ATI RN PEDIATRICS PROCTORED ACTUAL EXAM
WITH 70 NGN Q&A | 2026 UPDATED
Nursing Care of Children | Next Generation NCLEX Standards | Verified Answers | Grade A
Section 1: Growth and Development Across Pediatric Age Groups
Q1: A nurse is assessing a 4-month-old infant during a well-child visit. The infant can hold their head steady without
support, bears some weight on their legs when held in a standing position, and coos and babbles. Which developmental
stage according to Piaget is this infant in, and what gross motor milestone should the nurse expect next?
A. Formal operational stage; sitting alone without support
B. Sensorimotor stage; rolling from back to front [CORRECT]
C. Preoperational stage; walking independently
D. Concrete operational stage; standing without support
Correct Answer: B
Rationale: The infant is in the sensorimotor stage of Piaget's cognitive development, which spans from birth to approximately 2 years of age. Infants
learn through sensory experiences and motor activities during this period. At 4 months, head control is established and the next expected gross motor
milestone is rolling over (front to back first, then back to front at approximately 4-6 months). Sitting alone without support is expected at
approximately 8 months. Walking independently occurs at 12-15 months. The preoperational and concrete operational stages occur much later in
childhood.
Q2: A nurse is providing anticipatory guidance to the parents of a 2-year-old toddler. According to Erikson's
psychosocial development theory, which developmental task is the toddler currently working through?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt [CORRECT]
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B
Rationale: According to Erikson's theory, toddlers (ages 1-3 years) are in the autonomy vs. shame and doubt stage. During this period, toddlers
develop a sense of independence and autonomy as they gain control over their bodies through activities such as walking, toileting, and feeding
themselves. Trust vs. mistrust is the infant stage (birth to 1 year). Initiative vs. guilt is the preschool stage (3-5 years). Industry vs. inferiority is the
school-age stage (6-12 years). Promoting autonomy while providing appropriate limits is essential nursing care for toddlers.
Q3: A nurse is assessing a 10-month-old infant. Which fine motor milestone should the nurse expect the infant to have
achieved?
A. Pincer grasp [CORRECT]
B. Builds a tower of 6-7 cubes
C. Ties shoelaces
D. Uses a spoon effectively
Correct Answer: A
Rationale: The pincer grasp typically develops between 9 and 12 months of age and involves using the thumb and index finger to pick up small
objects. This is a critical fine motor milestone for infants. Building a tower of 6-7 cubes is expected at approximately 2-3 years (toddler/preschool).
Tying shoelaces is a school-age milestone (around 5-6 years). Using a spoon effectively develops around 12-15 months. The nurse should assess for
the pincer grasp during well-child visits in late infancy.
Q4: A nurse is educating parents about their newborn's fontanels. Which statement by a parent indicates a need for
further teaching?
A. The larger soft spot on the top of the head should close by 12-18 months of age
B. The smaller soft spot at the back of the head should close by 2-3 months of age
C. A sunken fontanel may indicate dehydration and I should report this immediately
D. A bulging fontanel is normal when the baby is crying and is never a concern [CORRECT]
Correct Answer: D
,Rationale: A bulging fontanel is never considered normal, even when crying. While transient increases in intracranial pressure from crying can cause
slight fontanel tension, a persistently bulging fontanel is a sign of increased intracranial pressure and requires immediate evaluation for conditions
such as meningitis, hydrocephalus, or intracranial hemorrhage. The anterior fontanel closes at 12-18 months and the posterior fontanel closes at 2-3
months. A sunken fontanel is a sign of dehydration. This parent requires immediate correction and further teaching.
Q5: A 4-year-old child is admitted to the pediatric unit for surgery. The nurse observes the child engaging in parallel play
in the playroom. Which developmental characteristic is the nurse observing?
A. The child plays cooperatively with other children toward a common goal
B. The child plays alongside but not directly with other children [CORRECT]
C. The child prefers solitary play and avoids all peer interaction
D. The child engages in competitive games with complex rules
Correct Answer: B
Rationale: Parallel play is characteristic of toddlers and young preschoolers (approximately 2-3 years), in which children play near each other but
not directly with each other. Each child engages in their own activity independently but in the presence of peers. Cooperative play, in which children
play together toward a common goal, develops later in the preschool period. Solitary play is seen in infants. Competitive games with rules are
characteristic of school-age children. Understanding play development is essential for planning age-appropriate activities.
Q6: A nurse is assessing the physical growth of a 9-month-old infant. The birth weight was 7 pounds. What is the
expected weight for this infant?
A. 14 pounds (doubled birth weight) [CORRECT]
B. 21 pounds (tripled birth weight)
C. 10.5 pounds (1.5 times birth weight)
D. 28 pounds (quadrupled birth weight)
Correct Answer: A
Rationale: An infant's weight typically doubles by 4-6 months and triples by 12 months. At 9 months, the infant's weight should be approximately
between 2 and 3 times the birth weight, approaching the 12-month expectation of tripling. At birth weight of 7 pounds, the infant should weigh
approximately 14 pounds by 6 months (doubled) and approximately 21 pounds by 12 months (tripled). At 9 months, the weight would be
approximately 17-19 pounds, making doubled birth weight (14 pounds) the most appropriate choice for the closest milestone already achieved. This is
important for nutritional assessment.
Q7: A nurse is caring for an adolescent patient. According to Erikson's theory, which psychosocial task is the adolescent
working to resolve?
A. Industry vs. Inferiority
B. Identity vs. Role Confusion [CORRECT]
C. Intimacy vs. Isolation
D. Autonomy vs. Shame and Doubt
Correct Answer: B
Rationale: According to Erikson's psychosocial development theory, adolescents (12-18 years) are in the identity vs. role confusion stage. The primary
developmental task is to develop a coherent sense of self and personal identity, including exploring values, beliefs, career goals, and sexual identity.
Industry vs. inferiority is the school-age stage (6-12 years). Intimacy vs. isolation is the young adult stage (18-40 years). Autonomy vs. shame and
doubt is the toddler stage (1-3 years). Nurses should support adolescents' identity exploration while providing a safe, nonjudgmental environment.
Q8: A nurse is providing anticipatory guidance to the parents of a 3-year-old child. The parents ask what play activities
are appropriate for their child's developmental level. Which response by the nurse is most appropriate?
A. Complex board games with rules and turn-taking
B. Drawing with crayons, building block towers, and pretend play [CORRECT]
C. Team sports and competitive activities
D. Abstract puzzle-solving and strategy games
Correct Answer: B
Rationale: Preschool children (3-5 years) benefit from activities that foster creativity, imagination, and developing fine motor skills. Drawing with
crayons, building block towers (4-6 blocks at age 3), and engaging in pretend/imaginative play are developmentally appropriate. Complex board
games with rules are more appropriate for school-age children. Team sports are for school-age and adolescent children. Abstract puzzle-solving
requires concrete or formal operational thinking, which develops later. Play is the work of childhood and should be developmentally appropriate.
, Q9: A school-age child (8 years old) is hospitalized. The nurse notes the child is concerned about falling behind
academically and wants to know when they can return to school. Which Erikson stage is most relevant to this child's
concern?
A. Trust vs. Mistrust
B. Initiative vs. Guilt
C. Industry vs. Inferiority [CORRECT]
D. Identity vs. Role Confusion
Correct Answer: C
Rationale: The school-age child (6-12 years) is in Erikson's industry vs. inferiority stage, in which children develop a sense of competence and
achievement through academic, social, and athletic activities. Concerns about falling behind academically reflect the child's need to feel productive
and competent. Feelings of inferiority can develop if the child perceives they are not keeping up with peers. The nurse should support continued
learning through hospital-based schooling or tutoring, and encourage the child's sense of accomplishment.
Q10: A nurse is assessing a 14-year-old adolescent. Which statement by the adolescent best demonstrates progression into
Piaget's formal operational stage?
A. I can only think about things I can actually see and touch
B. I understand that my actions have consequences for my future [CORRECT]
C. I believe that my thoughts can make it rain
D. I can only focus on one aspect of a situation at a time
Correct Answer: B
Rationale: The formal operational stage (approximately 11 years and older) is characterized by the ability to think abstractly, reason logically about
hypothetical situations, and understand cause-and-effect relationships beyond the immediate present. Understanding that current actions have future
consequences demonstrates abstract and forward-thinking, which is a hallmark of formal operational thought. Believing thoughts can cause events
(magical thinking) is characteristic of the preoperational stage. Centration (focusing on one aspect) is also preoperational. Concrete operational
thinking involves tangible, observable events.
Q11: A nurse is conducting a health assessment on a 12-month-old infant. Which gross motor milestone should the nurse
expect the infant to have achieved?
A. Sitting alone without support
B. Walking independently [CORRECT]
C. Running and climbing stairs
D. Riding a tricycle
Correct Answer: B
Rationale: Walking independently is a gross motor milestone expected at approximately 12-15 months of age. Sitting alone is achieved at
approximately 8 months. Running and climbing stairs are expected at approximately 2 years (toddler period). Riding a tricycle is a preschool
milestone, typically achieved at approximately 3 years. The nurse should assess gross motor milestones at each well-child visit and refer for
developmental evaluation if significant delays are identified.
Q12: A nurse is providing anticipatory guidance to the parents of an adolescent. Which topic is the highest priority to
address based on the leading cause of death in this age group?
A. Nutrition and obesity prevention
B. Immunization catch-up schedules
C. Injury prevention including seat belt use, helmet use, and substance abuse prevention [CORRECT]
D. Dental hygiene and oral health
Correct Answer: C
Rationale: Injury is the leading cause of death in adolescents, and the nurse should prioritize injury prevention during anticipatory guidance. Key
topics include motor vehicle safety (seat belt use, no texting while driving), helmet use for biking and sports, substance abuse prevention, suicide
prevention, and safe dating practices. While nutrition, immunizations, and dental health are important, they do not address the leading cause of
mortality. Adolescents engage in high-risk behaviors, making injury prevention a critical nursing priority.
Section 2: Pediatric Health Promotion, Prevention, and Anticipatory Guidance
Q13: A nurse is reviewing the immunization schedule with the parents of a 2-month-old infant. Which immunizations
should the nurse anticipate administering at this visit?
WITH 70 NGN Q&A | 2026 UPDATED
Nursing Care of Children | Next Generation NCLEX Standards | Verified Answers | Grade A
Section 1: Growth and Development Across Pediatric Age Groups
Q1: A nurse is assessing a 4-month-old infant during a well-child visit. The infant can hold their head steady without
support, bears some weight on their legs when held in a standing position, and coos and babbles. Which developmental
stage according to Piaget is this infant in, and what gross motor milestone should the nurse expect next?
A. Formal operational stage; sitting alone without support
B. Sensorimotor stage; rolling from back to front [CORRECT]
C. Preoperational stage; walking independently
D. Concrete operational stage; standing without support
Correct Answer: B
Rationale: The infant is in the sensorimotor stage of Piaget's cognitive development, which spans from birth to approximately 2 years of age. Infants
learn through sensory experiences and motor activities during this period. At 4 months, head control is established and the next expected gross motor
milestone is rolling over (front to back first, then back to front at approximately 4-6 months). Sitting alone without support is expected at
approximately 8 months. Walking independently occurs at 12-15 months. The preoperational and concrete operational stages occur much later in
childhood.
Q2: A nurse is providing anticipatory guidance to the parents of a 2-year-old toddler. According to Erikson's
psychosocial development theory, which developmental task is the toddler currently working through?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt [CORRECT]
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B
Rationale: According to Erikson's theory, toddlers (ages 1-3 years) are in the autonomy vs. shame and doubt stage. During this period, toddlers
develop a sense of independence and autonomy as they gain control over their bodies through activities such as walking, toileting, and feeding
themselves. Trust vs. mistrust is the infant stage (birth to 1 year). Initiative vs. guilt is the preschool stage (3-5 years). Industry vs. inferiority is the
school-age stage (6-12 years). Promoting autonomy while providing appropriate limits is essential nursing care for toddlers.
Q3: A nurse is assessing a 10-month-old infant. Which fine motor milestone should the nurse expect the infant to have
achieved?
A. Pincer grasp [CORRECT]
B. Builds a tower of 6-7 cubes
C. Ties shoelaces
D. Uses a spoon effectively
Correct Answer: A
Rationale: The pincer grasp typically develops between 9 and 12 months of age and involves using the thumb and index finger to pick up small
objects. This is a critical fine motor milestone for infants. Building a tower of 6-7 cubes is expected at approximately 2-3 years (toddler/preschool).
Tying shoelaces is a school-age milestone (around 5-6 years). Using a spoon effectively develops around 12-15 months. The nurse should assess for
the pincer grasp during well-child visits in late infancy.
Q4: A nurse is educating parents about their newborn's fontanels. Which statement by a parent indicates a need for
further teaching?
A. The larger soft spot on the top of the head should close by 12-18 months of age
B. The smaller soft spot at the back of the head should close by 2-3 months of age
C. A sunken fontanel may indicate dehydration and I should report this immediately
D. A bulging fontanel is normal when the baby is crying and is never a concern [CORRECT]
Correct Answer: D
,Rationale: A bulging fontanel is never considered normal, even when crying. While transient increases in intracranial pressure from crying can cause
slight fontanel tension, a persistently bulging fontanel is a sign of increased intracranial pressure and requires immediate evaluation for conditions
such as meningitis, hydrocephalus, or intracranial hemorrhage. The anterior fontanel closes at 12-18 months and the posterior fontanel closes at 2-3
months. A sunken fontanel is a sign of dehydration. This parent requires immediate correction and further teaching.
Q5: A 4-year-old child is admitted to the pediatric unit for surgery. The nurse observes the child engaging in parallel play
in the playroom. Which developmental characteristic is the nurse observing?
A. The child plays cooperatively with other children toward a common goal
B. The child plays alongside but not directly with other children [CORRECT]
C. The child prefers solitary play and avoids all peer interaction
D. The child engages in competitive games with complex rules
Correct Answer: B
Rationale: Parallel play is characteristic of toddlers and young preschoolers (approximately 2-3 years), in which children play near each other but
not directly with each other. Each child engages in their own activity independently but in the presence of peers. Cooperative play, in which children
play together toward a common goal, develops later in the preschool period. Solitary play is seen in infants. Competitive games with rules are
characteristic of school-age children. Understanding play development is essential for planning age-appropriate activities.
Q6: A nurse is assessing the physical growth of a 9-month-old infant. The birth weight was 7 pounds. What is the
expected weight for this infant?
A. 14 pounds (doubled birth weight) [CORRECT]
B. 21 pounds (tripled birth weight)
C. 10.5 pounds (1.5 times birth weight)
D. 28 pounds (quadrupled birth weight)
Correct Answer: A
Rationale: An infant's weight typically doubles by 4-6 months and triples by 12 months. At 9 months, the infant's weight should be approximately
between 2 and 3 times the birth weight, approaching the 12-month expectation of tripling. At birth weight of 7 pounds, the infant should weigh
approximately 14 pounds by 6 months (doubled) and approximately 21 pounds by 12 months (tripled). At 9 months, the weight would be
approximately 17-19 pounds, making doubled birth weight (14 pounds) the most appropriate choice for the closest milestone already achieved. This is
important for nutritional assessment.
Q7: A nurse is caring for an adolescent patient. According to Erikson's theory, which psychosocial task is the adolescent
working to resolve?
A. Industry vs. Inferiority
B. Identity vs. Role Confusion [CORRECT]
C. Intimacy vs. Isolation
D. Autonomy vs. Shame and Doubt
Correct Answer: B
Rationale: According to Erikson's psychosocial development theory, adolescents (12-18 years) are in the identity vs. role confusion stage. The primary
developmental task is to develop a coherent sense of self and personal identity, including exploring values, beliefs, career goals, and sexual identity.
Industry vs. inferiority is the school-age stage (6-12 years). Intimacy vs. isolation is the young adult stage (18-40 years). Autonomy vs. shame and
doubt is the toddler stage (1-3 years). Nurses should support adolescents' identity exploration while providing a safe, nonjudgmental environment.
Q8: A nurse is providing anticipatory guidance to the parents of a 3-year-old child. The parents ask what play activities
are appropriate for their child's developmental level. Which response by the nurse is most appropriate?
A. Complex board games with rules and turn-taking
B. Drawing with crayons, building block towers, and pretend play [CORRECT]
C. Team sports and competitive activities
D. Abstract puzzle-solving and strategy games
Correct Answer: B
Rationale: Preschool children (3-5 years) benefit from activities that foster creativity, imagination, and developing fine motor skills. Drawing with
crayons, building block towers (4-6 blocks at age 3), and engaging in pretend/imaginative play are developmentally appropriate. Complex board
games with rules are more appropriate for school-age children. Team sports are for school-age and adolescent children. Abstract puzzle-solving
requires concrete or formal operational thinking, which develops later. Play is the work of childhood and should be developmentally appropriate.
, Q9: A school-age child (8 years old) is hospitalized. The nurse notes the child is concerned about falling behind
academically and wants to know when they can return to school. Which Erikson stage is most relevant to this child's
concern?
A. Trust vs. Mistrust
B. Initiative vs. Guilt
C. Industry vs. Inferiority [CORRECT]
D. Identity vs. Role Confusion
Correct Answer: C
Rationale: The school-age child (6-12 years) is in Erikson's industry vs. inferiority stage, in which children develop a sense of competence and
achievement through academic, social, and athletic activities. Concerns about falling behind academically reflect the child's need to feel productive
and competent. Feelings of inferiority can develop if the child perceives they are not keeping up with peers. The nurse should support continued
learning through hospital-based schooling or tutoring, and encourage the child's sense of accomplishment.
Q10: A nurse is assessing a 14-year-old adolescent. Which statement by the adolescent best demonstrates progression into
Piaget's formal operational stage?
A. I can only think about things I can actually see and touch
B. I understand that my actions have consequences for my future [CORRECT]
C. I believe that my thoughts can make it rain
D. I can only focus on one aspect of a situation at a time
Correct Answer: B
Rationale: The formal operational stage (approximately 11 years and older) is characterized by the ability to think abstractly, reason logically about
hypothetical situations, and understand cause-and-effect relationships beyond the immediate present. Understanding that current actions have future
consequences demonstrates abstract and forward-thinking, which is a hallmark of formal operational thought. Believing thoughts can cause events
(magical thinking) is characteristic of the preoperational stage. Centration (focusing on one aspect) is also preoperational. Concrete operational
thinking involves tangible, observable events.
Q11: A nurse is conducting a health assessment on a 12-month-old infant. Which gross motor milestone should the nurse
expect the infant to have achieved?
A. Sitting alone without support
B. Walking independently [CORRECT]
C. Running and climbing stairs
D. Riding a tricycle
Correct Answer: B
Rationale: Walking independently is a gross motor milestone expected at approximately 12-15 months of age. Sitting alone is achieved at
approximately 8 months. Running and climbing stairs are expected at approximately 2 years (toddler period). Riding a tricycle is a preschool
milestone, typically achieved at approximately 3 years. The nurse should assess gross motor milestones at each well-child visit and refer for
developmental evaluation if significant delays are identified.
Q12: A nurse is providing anticipatory guidance to the parents of an adolescent. Which topic is the highest priority to
address based on the leading cause of death in this age group?
A. Nutrition and obesity prevention
B. Immunization catch-up schedules
C. Injury prevention including seat belt use, helmet use, and substance abuse prevention [CORRECT]
D. Dental hygiene and oral health
Correct Answer: C
Rationale: Injury is the leading cause of death in adolescents, and the nurse should prioritize injury prevention during anticipatory guidance. Key
topics include motor vehicle safety (seat belt use, no texting while driving), helmet use for biking and sports, substance abuse prevention, suicide
prevention, and safe dating practices. While nutrition, immunizations, and dental health are important, they do not address the leading cause of
mortality. Adolescents engage in high-risk behaviors, making injury prevention a critical nursing priority.
Section 2: Pediatric Health Promotion, Prevention, and Anticipatory Guidance
Q13: A nurse is reviewing the immunization schedule with the parents of a 2-month-old infant. Which immunizations
should the nurse anticipate administering at this visit?
