaso-occlusive crises in the past year. Which
intervention should the nurse anticipate as most critical to include in the plan of care?
A. Administer oral hydroxyurea and schedule outpatient follow-up.
B. Initiate exchange transfusion and provide supplemental oxygen.
C. Apply a patient-controlled analgesia pump with morphine and encourage incentive spirometry.
D. Start intravenous fluids at maintenance rate and administer folic acid.
Answer: B
Rationale: Acute chest syndrome is a life-threatening complication of sickle cell disease. Exchange
transfusion reduces the percentage of sickle hemoglobin, improving oxygenation, while supplemental
oxygen addresses hypoxemia. Hydroxyurea is a chronic therapy, not acute management. Incentive
spirometry is important but not the most critical intervention; fluids and folic acid are supportive but not
primary.
2. A school-age child is admitted with new-onset type 1 diabetes mellitus. The nurse is teaching the
family about insulin administration. Which statement by the parent indicates a correct
understanding of insulin storage and preparation?
A. I will store the opened insulin vials in the freezer to keep them potent.
B. I should roll the NPH insulin vial vigorously before drawing it up.
C. I will administer regular insulin first when mixing with NPH insulin.
D. I can use the insulin pen for up to 30 days after the first use.
Answer: C
Rationale: When mixing insulins, clear (regular) insulin should be drawn up before cloudy (NPH) to
avoid contamination. Opened vials should not be frozen; they are stable at room temperature for 28
days. NPH should be gently rolled, not shaken. Insulin pens typically have a 28-day expiration after first
use, not 30 days, though this varies; however, option C is the most established principle.
3. A nurse is assessing a toddler with suspected lead toxicity. The child's blood lead level is 45
mcg/dL. Which assessment finding is most consistent with this level of exposure?
A. Peripheral neuropathy and wrist drop.
B. Abdominal pain, irritability, and delayed language development.
C. Macrocephaly and frontal bossing.
D. Polyuria and polydipsia.
Answer: B
Page 1
,Rationale: A blood lead level of 45 mcg/dL indicates moderate toxicity. Common symptoms include abdominal pain,
irritability, and developmental delays (especially language). Peripheral neuropathy and wrist drop are seen in severe chronic
toxicity (>70 mcg/dL). Macrocephaly and frontal bossing are associated with hydrocephalus or thalassemia. Polyuria and
polydipsia suggest diabetes insipidus or hyperglycemia.
4. A nurse is caring for an infant with a congenital heart defect that causes increased pulmonary
blood flow. Which pathophysiological consequence is most likely to occur if the defect remains
uncorrected?
A. Progressive cyanosis due to right-to-left shunting.
B. Pulmonary vascular obstructive disease and Eisenmenger syndrome.
C. Decreased cardiac output from left ventricular hypertrophy.
D. Systemic hypotension from decreased afterload.
Answer: B
Rationale: Increased pulmonary blood flow (e.g., ventricular septal defect, patent ductus arteriosus)
leads to pulmonary overcirculation. Over time, this causes pulmonary vascular remodeling and
increased resistance, eventually reversing shunt direction (Eisenmenger syndrome). Cyanosis develops
late. Left ventricular hypertrophy may occur but is secondary. Systemic hypotension is not typical.
5. A nurse is evaluating the growth of a child with cystic fibrosis. The child's weight has dropped
from the 25th percentile to the 5th percentile over 6 months despite pancreatic enzyme
replacement. Which intervention should the nurse prioritize?
A. Increase the dose of pancreatic enzymes with each meal and snack.
B. Recommend a high-calorie, high-protein diet with nocturnal gastrostomy feedings.
C. Switch to a low-fat diet to reduce steatorrhea.
D. Add a proton pump inhibitor to reduce gastric acidity.
Answer: B
Rationale: Persistent weight loss despite enzyme therapy indicates inadequate caloric intake. Nocturnal
gastrostomy feedings provide supplemental nutrition. Increasing enzymes may help but is not sufficient if
intake is low. A low-fat diet is contraindicated because CF requires high fat for calories. Proton pump
inhibitors can improve enzyme efficacy but are secondary to caloric support.
6. A nurse is assessing an adolescent with suspected anorexia nervosa. Which laboratory finding is
most consistent with this diagnosis?
A. Elevated serum potassium.
B. Elevated serum amylase.
C. Leukocytosis with left shift.
D. Decreased serum phosphorus.
Answer: D
Rationale: Anorexia nervosa often leads to refeeding syndrome risk, with hypophosphatemia being a
hallmark. Electrolyte imbalances include hypokalemia, not hyperkalemia. Serum amylase may be
elevated in bulimia (due to vomiting) but not typically in restricting-type anorexia. Leukocytosis is not
characteristic; instead, leukopenia may occur.
Page 2
,7. A preterm infant in the neonatal intensive care unit develops apnea and bradycardia. The nurse
administers caffeine citrate. Which mechanism of action explains the therapeutic effect of caffeine
in this setting?
A. Adenosine receptor antagonism leading to increased respiratory drive.
B. Beta-adrenergic receptor stimulation increasing heart rate.
C. Inhibition of phosphodiesterase causing bronchodilation.
D. Central alpha-2 agonism reducing sympathetic outflow.
Answer: A
Rationale: Caffeine citrate is a methylxanthine that acts as a competitive antagonist of adenosine
receptors. Adenosine inhibits respiratory drive; by blocking its effects, caffeine increases central
respiratory output and improves diaphragmatic contractility. Beta-adrenergic stimulation is not the
primary mechanism. Phosphodiesterase inhibition is associated with theophylline, not caffeine. Alpha-2
agonism is unrelated.
8. A nurse is preparing to administer immunizations to a 2-month-old infant. The mother reports
that the infant had a temperature of 100.4°F (38°C) after the first hepatitis B vaccine. Which action
should the nurse take?
A. Withhold all vaccines and reschedule when the infant is older.
B. Administer the vaccines as scheduled and counsel the mother about expected fever.
C. Administer only the inactivated polio vaccine and defer live vaccines.
D. Administer acetaminophen 15 minutes before vaccination to prevent fever.
Answer: B
Rationale: A mild fever after a previous vaccine is not a contraindication to subsequent doses. The CDC
recommends proceeding with routine immunizations. Acetaminophen prophylaxis is not routinely
recommended as it may reduce immune response. Live vaccines are not contraindicated based on prior
mild fever. Withholding vaccines unnecessarily leaves the infant unprotected.
9. A nurse is assessing a child with acute lymphoblastic leukemia (ALL) who is receiving
methotrexate. The child develops stomatitis and a serum methotrexate level of 1.5 µmol/L at 72
hours post-infusion. Which intervention is most appropriate?
A. Administer leucovorin rescue and continue monitoring levels.
B. Increase intravenous fluids and alkalinize the urine.
C. Administer mesna to prevent hemorrhagic cystitis.
D. Discontinue methotrexate and start cytarabine.
Answer: A
Rationale: A methotrexate level >1 µmol/L at 72 hours indicates delayed clearance, risking severe
toxicity. Leucovorin (folinic acid) rescue bypasses the blocked dihydrofolate reductase, protecting
normal cells. Urine alkalinization is standard during infusion but does not address existing toxicity.
Mesna is for cyclophosphamide. Discontinuing methotrexate alone is insufficient.
Page 3
, 10. A nurse is caring for a child with nephrotic syndrome. The child has generalized edema,
proteinuria (3+), and serum albumin of 1.8 g/dL. The physician orders intravenous albumin
infusion followed by furosemide. Which mechanism explains the rationale for this combination?
A. Albumin increases oncotic pressure, drawing fluid into the vasculature, and furosemide then promotes
diuresis.
B. Albumin binds furosemide, prolonging its half-life and enhancing diuretic effect.
C. Furosemide reduces albumin catabolism, increasing serum albumin levels.
D. Albumin stimulates aldosterone secretion, and furosemide counteracts potassium loss.
Answer: A
Rationale: In nephrotic syndrome, hypoalbuminemia reduces plasma oncotic pressure, causing edema.
Albumin infusion transiently raises oncotic pressure, shifting fluid from interstitium to vasculature,
which furosemide then excretes. Albumin does not bind furosemide significantly; furosemide's action is
independent of albumin. Furosemide does not affect albumin catabolism. Aldosterone is not stimulated
by albumin.
11. A child with a history of recurrent sinopulmonary infections, failure to thrive, and digital
clubbing is being evaluated. Sweat chloride test is borderline. Genetic testing reveals a CFTR
mutation that is not fully penetrant. Which of the following best explains the variable expressivity
in this case?
A. Modifier genes and environmental factors influence the phenotypic outcome.
B. The mutation is in a non-coding region, so it is never expressed.
C. Cystic fibrosis requires two different mutations for disease manifestation.
D. The borderline sweat test indicates the child is a carrier only.
Answer: A
Rationale: Variable expressivity in cystic fibrosis can result from modifier genes, environmental factors,
and other genetic variants that alter the severity of the disease. The child has a CFTR mutation with
incomplete penetrance, and the borderline sweat test suggests a milder phenotype, which is consistent
with the influence of genetic and environmental modifiers.
12. A patient with sickle cell disease develops acute chest syndrome. Initial oxygen saturation is
89% on room air. In addition to oxygen, which intervention has the strongest evidence for reducing
mortality in this scenario?
A. Empiric broad-spectrum antibiotics including a macrolide.
B. Simple blood transfusion to target hemoglobin of 10 g/dL.
C. Intravenous corticosteroids to reduce inflammation.
D. Exchange transfusion to lower hemoglobin S below 30%.
Answer: A
Rationale: Acute chest syndrome is often triggered by infection, and prompt administration of
broad-spectrum antibiotics (including coverage for atypical pathogens) is recommended to reduce
mortality. While transfusion may be needed for severe cases, antibiotics are first-line. Corticosteroids
are not routinely indicated unless there is associated asthma.
Page 4
Comprehensive Test Bank 2025/ 2026
1. A pediatric patient with sickle cell disease presents with acute chest syndrome. The nurse notes a
hemoglobin level of 6.2 g/dL, reticulocyte count of 12%, and a chest X-ray showing a left lower
lobe infiltrate. The patient has a history of two prior vaso-occlusive crises in the past year. Which
intervention should the nurse anticipate as most critical to include in the plan of care?
A. Administer oral hydroxyurea and schedule outpatient follow-up.
B. Initiate exchange transfusion and provide supplemental oxygen.
C. Apply a patient-controlled analgesia pump with morphine and encourage incentive spirometry.
D. Start intravenous fluids at maintenance rate and administer folic acid.
Answer: B
Rationale: Acute chest syndrome is a life-threatening complication of sickle cell disease. Exchange
transfusion reduces the percentage of sickle hemoglobin, improving oxygenation, while supplemental
oxygen addresses hypoxemia. Hydroxyurea is a chronic therapy, not acute management. Incentive
spirometry is important but not the most critical intervention; fluids and folic acid are supportive but not
primary.
2. A school-age child is admitted with new-onset type 1 diabetes mellitus. The nurse is teaching the
family about insulin administration. Which statement by the parent indicates a correct
understanding of insulin storage and preparation?
A. I will store the opened insulin vials in the freezer to keep them potent.
B. I should roll the NPH insulin vial vigorously before drawing it up.
C. I will administer regular insulin first when mixing with NPH insulin.
D. I can use the insulin pen for up to 30 days after the first use.
Answer: C
Rationale: When mixing insulins, clear (regular) insulin should be drawn up before cloudy (NPH) to
avoid contamination. Opened vials should not be frozen; they are stable at room temperature for 28
days. NPH should be gently rolled, not shaken. Insulin pens typically have a 28-day expiration after first
use, not 30 days, though this varies; however, option C is the most established principle.
3. A nurse is assessing a toddler with suspected lead toxicity. The child's blood lead level is 45
mcg/dL. Which assessment finding is most consistent with this level of exposure?
A. Peripheral neuropathy and wrist drop.
B. Abdominal pain, irritability, and delayed language development.
C. Macrocephaly and frontal bossing.
D. Polyuria and polydipsia.
Answer: B
Page 1
,Rationale: A blood lead level of 45 mcg/dL indicates moderate toxicity. Common symptoms include abdominal pain,
irritability, and developmental delays (especially language). Peripheral neuropathy and wrist drop are seen in severe chronic
toxicity (>70 mcg/dL). Macrocephaly and frontal bossing are associated with hydrocephalus or thalassemia. Polyuria and
polydipsia suggest diabetes insipidus or hyperglycemia.
4. A nurse is caring for an infant with a congenital heart defect that causes increased pulmonary
blood flow. Which pathophysiological consequence is most likely to occur if the defect remains
uncorrected?
A. Progressive cyanosis due to right-to-left shunting.
B. Pulmonary vascular obstructive disease and Eisenmenger syndrome.
C. Decreased cardiac output from left ventricular hypertrophy.
D. Systemic hypotension from decreased afterload.
Answer: B
Rationale: Increased pulmonary blood flow (e.g., ventricular septal defect, patent ductus arteriosus)
leads to pulmonary overcirculation. Over time, this causes pulmonary vascular remodeling and
increased resistance, eventually reversing shunt direction (Eisenmenger syndrome). Cyanosis develops
late. Left ventricular hypertrophy may occur but is secondary. Systemic hypotension is not typical.
5. A nurse is evaluating the growth of a child with cystic fibrosis. The child's weight has dropped
from the 25th percentile to the 5th percentile over 6 months despite pancreatic enzyme
replacement. Which intervention should the nurse prioritize?
A. Increase the dose of pancreatic enzymes with each meal and snack.
B. Recommend a high-calorie, high-protein diet with nocturnal gastrostomy feedings.
C. Switch to a low-fat diet to reduce steatorrhea.
D. Add a proton pump inhibitor to reduce gastric acidity.
Answer: B
Rationale: Persistent weight loss despite enzyme therapy indicates inadequate caloric intake. Nocturnal
gastrostomy feedings provide supplemental nutrition. Increasing enzymes may help but is not sufficient if
intake is low. A low-fat diet is contraindicated because CF requires high fat for calories. Proton pump
inhibitors can improve enzyme efficacy but are secondary to caloric support.
6. A nurse is assessing an adolescent with suspected anorexia nervosa. Which laboratory finding is
most consistent with this diagnosis?
A. Elevated serum potassium.
B. Elevated serum amylase.
C. Leukocytosis with left shift.
D. Decreased serum phosphorus.
Answer: D
Rationale: Anorexia nervosa often leads to refeeding syndrome risk, with hypophosphatemia being a
hallmark. Electrolyte imbalances include hypokalemia, not hyperkalemia. Serum amylase may be
elevated in bulimia (due to vomiting) but not typically in restricting-type anorexia. Leukocytosis is not
characteristic; instead, leukopenia may occur.
Page 2
,7. A preterm infant in the neonatal intensive care unit develops apnea and bradycardia. The nurse
administers caffeine citrate. Which mechanism of action explains the therapeutic effect of caffeine
in this setting?
A. Adenosine receptor antagonism leading to increased respiratory drive.
B. Beta-adrenergic receptor stimulation increasing heart rate.
C. Inhibition of phosphodiesterase causing bronchodilation.
D. Central alpha-2 agonism reducing sympathetic outflow.
Answer: A
Rationale: Caffeine citrate is a methylxanthine that acts as a competitive antagonist of adenosine
receptors. Adenosine inhibits respiratory drive; by blocking its effects, caffeine increases central
respiratory output and improves diaphragmatic contractility. Beta-adrenergic stimulation is not the
primary mechanism. Phosphodiesterase inhibition is associated with theophylline, not caffeine. Alpha-2
agonism is unrelated.
8. A nurse is preparing to administer immunizations to a 2-month-old infant. The mother reports
that the infant had a temperature of 100.4°F (38°C) after the first hepatitis B vaccine. Which action
should the nurse take?
A. Withhold all vaccines and reschedule when the infant is older.
B. Administer the vaccines as scheduled and counsel the mother about expected fever.
C. Administer only the inactivated polio vaccine and defer live vaccines.
D. Administer acetaminophen 15 minutes before vaccination to prevent fever.
Answer: B
Rationale: A mild fever after a previous vaccine is not a contraindication to subsequent doses. The CDC
recommends proceeding with routine immunizations. Acetaminophen prophylaxis is not routinely
recommended as it may reduce immune response. Live vaccines are not contraindicated based on prior
mild fever. Withholding vaccines unnecessarily leaves the infant unprotected.
9. A nurse is assessing a child with acute lymphoblastic leukemia (ALL) who is receiving
methotrexate. The child develops stomatitis and a serum methotrexate level of 1.5 µmol/L at 72
hours post-infusion. Which intervention is most appropriate?
A. Administer leucovorin rescue and continue monitoring levels.
B. Increase intravenous fluids and alkalinize the urine.
C. Administer mesna to prevent hemorrhagic cystitis.
D. Discontinue methotrexate and start cytarabine.
Answer: A
Rationale: A methotrexate level >1 µmol/L at 72 hours indicates delayed clearance, risking severe
toxicity. Leucovorin (folinic acid) rescue bypasses the blocked dihydrofolate reductase, protecting
normal cells. Urine alkalinization is standard during infusion but does not address existing toxicity.
Mesna is for cyclophosphamide. Discontinuing methotrexate alone is insufficient.
Page 3
, 10. A nurse is caring for a child with nephrotic syndrome. The child has generalized edema,
proteinuria (3+), and serum albumin of 1.8 g/dL. The physician orders intravenous albumin
infusion followed by furosemide. Which mechanism explains the rationale for this combination?
A. Albumin increases oncotic pressure, drawing fluid into the vasculature, and furosemide then promotes
diuresis.
B. Albumin binds furosemide, prolonging its half-life and enhancing diuretic effect.
C. Furosemide reduces albumin catabolism, increasing serum albumin levels.
D. Albumin stimulates aldosterone secretion, and furosemide counteracts potassium loss.
Answer: A
Rationale: In nephrotic syndrome, hypoalbuminemia reduces plasma oncotic pressure, causing edema.
Albumin infusion transiently raises oncotic pressure, shifting fluid from interstitium to vasculature,
which furosemide then excretes. Albumin does not bind furosemide significantly; furosemide's action is
independent of albumin. Furosemide does not affect albumin catabolism. Aldosterone is not stimulated
by albumin.
11. A child with a history of recurrent sinopulmonary infections, failure to thrive, and digital
clubbing is being evaluated. Sweat chloride test is borderline. Genetic testing reveals a CFTR
mutation that is not fully penetrant. Which of the following best explains the variable expressivity
in this case?
A. Modifier genes and environmental factors influence the phenotypic outcome.
B. The mutation is in a non-coding region, so it is never expressed.
C. Cystic fibrosis requires two different mutations for disease manifestation.
D. The borderline sweat test indicates the child is a carrier only.
Answer: A
Rationale: Variable expressivity in cystic fibrosis can result from modifier genes, environmental factors,
and other genetic variants that alter the severity of the disease. The child has a CFTR mutation with
incomplete penetrance, and the borderline sweat test suggests a milder phenotype, which is consistent
with the influence of genetic and environmental modifiers.
12. A patient with sickle cell disease develops acute chest syndrome. Initial oxygen saturation is
89% on room air. In addition to oxygen, which intervention has the strongest evidence for reducing
mortality in this scenario?
A. Empiric broad-spectrum antibiotics including a macrolide.
B. Simple blood transfusion to target hemoglobin of 10 g/dL.
C. Intravenous corticosteroids to reduce inflammation.
D. Exchange transfusion to lower hemoglobin S below 30%.
Answer: A
Rationale: Acute chest syndrome is often triggered by infection, and prompt administration of
broad-spectrum antibiotics (including coverage for atypical pathogens) is recommended to reduce
mortality. While transfusion may be needed for severe cases, antibiotics are first-line. Corticosteroids
are not routinely indicated unless there is associated asthma.
Page 4
