2026/2027 ATI PN Nursing Care of Children Proctored Exam
Comprehensive Study Guide | 150 Verified Questions with Answer Breakdowns | NGN Test Plan Standards
Aligned with NCLEX-PN Pediatric Nursing Competencies
Section 1: Growth and Development Across Pediatric Age Groups
Q1: A nurse is assessing a 4-month-old infant at a well-child visit. The infant can hold their head steady when sitting with
support, rolls from front to back, and coos and laughs. Which developmental milestone should the nurse anticipate the
infant will achieve next?
A. Sitting alone without support
B. Walking with assistance
C. Transferring objects from hand to hand [CORRECT]
D. Using a pincer grasp to pick up small objects
Correct Answer: C
Rationale: By 4 to 5 months, infants begin to transfer objects from one hand to the other, representing advancing fine motor
development within the sensorimotor stage. Sitting alone typically develops around 6 to 8 months, walking with assistance occurs closer
to 9 to 12 months, and the pincer grasp emerges at approximately 9 months of age according to established developmental milestone
guidelines.
Q2: A nurse is providing anticipatory guidance to the parents of a 12-month-old infant. The infant can pull to a stand,
crawl, and say 'mama' and 'dada' nonspecifically. Which statement by the parents indicates an understanding of the
expected developmental milestones for this age?
A. "We expect our child to walk independently within the next few months." [CORRECT]
B. "Our child should be able to use a spoon to feed themselves independently."
C. "We should expect our child to speak in two-word sentences by now."
D. "Our child should be able to ride a tricycle by the next visit."
Correct Answer: A
Rationale: Walking independently is expected between 12 and 15 months, so this parent statement reflects accurate understanding of
gross motor milestones. Using a spoon independently is a fine motor skill expected closer to 15 to 18 months, two-word sentences
typically emerge around 18 to 24 months, and tricycle riding is a skill expected around age 3 years.
Q3: A nurse is conducting a developmental assessment on a 6-month-old infant. Which finding indicates the infant is
meeting expected gross motor milestones?
A. The infant sits alone without support for brief periods
B. The infant can bear weight on their legs when supported in a standing position [CORRECT]
C. The infant walks while holding onto furniture
D. The infant can stand alone without support
Correct Answer: B
Rationale: Bearing weight on the legs when supported in a standing position is an expected gross motor milestone at 6 months. Sitting
alone without support typically develops at 8 months, cruising occurs around 9 to 12 months, and standing alone is expected closer to 12
months according to the CDC developmental milestones.
Q4: According to Erikson's psychosocial development theory, which stage describes the developmental task of a toddler
aged 1 to 3 years?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt [CORRECT]
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B
,2026/2027 ATI PN Nursing Care of Children Proctored Exam 150 Questions
Rationale: Erikson identifies the psychosocial stage for toddlers (1 to 3 years) as Autonomy vs. Shame and Doubt, during which children
develop a sense of independence and self-control through activities such as feeding, dressing, and toileting. Trust vs. Mistrust applies to
infancy, Initiative vs. Guilt to preschoolers (3 to 5 years), and Industry vs. Inferiority to school-age children (6 to 12 years).
Q5: A nurse is assessing the anterior fontanel of a 9-month-old infant during a well-child visit. Which finding should the
nurse recognize as expected?
A. The anterior fontanel is closed
B. The anterior fontanel is open and slightly bulging when the infant is crying [CORRECT]
C. The anterior fontanel is sunken and depressed at rest
D. The anterior fontanel is significantly larger than 5 cm
Correct Answer: B
Rationale: The anterior fontanel typically closes between 12 and 18 months of age, so it should remain open at 9 months. A slight bulge
when crying is a normal finding due to increased intracranial pressure from Valsalva-like effort. A sunken fontanel at rest suggests
dehydration, and a fontanel larger than 5 cm may indicate increased intracranial pressure, hypothyroidism, or rickets.
Q6: A nurse is teaching a parenting class about developmental milestones for preschoolers (3 to 5 years). Which statement
by a parent indicates the need for additional teaching?
A. "My child should be able to balance on one foot for a few seconds."
B. "My child can hop on one foot and skip." [CORRECT]
C. "My child should be drawing circles and crosses."
D. "My child is learning to share and take turns with other children."
Correct Answer: B
Rationale: Hopping on one foot and skipping are gross motor skills that typically develop during the later preschool to early school-age
period (4 to 6 years), and are not yet fully achieved by all 3 to 5 year olds. Balancing on one foot, drawing shapes, and learning to share
and take turns are all appropriate expected milestones for the preschool age group according to Piaget and Erikson developmental
frameworks.
Q7: A nurse is caring for an adolescent patient. According to Piaget's theory of cognitive development, which stage is the
adolescent expected to be functioning within?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational [CORRECT]
Correct Answer: D
Rationale: Piaget identifies the formal operational stage as beginning around age 11 to 12 years and extending through adolescence
and into adulthood. This stage is characterized by the ability to think abstractly, reason hypothetically, and engage in systematic
problem-solving. The sensorimotor stage applies to birth to 2 years, preoperational to 2 to 7 years, and concrete operational to 7 to 11
years.
Q8: A nurse is assessing a 2-year-old toddler in the clinic. Which behavior is most consistent with the toddler's expected
developmental level according to Erikson's theory?
A. Engaging in cooperative board games with peers
B. Insisting on dressing independently and saying no frequently [CORRECT]
C. Demonstrating concern about peer acceptance and social status
D. Showing capacity for abstract reasoning and hypothetical thinking
Correct Answer: B
Rationale: The toddler's insistence on self-care activities like dressing independently and frequent use of the word no are classic
manifestations of the Autonomy vs. Shame and Doubt stage. These behaviors reflect the toddler's developing sense of independence and
desire for self-control. Cooperative games, peer acceptance concerns, and abstract reasoning are characteristic of later developmental
stages.
Q9: A nurse is providing education to the parents of a newborn regarding growth expectations. Which statement by the
nurse is accurate regarding infant weight gain?
Page 2
,2026/2027 ATI PN Nursing Care of Children Proctored Exam 150 Questions
A. Birth weight typically doubles by 3 months and triples by 6 months
B. Birth weight typically doubles by 5 months and triples by 12 months [CORRECT]
C. Birth weight typically triples by 6 months and quadruples by 12 months
D. Birth weight typically doubles by 12 months and triples by 18 months
Correct Answer: B
Rationale: Infant birth weight typically doubles by approximately 5 months of age and triples by 12 months of age. These are
well-established pediatric growth parameters used to assess nutritional adequacy and overall health. The other options present
incorrect timelines for expected weight gain patterns during the first year of life.
Q10: A school-age child is having difficulty completing homework assignments and frequently compares their academic
performance to classmates. According to Erikson's developmental theory, which psychosocial crisis is this child
experiencing?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority [CORRECT]
Correct Answer: D
Rationale: Industry vs. Inferiority is the psychosocial crisis for school-age children (6 to 12 years). During this stage, children develop
competence through academic and social activities, and comparison with peers is common. Success in this stage leads to a sense of
industry, while repeated failure or negative feedback can result in feelings of inferiority that may persist into adolescence and
adulthood.
Q11: A nurse observes a 3-year-old child in the playroom stacking blocks to build a tower and pretending to cook in the
play kitchen. According to Piaget's theory, which cognitive stage is this child demonstrating?
A. Sensorimotor stage
B. Preoperational stage [CORRECT]
C. Concrete operational stage
D. Formal operational stage
Correct Answer: B
Rationale: The preoperational stage (ages 2 to 7 years) is characterized by symbolic play, egocentrism, and magical thinking. A
3-year-old engaging in pretend play such as building with blocks and pretending to cook is demonstrating symbolic function, a hallmark
of this cognitive stage. The sensorimotor stage applies to birth to 2 years, while the concrete and formal operational stages apply to
older children and adolescents respectively.
Q12: A nurse is assessing a 15-month-old toddler. Which fine motor skill should the nurse expect to find?
A. Scribbling with a crayon [CORRECT]
B. Tying shoelaces independently
C. Writing their first name
D. Using scissors to cut along a line
Correct Answer: A
Rationale: Scribbling with a crayon is an expected fine motor milestone for a 15-month-old toddler. Tying shoelaces typically develops
around age 5 to 6 years, writing their first name is expected around age 4 to 5 years, and using scissors to cut along a line emerges
around age 4 years. These later skills require the finer coordination that develops throughout the preschool and early school-age
periods.
Q13: A nurse is providing anticipatory guidance to the parents of an 18-month-old toddler. The parents express concern
that their child does not play with other children at daycare but plays next to them. Which response by the nurse is most
appropriate?
A. "This is concerning and may indicate a social development delay."
B. "Your child should be actively playing cooperatively with other children by now."
C. "This is called parallel play and is an expected behavior for toddlers at this age." [CORRECT]
D. "Your child needs to be evaluated for autism spectrum disorder immediately."
Page 3
, 2026/2027 ATI PN Nursing Care of Children Proctored Exam 150 Questions
Correct Answer: C
Rationale: Parallel play, in which a child plays alongside but not directly with other children, is a hallmark behavioral characteristic of
toddlers (1 to 3 years). This is entirely normal and expected developmental behavior that precedes the cooperative play that emerges
during the preschool years. Suggesting developmental delay, autism evaluation, or expecting cooperative play at this age reflects
misunderstanding of normal toddler social development.
Q14: A nurse is caring for a 14-year-old adolescent who recently started high school. The adolescent has been
experimenting with different hairstyles and clothing styles and has changed friend groups several times this year.
According to Erikson's theory, which psychosocial crisis is this adolescent navigating?
A. Industry vs. Inferiority
B. Identity vs. Role Confusion [CORRECT]
C. Intimacy vs. Isolation
D. Autonomy vs. Shame and Doubt
Correct Answer: B
Rationale: Identity vs. Role Confusion is the psychosocial crisis of adolescence (12 to 18 years). During this stage, adolescents explore
different roles, values, beliefs, and identities to form a coherent sense of self. Experimenting with appearance and social groups is a
classic manifestation of this developmental task. Successful resolution leads to a strong identity, while failure may result in role
confusion.
Q15: A nurse is assessing a 2-week-old newborn. The posterior fontanel should be in which state at this age?
A. Wide open and palpable
B. Closed [CORRECT]
C. Bulging
D. Sunken
Correct Answer: B
Rationale: The posterior fontanel typically closes by 2 to 3 months of age, but it is often small and difficult to palpate by 2 weeks and
may be nearly closed. In many newborns, the posterior fontanel is already closed or very small at birth. A wide open posterior fontanel,
bulging fontanel, or sunken fontanel would warrant further assessment for possible underlying conditions.
Q16: Which type of play is most characteristic of the preschool-age child (3 to 5 years)?
A. Parallel play
B. Associative and cooperative play [CORRECT]
C. Solitary play
D. Competitive play
Correct Answer: B
Rationale: Preschool children (3 to 5 years) engage primarily in associative and cooperative play, where they begin to interact with
peers, share toys, and participate in group activities with common goals. Parallel play is characteristic of toddlers (1 to 3 years),
solitary play is seen in infants, and competitive play with formal rules emerges during the school-age period (6 to 12 years).
Q17: A nurse is assessing a 10-month-old infant. Which developmental finding would be considered a red flag requiring
further evaluation?
A. The infant can pull to a stand holding onto furniture
B. The infant does not respond to their name when called [CORRECT]
C. The infant babbles using consonant-vowel combinations
D. The infant can sit unsupported and reach for toys
Correct Answer: B
Rationale: Not responding to their name by 10 months is a potential red flag for developmental delay, particularly in social
communication and hearing. By this age, infants should consistently respond to their name. Pulling to a stand, babbling, and sitting
unsupported with reaching are all expected developmental milestones for a 10-month-old and do not indicate any concern.
Q18: A nurse is counseling the parents of a 5-year-old child who is beginning kindergarten. Which statement by the nurse
best describes the cognitive abilities of a child in the concrete operational stage?
A. "Your child can now think abstractly about hypothetical situations."
Page 4
Comprehensive Study Guide | 150 Verified Questions with Answer Breakdowns | NGN Test Plan Standards
Aligned with NCLEX-PN Pediatric Nursing Competencies
Section 1: Growth and Development Across Pediatric Age Groups
Q1: A nurse is assessing a 4-month-old infant at a well-child visit. The infant can hold their head steady when sitting with
support, rolls from front to back, and coos and laughs. Which developmental milestone should the nurse anticipate the
infant will achieve next?
A. Sitting alone without support
B. Walking with assistance
C. Transferring objects from hand to hand [CORRECT]
D. Using a pincer grasp to pick up small objects
Correct Answer: C
Rationale: By 4 to 5 months, infants begin to transfer objects from one hand to the other, representing advancing fine motor
development within the sensorimotor stage. Sitting alone typically develops around 6 to 8 months, walking with assistance occurs closer
to 9 to 12 months, and the pincer grasp emerges at approximately 9 months of age according to established developmental milestone
guidelines.
Q2: A nurse is providing anticipatory guidance to the parents of a 12-month-old infant. The infant can pull to a stand,
crawl, and say 'mama' and 'dada' nonspecifically. Which statement by the parents indicates an understanding of the
expected developmental milestones for this age?
A. "We expect our child to walk independently within the next few months." [CORRECT]
B. "Our child should be able to use a spoon to feed themselves independently."
C. "We should expect our child to speak in two-word sentences by now."
D. "Our child should be able to ride a tricycle by the next visit."
Correct Answer: A
Rationale: Walking independently is expected between 12 and 15 months, so this parent statement reflects accurate understanding of
gross motor milestones. Using a spoon independently is a fine motor skill expected closer to 15 to 18 months, two-word sentences
typically emerge around 18 to 24 months, and tricycle riding is a skill expected around age 3 years.
Q3: A nurse is conducting a developmental assessment on a 6-month-old infant. Which finding indicates the infant is
meeting expected gross motor milestones?
A. The infant sits alone without support for brief periods
B. The infant can bear weight on their legs when supported in a standing position [CORRECT]
C. The infant walks while holding onto furniture
D. The infant can stand alone without support
Correct Answer: B
Rationale: Bearing weight on the legs when supported in a standing position is an expected gross motor milestone at 6 months. Sitting
alone without support typically develops at 8 months, cruising occurs around 9 to 12 months, and standing alone is expected closer to 12
months according to the CDC developmental milestones.
Q4: According to Erikson's psychosocial development theory, which stage describes the developmental task of a toddler
aged 1 to 3 years?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt [CORRECT]
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B
,2026/2027 ATI PN Nursing Care of Children Proctored Exam 150 Questions
Rationale: Erikson identifies the psychosocial stage for toddlers (1 to 3 years) as Autonomy vs. Shame and Doubt, during which children
develop a sense of independence and self-control through activities such as feeding, dressing, and toileting. Trust vs. Mistrust applies to
infancy, Initiative vs. Guilt to preschoolers (3 to 5 years), and Industry vs. Inferiority to school-age children (6 to 12 years).
Q5: A nurse is assessing the anterior fontanel of a 9-month-old infant during a well-child visit. Which finding should the
nurse recognize as expected?
A. The anterior fontanel is closed
B. The anterior fontanel is open and slightly bulging when the infant is crying [CORRECT]
C. The anterior fontanel is sunken and depressed at rest
D. The anterior fontanel is significantly larger than 5 cm
Correct Answer: B
Rationale: The anterior fontanel typically closes between 12 and 18 months of age, so it should remain open at 9 months. A slight bulge
when crying is a normal finding due to increased intracranial pressure from Valsalva-like effort. A sunken fontanel at rest suggests
dehydration, and a fontanel larger than 5 cm may indicate increased intracranial pressure, hypothyroidism, or rickets.
Q6: A nurse is teaching a parenting class about developmental milestones for preschoolers (3 to 5 years). Which statement
by a parent indicates the need for additional teaching?
A. "My child should be able to balance on one foot for a few seconds."
B. "My child can hop on one foot and skip." [CORRECT]
C. "My child should be drawing circles and crosses."
D. "My child is learning to share and take turns with other children."
Correct Answer: B
Rationale: Hopping on one foot and skipping are gross motor skills that typically develop during the later preschool to early school-age
period (4 to 6 years), and are not yet fully achieved by all 3 to 5 year olds. Balancing on one foot, drawing shapes, and learning to share
and take turns are all appropriate expected milestones for the preschool age group according to Piaget and Erikson developmental
frameworks.
Q7: A nurse is caring for an adolescent patient. According to Piaget's theory of cognitive development, which stage is the
adolescent expected to be functioning within?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational [CORRECT]
Correct Answer: D
Rationale: Piaget identifies the formal operational stage as beginning around age 11 to 12 years and extending through adolescence
and into adulthood. This stage is characterized by the ability to think abstractly, reason hypothetically, and engage in systematic
problem-solving. The sensorimotor stage applies to birth to 2 years, preoperational to 2 to 7 years, and concrete operational to 7 to 11
years.
Q8: A nurse is assessing a 2-year-old toddler in the clinic. Which behavior is most consistent with the toddler's expected
developmental level according to Erikson's theory?
A. Engaging in cooperative board games with peers
B. Insisting on dressing independently and saying no frequently [CORRECT]
C. Demonstrating concern about peer acceptance and social status
D. Showing capacity for abstract reasoning and hypothetical thinking
Correct Answer: B
Rationale: The toddler's insistence on self-care activities like dressing independently and frequent use of the word no are classic
manifestations of the Autonomy vs. Shame and Doubt stage. These behaviors reflect the toddler's developing sense of independence and
desire for self-control. Cooperative games, peer acceptance concerns, and abstract reasoning are characteristic of later developmental
stages.
Q9: A nurse is providing education to the parents of a newborn regarding growth expectations. Which statement by the
nurse is accurate regarding infant weight gain?
Page 2
,2026/2027 ATI PN Nursing Care of Children Proctored Exam 150 Questions
A. Birth weight typically doubles by 3 months and triples by 6 months
B. Birth weight typically doubles by 5 months and triples by 12 months [CORRECT]
C. Birth weight typically triples by 6 months and quadruples by 12 months
D. Birth weight typically doubles by 12 months and triples by 18 months
Correct Answer: B
Rationale: Infant birth weight typically doubles by approximately 5 months of age and triples by 12 months of age. These are
well-established pediatric growth parameters used to assess nutritional adequacy and overall health. The other options present
incorrect timelines for expected weight gain patterns during the first year of life.
Q10: A school-age child is having difficulty completing homework assignments and frequently compares their academic
performance to classmates. According to Erikson's developmental theory, which psychosocial crisis is this child
experiencing?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority [CORRECT]
Correct Answer: D
Rationale: Industry vs. Inferiority is the psychosocial crisis for school-age children (6 to 12 years). During this stage, children develop
competence through academic and social activities, and comparison with peers is common. Success in this stage leads to a sense of
industry, while repeated failure or negative feedback can result in feelings of inferiority that may persist into adolescence and
adulthood.
Q11: A nurse observes a 3-year-old child in the playroom stacking blocks to build a tower and pretending to cook in the
play kitchen. According to Piaget's theory, which cognitive stage is this child demonstrating?
A. Sensorimotor stage
B. Preoperational stage [CORRECT]
C. Concrete operational stage
D. Formal operational stage
Correct Answer: B
Rationale: The preoperational stage (ages 2 to 7 years) is characterized by symbolic play, egocentrism, and magical thinking. A
3-year-old engaging in pretend play such as building with blocks and pretending to cook is demonstrating symbolic function, a hallmark
of this cognitive stage. The sensorimotor stage applies to birth to 2 years, while the concrete and formal operational stages apply to
older children and adolescents respectively.
Q12: A nurse is assessing a 15-month-old toddler. Which fine motor skill should the nurse expect to find?
A. Scribbling with a crayon [CORRECT]
B. Tying shoelaces independently
C. Writing their first name
D. Using scissors to cut along a line
Correct Answer: A
Rationale: Scribbling with a crayon is an expected fine motor milestone for a 15-month-old toddler. Tying shoelaces typically develops
around age 5 to 6 years, writing their first name is expected around age 4 to 5 years, and using scissors to cut along a line emerges
around age 4 years. These later skills require the finer coordination that develops throughout the preschool and early school-age
periods.
Q13: A nurse is providing anticipatory guidance to the parents of an 18-month-old toddler. The parents express concern
that their child does not play with other children at daycare but plays next to them. Which response by the nurse is most
appropriate?
A. "This is concerning and may indicate a social development delay."
B. "Your child should be actively playing cooperatively with other children by now."
C. "This is called parallel play and is an expected behavior for toddlers at this age." [CORRECT]
D. "Your child needs to be evaluated for autism spectrum disorder immediately."
Page 3
, 2026/2027 ATI PN Nursing Care of Children Proctored Exam 150 Questions
Correct Answer: C
Rationale: Parallel play, in which a child plays alongside but not directly with other children, is a hallmark behavioral characteristic of
toddlers (1 to 3 years). This is entirely normal and expected developmental behavior that precedes the cooperative play that emerges
during the preschool years. Suggesting developmental delay, autism evaluation, or expecting cooperative play at this age reflects
misunderstanding of normal toddler social development.
Q14: A nurse is caring for a 14-year-old adolescent who recently started high school. The adolescent has been
experimenting with different hairstyles and clothing styles and has changed friend groups several times this year.
According to Erikson's theory, which psychosocial crisis is this adolescent navigating?
A. Industry vs. Inferiority
B. Identity vs. Role Confusion [CORRECT]
C. Intimacy vs. Isolation
D. Autonomy vs. Shame and Doubt
Correct Answer: B
Rationale: Identity vs. Role Confusion is the psychosocial crisis of adolescence (12 to 18 years). During this stage, adolescents explore
different roles, values, beliefs, and identities to form a coherent sense of self. Experimenting with appearance and social groups is a
classic manifestation of this developmental task. Successful resolution leads to a strong identity, while failure may result in role
confusion.
Q15: A nurse is assessing a 2-week-old newborn. The posterior fontanel should be in which state at this age?
A. Wide open and palpable
B. Closed [CORRECT]
C. Bulging
D. Sunken
Correct Answer: B
Rationale: The posterior fontanel typically closes by 2 to 3 months of age, but it is often small and difficult to palpate by 2 weeks and
may be nearly closed. In many newborns, the posterior fontanel is already closed or very small at birth. A wide open posterior fontanel,
bulging fontanel, or sunken fontanel would warrant further assessment for possible underlying conditions.
Q16: Which type of play is most characteristic of the preschool-age child (3 to 5 years)?
A. Parallel play
B. Associative and cooperative play [CORRECT]
C. Solitary play
D. Competitive play
Correct Answer: B
Rationale: Preschool children (3 to 5 years) engage primarily in associative and cooperative play, where they begin to interact with
peers, share toys, and participate in group activities with common goals. Parallel play is characteristic of toddlers (1 to 3 years),
solitary play is seen in infants, and competitive play with formal rules emerges during the school-age period (6 to 12 years).
Q17: A nurse is assessing a 10-month-old infant. Which developmental finding would be considered a red flag requiring
further evaluation?
A. The infant can pull to a stand holding onto furniture
B. The infant does not respond to their name when called [CORRECT]
C. The infant babbles using consonant-vowel combinations
D. The infant can sit unsupported and reach for toys
Correct Answer: B
Rationale: Not responding to their name by 10 months is a potential red flag for developmental delay, particularly in social
communication and hearing. By this age, infants should consistently respond to their name. Pulling to a stand, babbling, and sitting
unsupported with reaching are all expected developmental milestones for a 10-month-old and do not indicate any concern.
Q18: A nurse is counseling the parents of a 5-year-old child who is beginning kindergarten. Which statement by the nurse
best describes the cognitive abilities of a child in the concrete operational stage?
A. "Your child can now think abstractly about hypothetical situations."
Page 4
