ATI Pediatrics Proctored Assessment – Original
Practice Questions & Answers | Comprehensive
Pediatric Nursing Study Guide & Assessment
Preparation | Pediatric Growth & Development,
Newborn & Infant Care, Pediatric Assessment,
Health Promotion, Immunizations, Communicable
Diseases, Respiratory & Cardiovascular Disorders,
Gastrointestinal & Endocrine Conditions,
Neurological & Hematological Disorders, Pediatric
Emergencies, Medication Safety, Psychosocial Care
& Family-Centered Nursing
Question 1: A 2-day-old newborn is being evaluated for jaundice. The total
serum bilirubin level is 18 mg/dL, and the direct (conjugated) fraction is 1.5
mg/dL. Which of the following is the most likely underlying etiology for this
presentation?
A. Physiologic jaundice of the newborn
B. Breastfeeding-associated jaundice
C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
D. Biliary atresia
CORRECT ANSWER: C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Rationale: An elevated total bilirubin with a direct fraction of less than 20% (1.5/18 =
8.3%) indicates an unconjugated hyperbilirubinemia. In a 2-day-old, a level of 18 mg/dL
is above the physiologic range and suggests a pathologic process. G6PD deficiency is a
common cause of hemolytic disease in the newborn, leading to an unconjugated
hyperbilirubinemia. Biliary atresia presents with a conjugated (direct)
hyperbilirubinemia.
Question 2: A 6-month-old infant presents with failure to thrive, recurrent
respiratory infections, and a chronic cough. A chest radiograph reveals
hyperinflation and peribronchial cuffing. Which of the following diagnostic
tests is most definitive for confirming the suspected diagnosis?
A. Sweat chloride test
B. Serum immunoglobulin levels
C. Pulmonary function tests
D. Genetic testing for CFTR mutations
CORRECT ANSWER: A. Sweat chloride test
Rationale: The clinical presentation is highly suggestive of cystic fibrosis (CF). While
genetic testing for CFTR mutations is important, the sweat chloride test remains the
gold standard for the diagnosis of CF, with a value greater than 60 mEq/L being
diagnostic in the appropriate clinical context.
,Question 3: An adolescent patient with type 1 diabetes mellitus presents to the
clinic with a blood glucose level of 320 mg/dL, nausea, vomiting, and
abdominal pain. His breath has a fruity odor. Which of the following acid-base
disturbances is most consistent with this presentation?
A. Metabolic acidosis with an elevated anion gap
B. Metabolic acidosis with a normal anion gap
C. Respiratory acidosis
D. Metabolic alkalosis
CORRECT ANSWER: A. Metabolic acidosis with an elevated anion gap
Rationale: The patient is presenting with diabetic ketoacidosis (DKA). The accumulation
of ketoacids leads to a high anion gap metabolic acidosis. A normal anion gap metabolic
acidosis is seen in conditions like diarrhea or renal tubular acidosis, which are not
consistent with this presentation.
Question 4: A 4-year-old child is brought to the emergency department with a
barking cough, hoarseness, and inspiratory stridor. Symptoms are worse at
night. Which of the following is the most likely diagnosis?
A. Bacterial tracheitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
CORRECT ANSWER: C. Croup (laryngotracheobronchitis)
Rationale: Croup is a viral infection characterized by the classic triad of a barking cough,
hoarseness, and inspiratory stridor, often worsening at night. Epiglottitis typically
presents with a sudden onset of high fever, drooling, and a tripod position, while
bacterial tracheitis presents with a more toxic appearance. Foreign body aspiration
usually has a sudden onset of choking.
Question 5: A 2-week-old neonate presents with projectile vomiting after
feeds. The vomitus is non-bilious. On physical examination, an olive-shaped
mass is palpable in the right upper quadrant. Which of the following is the
most appropriate initial management step?
A. Initiation of feeding with a hydrolyzed formula
B. Administration of intravenous fluids and electrolytes
C. Pyloromyotomy
D. Upper gastrointestinal (GI) series
CORRECT ANSWER: B. Administration of intravenous fluids and electrolytes
Rationale: The presentation is classic for pyloric stenosis. The infant is likely dehydrated
and has a hypochloremic metabolic alkalosis due to vomiting. The first step in
management is to correct the fluid and electrolyte imbalances with IV fluids before
proceeding to surgery (pyloromyotomy).
,Question 6: A 3-year-old child with sickle cell disease presents with a fever of
101.5°F and pallor. The mother reports the child has been lethargic for the past
day. Which of the following is the most immediate and critical concern?
A. Acute chest syndrome
B. Aplastic crisis due to Parvovirus B19
C. Splenic sequestration crisis
D. Vaso-occlusive pain crisis
CORRECT ANSWER: C. Splenic sequestration crisis
Rationale: In a young child with sickle cell disease, fever, pallor, and lethargy are
hallmark signs of an acute splenic sequestration crisis, where blood pools in the spleen
leading to a sudden drop in hemoglobin and hypovolemic shock. This is a life-
threatening emergency requiring immediate intervention, more so than a pain crisis or
aplastic crisis, though aplastic crisis also presents with pallor.
Question 7: An 8-year-old boy is brought in for a routine well-child visit. His
body mass index (BMI) is at the 97th percentile for age and sex. He has
acanthosis nigricans on his neck. Which of the following screening tests is
most appropriate to order at this visit?
A. Fasting lipid panel
B. Fasting plasma glucose
C. Oral glucose tolerance test (OGTT)
D. Glycated hemoglobin (HbA1c)
CORRECT ANSWER: D. Glycated hemoglobin (HbA1c)
Rationale: The presence of obesity (BMI >95th percentile) and acanthosis nigricans
places this child at high risk for type 2 diabetes mellitus. The American Diabetes
Association recommends screening high-risk children with either a fasting plasma
glucose, OGTT, or HbA1c. However, HbA1c is a convenient and reliable non-fasting test
that correlates with chronic hyperglycemia.
Question 8: A 15-year-old female presents with secondary amenorrhea for 6
months. She has a history of restrictive eating and excessive exercise. Her BMI
is 16.5. Which of the following is the most likely cause of her amenorrhea?
A. Polycystic ovarian syndrome (PCOS)
B. Pregnancy
C. Hypothalamic amenorrhea
D. Premature ovarian failure
CORRECT ANSWER: C. Hypothalamic amenorrhea
Rationale: The patient's history of restrictive eating, excessive exercise, and low BMI are
classic risk factors for functional hypothalamic amenorrhea. This condition results from
a suppression of the hypothalamic-pituitary-ovarian axis due to energy deficiency and
stress, leading to decreased gonadotropin-releasing hormone (GnRH) pulsatility.
, Question 9: A 5-day-old neonate has a positive newborn screen for congenital
hypothyroidism. Which of the following clinical findings is most consistent
with this diagnosis?
A. Hypertonia and jitteriness
B. Prolonged jaundice and macroglossia
C. Tachycardia and diaphoresis
D. Bulging fontanelle and vomiting
CORRECT ANSWER: B. Prolonged jaundice and macroglossia
Rationale: Congenital hypothyroidism presents with a variety of signs, including
prolonged jaundice, macroglossia, hypotonia, umbilical hernia, constipation, and a
hoarse cry. Hypertonia and jitteriness are more associated with neonatal abstinence
syndrome or hypoglycemia.
Question 10: A 16-year-old male presents with sudden-onset scrotal pain,
nausea, and vomiting. On examination, the testis is tender and swollen, and
the cremasteric reflex is absent. Which of the following is the most appropriate
initial action?
A. Administer antibiotics for epididymitis
B. Perform a urinalysis and culture
C. Schedule a scrotal ultrasound for the next day
D. Arrange for immediate surgical exploration
CORRECT ANSWER: D. Arrange for immediate surgical exploration
Rationale: The sudden onset of severe scrotal pain with nausea, vomiting, and an absent
cremasteric reflex is highly concerning for testicular torsion. This is a surgical
emergency requiring immediate urologic consultation and exploration to salvage the
testicle, with the "golden window" being within 4-6 hours of symptom onset.
Question 11: A 10-year-old child with a history of atopic dermatitis is brought
in for a skin infection. The lesions are honey-crusted, erythematous plaques
on the face and extremities. Which of the following is the most likely causative
organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Pseudomonas aeruginosa
D. Herpes simplex virus
CORRECT ANSWER: A. Staphylococcus aureus
Rationale: The appearance of honey-crusted lesions is classic for impetigo, which is
most commonly caused by Staphylococcus aureus. While Streptococcus pyogenes can
also cause impetigo, S. aureus is the predominant pathogen in the current era.
Practice Questions & Answers | Comprehensive
Pediatric Nursing Study Guide & Assessment
Preparation | Pediatric Growth & Development,
Newborn & Infant Care, Pediatric Assessment,
Health Promotion, Immunizations, Communicable
Diseases, Respiratory & Cardiovascular Disorders,
Gastrointestinal & Endocrine Conditions,
Neurological & Hematological Disorders, Pediatric
Emergencies, Medication Safety, Psychosocial Care
& Family-Centered Nursing
Question 1: A 2-day-old newborn is being evaluated for jaundice. The total
serum bilirubin level is 18 mg/dL, and the direct (conjugated) fraction is 1.5
mg/dL. Which of the following is the most likely underlying etiology for this
presentation?
A. Physiologic jaundice of the newborn
B. Breastfeeding-associated jaundice
C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
D. Biliary atresia
CORRECT ANSWER: C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Rationale: An elevated total bilirubin with a direct fraction of less than 20% (1.5/18 =
8.3%) indicates an unconjugated hyperbilirubinemia. In a 2-day-old, a level of 18 mg/dL
is above the physiologic range and suggests a pathologic process. G6PD deficiency is a
common cause of hemolytic disease in the newborn, leading to an unconjugated
hyperbilirubinemia. Biliary atresia presents with a conjugated (direct)
hyperbilirubinemia.
Question 2: A 6-month-old infant presents with failure to thrive, recurrent
respiratory infections, and a chronic cough. A chest radiograph reveals
hyperinflation and peribronchial cuffing. Which of the following diagnostic
tests is most definitive for confirming the suspected diagnosis?
A. Sweat chloride test
B. Serum immunoglobulin levels
C. Pulmonary function tests
D. Genetic testing for CFTR mutations
CORRECT ANSWER: A. Sweat chloride test
Rationale: The clinical presentation is highly suggestive of cystic fibrosis (CF). While
genetic testing for CFTR mutations is important, the sweat chloride test remains the
gold standard for the diagnosis of CF, with a value greater than 60 mEq/L being
diagnostic in the appropriate clinical context.
,Question 3: An adolescent patient with type 1 diabetes mellitus presents to the
clinic with a blood glucose level of 320 mg/dL, nausea, vomiting, and
abdominal pain. His breath has a fruity odor. Which of the following acid-base
disturbances is most consistent with this presentation?
A. Metabolic acidosis with an elevated anion gap
B. Metabolic acidosis with a normal anion gap
C. Respiratory acidosis
D. Metabolic alkalosis
CORRECT ANSWER: A. Metabolic acidosis with an elevated anion gap
Rationale: The patient is presenting with diabetic ketoacidosis (DKA). The accumulation
of ketoacids leads to a high anion gap metabolic acidosis. A normal anion gap metabolic
acidosis is seen in conditions like diarrhea or renal tubular acidosis, which are not
consistent with this presentation.
Question 4: A 4-year-old child is brought to the emergency department with a
barking cough, hoarseness, and inspiratory stridor. Symptoms are worse at
night. Which of the following is the most likely diagnosis?
A. Bacterial tracheitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
CORRECT ANSWER: C. Croup (laryngotracheobronchitis)
Rationale: Croup is a viral infection characterized by the classic triad of a barking cough,
hoarseness, and inspiratory stridor, often worsening at night. Epiglottitis typically
presents with a sudden onset of high fever, drooling, and a tripod position, while
bacterial tracheitis presents with a more toxic appearance. Foreign body aspiration
usually has a sudden onset of choking.
Question 5: A 2-week-old neonate presents with projectile vomiting after
feeds. The vomitus is non-bilious. On physical examination, an olive-shaped
mass is palpable in the right upper quadrant. Which of the following is the
most appropriate initial management step?
A. Initiation of feeding with a hydrolyzed formula
B. Administration of intravenous fluids and electrolytes
C. Pyloromyotomy
D. Upper gastrointestinal (GI) series
CORRECT ANSWER: B. Administration of intravenous fluids and electrolytes
Rationale: The presentation is classic for pyloric stenosis. The infant is likely dehydrated
and has a hypochloremic metabolic alkalosis due to vomiting. The first step in
management is to correct the fluid and electrolyte imbalances with IV fluids before
proceeding to surgery (pyloromyotomy).
,Question 6: A 3-year-old child with sickle cell disease presents with a fever of
101.5°F and pallor. The mother reports the child has been lethargic for the past
day. Which of the following is the most immediate and critical concern?
A. Acute chest syndrome
B. Aplastic crisis due to Parvovirus B19
C. Splenic sequestration crisis
D. Vaso-occlusive pain crisis
CORRECT ANSWER: C. Splenic sequestration crisis
Rationale: In a young child with sickle cell disease, fever, pallor, and lethargy are
hallmark signs of an acute splenic sequestration crisis, where blood pools in the spleen
leading to a sudden drop in hemoglobin and hypovolemic shock. This is a life-
threatening emergency requiring immediate intervention, more so than a pain crisis or
aplastic crisis, though aplastic crisis also presents with pallor.
Question 7: An 8-year-old boy is brought in for a routine well-child visit. His
body mass index (BMI) is at the 97th percentile for age and sex. He has
acanthosis nigricans on his neck. Which of the following screening tests is
most appropriate to order at this visit?
A. Fasting lipid panel
B. Fasting plasma glucose
C. Oral glucose tolerance test (OGTT)
D. Glycated hemoglobin (HbA1c)
CORRECT ANSWER: D. Glycated hemoglobin (HbA1c)
Rationale: The presence of obesity (BMI >95th percentile) and acanthosis nigricans
places this child at high risk for type 2 diabetes mellitus. The American Diabetes
Association recommends screening high-risk children with either a fasting plasma
glucose, OGTT, or HbA1c. However, HbA1c is a convenient and reliable non-fasting test
that correlates with chronic hyperglycemia.
Question 8: A 15-year-old female presents with secondary amenorrhea for 6
months. She has a history of restrictive eating and excessive exercise. Her BMI
is 16.5. Which of the following is the most likely cause of her amenorrhea?
A. Polycystic ovarian syndrome (PCOS)
B. Pregnancy
C. Hypothalamic amenorrhea
D. Premature ovarian failure
CORRECT ANSWER: C. Hypothalamic amenorrhea
Rationale: The patient's history of restrictive eating, excessive exercise, and low BMI are
classic risk factors for functional hypothalamic amenorrhea. This condition results from
a suppression of the hypothalamic-pituitary-ovarian axis due to energy deficiency and
stress, leading to decreased gonadotropin-releasing hormone (GnRH) pulsatility.
, Question 9: A 5-day-old neonate has a positive newborn screen for congenital
hypothyroidism. Which of the following clinical findings is most consistent
with this diagnosis?
A. Hypertonia and jitteriness
B. Prolonged jaundice and macroglossia
C. Tachycardia and diaphoresis
D. Bulging fontanelle and vomiting
CORRECT ANSWER: B. Prolonged jaundice and macroglossia
Rationale: Congenital hypothyroidism presents with a variety of signs, including
prolonged jaundice, macroglossia, hypotonia, umbilical hernia, constipation, and a
hoarse cry. Hypertonia and jitteriness are more associated with neonatal abstinence
syndrome or hypoglycemia.
Question 10: A 16-year-old male presents with sudden-onset scrotal pain,
nausea, and vomiting. On examination, the testis is tender and swollen, and
the cremasteric reflex is absent. Which of the following is the most appropriate
initial action?
A. Administer antibiotics for epididymitis
B. Perform a urinalysis and culture
C. Schedule a scrotal ultrasound for the next day
D. Arrange for immediate surgical exploration
CORRECT ANSWER: D. Arrange for immediate surgical exploration
Rationale: The sudden onset of severe scrotal pain with nausea, vomiting, and an absent
cremasteric reflex is highly concerning for testicular torsion. This is a surgical
emergency requiring immediate urologic consultation and exploration to salvage the
testicle, with the "golden window" being within 4-6 hours of symptom onset.
Question 11: A 10-year-old child with a history of atopic dermatitis is brought
in for a skin infection. The lesions are honey-crusted, erythematous plaques
on the face and extremities. Which of the following is the most likely causative
organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Pseudomonas aeruginosa
D. Herpes simplex virus
CORRECT ANSWER: A. Staphylococcus aureus
Rationale: The appearance of honey-crusted lesions is classic for impetigo, which is
most commonly caused by Staphylococcus aureus. While Streptococcus pyogenes can
also cause impetigo, S. aureus is the predominant pathogen in the current era.
