ATI Pediatrics Proctored Exam 2023 RN Nursing Comprehensive
Test Bank 2025/ 2026 EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF - 250
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Pediatric Nursing
Description Comprehensive assessment of advanced pediatric nursing knowledge, integrating
pathophysiology, pharmacology, evidence-based interventions, and
family-centered care across the pediatric continuum. Emphasizes clinical
reasoning, prioritization, and safety in the care of children from infancy through
adolescence.
Expected Grade A+
Total Questions 250
Duration 3 hours
Learning Outcomes 1. Apply developmental theories to age-specific nursing interventions and
anticipatory guidance.
2. Differentiate between normal and pathological findings in pediatric assessment.
3. Prioritize nursing care for acute and chronic pediatric conditions using clinical
reasoning.
4. Calculate and administer pediatric medications safely, incorporating
pharmacokinetic differences.
5. Evaluate the effectiveness of nursing interventions and modify plans based on
patient responses.
Accreditation Designed to meet AACN Baccalaureate Essentials and NCLEX-RN test plan
standards for pediatric nursing.
Page 1
,1. A child with a ventriculoperitoneal shunt presents with fever, headache, and
nuchal rigidity. CSF analysis reveals elevated WBCs, low glucose, and elevated
protein. Which pathogen is most likely responsible?
A. Staphylococcus epidermidis
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Escherichia coli
Answer: A. Staphylococcus epidermidis
Staphylococcus epidermidis is a common cause of shunt infections due to skin flora
contamination during insertion or revision. The CSF profile (elevated WBCs, low
glucose, high protein) is consistent with bacterial meningitis. N. meningitidis and S.
pneumoniae are more common in community-acquired meningitis without a shunt. E.
coli is typical in neonates.
2. Which of the following best explains the increased risk of hypoglycemia in a child
receiving total parenteral nutrition (TPN) that is abruptly discontinued?
A. Rebound hyperinsulinemia from the high glucose content of TPN
B. Depletion of hepatic glycogen stores due to prolonged fasting
C. Increased peripheral glucose utilization from concurrent infection
D. Decreased gluconeogenesis due to amino acid load in TPN
Answer: A. Rebound hyperinsulinemia from the high glucose content of TPN
Abrupt discontinuation of TPN, which has a high dextrose concentration, causes a
sudden drop in exogenous glucose while endogenous insulin secretion remains elevated,
leading to rebound hypoglycemia. Hepatic glycogen stores are typically maintained
during TPN. Infection may increase glucose utilization but is not the primary
mechanism. TPN amino acids support gluconeogenesis.
Page 2
,3. A child with cystic fibrosis has a sweat chloride level of 75 mmol/L and is
homozygous for F508 mutation. Which pathophysiological consequence directly
explains the development of pancreatic insufficiency in this patient?
A. Increased viscosity of pancreatic secretions due to defective chloride transport
B. Autoimmune destruction of pancreatic acinar cells
C. Obstruction of pancreatic ducts by inspissated secretions leading to fibrosis
D. Impaired bicarbonate secretion causing acidic duodenal pH and enzyme inactivation
Answer: C. Obstruction of pancreatic ducts by inspissated secretions leading to
fibrosis
In cystic fibrosis, defective CFTR protein leads to thick, tenacious secretions that
obstruct pancreatic ducts. This causes backup of digestive enzymes, autodigestion, and
progressive fibrosis, resulting in pancreatic insufficiency. While increased viscosity (A)
is a factor, the key is ductal obstruction (C). Autoimmune destruction (B) is not typical.
Bicarbonate secretion is also impaired (D) but is not the primary cause of pancreatic
insufficiency.
4. A pediatric patient with suspected intussusception undergoes an air enema under
fluoroscopic guidance. After successful reduction, the nurse should prioritize
monitoring for which complication?
A. Perforation with peritonitis
B. Recurrence of intussusception within 24 hours
C. Fluid overload from absorbed irrigation fluid
D. Sepsis from translocation of gut bacteria
Answer: A. Perforation with peritonitis
Air enema reduction carries a risk of bowel perforation, which can lead to peritonitis;
this is the most immediate and life-threatening complication. Recurrence (B) is common
but usually occurs later. Fluid overload (C) is more relevant with liquid contrast. Sepsis
(D) is less immediate and not directly related to the procedure itself.
Page 3
, 5. A nurse is assessing a child with suspected acute rheumatic fever (ARF) using the
updated Jones criteria. Which finding would satisfy a major criterion?
A. Arthralgia of the left knee without objective inflammation
B. Erythema marginatum on the trunk
C. Prolonged PR interval on ECG
D. History of streptococcal pharyngitis confirmed by throat culture
Answer: B. Erythema marginatum on the trunk
Erythema marginatum is one of the major Jones criteria for ARF. Arthralgia (A) is a
minor criterion unless it is polyarthritis (a major criterion). Prolonged PR interval (C)
is a minor criterion. History of streptococcal infection (D) is supportive evidence but
not a major criterion.
6. A child with nephrotic syndrome is being treated with prednisone. After 4 weeks,
the urine protein remains 3+ on dipstick. Which finding would most suggest
steroid-resistant nephrotic syndrome?
A. Serum albumin 2.8 g/dL
B. Presence of dysmorphic RBCs on urine microscopy
C. Normal complement C3 level
D. Elevated serum cholesterol
Answer: B. Presence of dysmorphic RBCs on urine microscopy
Dysmorphic RBCs indicate glomerular hematuria, which is atypical for minimal
change disease (the most common cause of steroid-sensitive nephrotic syndrome). Their
presence suggests a different pathology such as focal segmental glomerulosclerosis,
which is often steroid-resistant. Low albumin (A) and hypercholesterolemia (D) are
typical of nephrotic syndrome regardless of steroid response. Normal C3 (C) is common
in minimal change disease.
Page 4
Test Bank 2025/ 2026 EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF - 250
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Pediatric Nursing
Description Comprehensive assessment of advanced pediatric nursing knowledge, integrating
pathophysiology, pharmacology, evidence-based interventions, and
family-centered care across the pediatric continuum. Emphasizes clinical
reasoning, prioritization, and safety in the care of children from infancy through
adolescence.
Expected Grade A+
Total Questions 250
Duration 3 hours
Learning Outcomes 1. Apply developmental theories to age-specific nursing interventions and
anticipatory guidance.
2. Differentiate between normal and pathological findings in pediatric assessment.
3. Prioritize nursing care for acute and chronic pediatric conditions using clinical
reasoning.
4. Calculate and administer pediatric medications safely, incorporating
pharmacokinetic differences.
5. Evaluate the effectiveness of nursing interventions and modify plans based on
patient responses.
Accreditation Designed to meet AACN Baccalaureate Essentials and NCLEX-RN test plan
standards for pediatric nursing.
Page 1
,1. A child with a ventriculoperitoneal shunt presents with fever, headache, and
nuchal rigidity. CSF analysis reveals elevated WBCs, low glucose, and elevated
protein. Which pathogen is most likely responsible?
A. Staphylococcus epidermidis
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Escherichia coli
Answer: A. Staphylococcus epidermidis
Staphylococcus epidermidis is a common cause of shunt infections due to skin flora
contamination during insertion or revision. The CSF profile (elevated WBCs, low
glucose, high protein) is consistent with bacterial meningitis. N. meningitidis and S.
pneumoniae are more common in community-acquired meningitis without a shunt. E.
coli is typical in neonates.
2. Which of the following best explains the increased risk of hypoglycemia in a child
receiving total parenteral nutrition (TPN) that is abruptly discontinued?
A. Rebound hyperinsulinemia from the high glucose content of TPN
B. Depletion of hepatic glycogen stores due to prolonged fasting
C. Increased peripheral glucose utilization from concurrent infection
D. Decreased gluconeogenesis due to amino acid load in TPN
Answer: A. Rebound hyperinsulinemia from the high glucose content of TPN
Abrupt discontinuation of TPN, which has a high dextrose concentration, causes a
sudden drop in exogenous glucose while endogenous insulin secretion remains elevated,
leading to rebound hypoglycemia. Hepatic glycogen stores are typically maintained
during TPN. Infection may increase glucose utilization but is not the primary
mechanism. TPN amino acids support gluconeogenesis.
Page 2
,3. A child with cystic fibrosis has a sweat chloride level of 75 mmol/L and is
homozygous for F508 mutation. Which pathophysiological consequence directly
explains the development of pancreatic insufficiency in this patient?
A. Increased viscosity of pancreatic secretions due to defective chloride transport
B. Autoimmune destruction of pancreatic acinar cells
C. Obstruction of pancreatic ducts by inspissated secretions leading to fibrosis
D. Impaired bicarbonate secretion causing acidic duodenal pH and enzyme inactivation
Answer: C. Obstruction of pancreatic ducts by inspissated secretions leading to
fibrosis
In cystic fibrosis, defective CFTR protein leads to thick, tenacious secretions that
obstruct pancreatic ducts. This causes backup of digestive enzymes, autodigestion, and
progressive fibrosis, resulting in pancreatic insufficiency. While increased viscosity (A)
is a factor, the key is ductal obstruction (C). Autoimmune destruction (B) is not typical.
Bicarbonate secretion is also impaired (D) but is not the primary cause of pancreatic
insufficiency.
4. A pediatric patient with suspected intussusception undergoes an air enema under
fluoroscopic guidance. After successful reduction, the nurse should prioritize
monitoring for which complication?
A. Perforation with peritonitis
B. Recurrence of intussusception within 24 hours
C. Fluid overload from absorbed irrigation fluid
D. Sepsis from translocation of gut bacteria
Answer: A. Perforation with peritonitis
Air enema reduction carries a risk of bowel perforation, which can lead to peritonitis;
this is the most immediate and life-threatening complication. Recurrence (B) is common
but usually occurs later. Fluid overload (C) is more relevant with liquid contrast. Sepsis
(D) is less immediate and not directly related to the procedure itself.
Page 3
, 5. A nurse is assessing a child with suspected acute rheumatic fever (ARF) using the
updated Jones criteria. Which finding would satisfy a major criterion?
A. Arthralgia of the left knee without objective inflammation
B. Erythema marginatum on the trunk
C. Prolonged PR interval on ECG
D. History of streptococcal pharyngitis confirmed by throat culture
Answer: B. Erythema marginatum on the trunk
Erythema marginatum is one of the major Jones criteria for ARF. Arthralgia (A) is a
minor criterion unless it is polyarthritis (a major criterion). Prolonged PR interval (C)
is a minor criterion. History of streptococcal infection (D) is supportive evidence but
not a major criterion.
6. A child with nephrotic syndrome is being treated with prednisone. After 4 weeks,
the urine protein remains 3+ on dipstick. Which finding would most suggest
steroid-resistant nephrotic syndrome?
A. Serum albumin 2.8 g/dL
B. Presence of dysmorphic RBCs on urine microscopy
C. Normal complement C3 level
D. Elevated serum cholesterol
Answer: B. Presence of dysmorphic RBCs on urine microscopy
Dysmorphic RBCs indicate glomerular hematuria, which is atypical for minimal
change disease (the most common cause of steroid-sensitive nephrotic syndrome). Their
presence suggests a different pathology such as focal segmental glomerulosclerosis,
which is often steroid-resistant. Low albumin (A) and hypercholesterolemia (D) are
typical of nephrotic syndrome regardless of steroid response. Normal C3 (C) is common
in minimal change disease.
Page 4
