ATI RN PEDIATRIC NURSING PROCTORED
EXAM 2026 | PRACTICE QUESTIONS,
VERIFIED ANSWERS & NGN RATIONALES |
PEDIATRICS STUDY GUIDE
• This comprehensive 200-question practice exam mirrors the ATI RN Pediatric
Nursing Proctored format with NGN-style rationales, covering all major pediatric
topics to prepare you for high-stakes testing.
• Study by completing questions by topic area, reviewing detailed rationales for
both correct and incorrect options, and focusing on areas where you score below
80% before attempting full-length practice tests.
QUESTION 1
A nurse is assessing a 6-month-old infant. Which of the following findings
would the nurse expect to observe as a normal developmental milestone at
this age?
A) Pulling to stand independently
B) Speaking 2-3 word sentences
C) Rolling from supine to prone
D) Pincer grasp with thumb and forefinger
E) Walking with a wide-based gait
CORRECT ANSWER: C) Rolling from supine to prone
At 6 months of age, infants typically demonstrate the ability to roll from supine to
prone and prone to supine positions. This motor milestone indicates developing
trunk control and is part of normal gross motor development. Pulling to stand
independently typically occurs between 9-12 months. Speaking 2-3 word sentences
is expected around 18-24 months. A refined pincer grasp typically develops
between 8-10 months, with the crude raking grasp present at 6 months. Walking
with a wide-based gait occurs around 12-15 months after independent walking
begins.
,QUESTION 2
A nurse is caring for a 3-year-old child who has been hospitalized for 5 days.
The child exhibits behaviors including crying when parents leave, refusing to
eat, and withdrawal from play activities. The nurse recognizes these findings
as characteristic of which stage of separation anxiety?
A) Protest phase
B) Despair phase
C) Detachment phase
D) Denial phase
E) Regression phase
CORRECT ANSWER: B) Despair phase
The despair phase of separation anxiety occurs after the initial protest phase and is
characterized by withdrawal, decreased appetite, apathy, and little interest in play
or activities. The child may cry less but appears sad and depressed. The protest
phase involves active crying, resistance, and aggression. The detachment phase is
the final stage where the child appears to have adjusted but may show indifference.
Denial and regression are not recognized phases of separation anxiety but may
occur as defense mechanisms.
QUESTION 3
A nurse is providing education to the parents of a newborn regarding
breastfeeding. Which statement by the parent indicates an understanding of
proper latch technique?
A) "My baby should have just the nipple in their mouth"
B) "Most of the areola should be in my baby's mouth, with the lower lip turned
outward"
C) "I should hear clicking or smacking sounds during feeding"
D) "The baby's chin should be tucked to their chest during feeding"
,E) "I need to pull my breast away if my baby creates any suction"
CORRECT ANSWER: B) Most of the areola should be in my baby's mouth, with
the lower lip turned outward
Proper latch technique involves the baby taking most of the areola into the mouth
with the lower lip turned outward (everted). This allows the baby to compress the
milk ducts and extract milk efficiently while minimizing nipple trauma. Having only
the nipple in the mouth leads to poor milk transfer and nipple pain. Clicking or
smacking sounds indicate an inadequate latch. The baby's chin should be tilted
slightly away from the chest, not tucked. Pulling the breast away disrupts feeding
and prevents milk transfer.
QUESTION 4
A nurse is calculating the daily maintenance fluid requirements for a 22-kg
child using the Holliday-Segar formula. What is the appropriate daily
maintenance fluid volume for this child?
A) 1,300 mL
B) 1,500 mL
C) 1,700 mL
D) 1,900 mL
E) 2,100 mL
CORRECT ANSWER: C) 1,700 mL
Using the Holliday-Segar formula: 100 mL/kg for the first 10 kg, 50 mL/kg for the
next 10 kg, and 20 mL/kg for each additional kg. For this 22-kg child: (100 × 10) + (50
× 10) + (20 × 2) = 1,000 + 500 + 200 = 1,700 mL per 24 hours. This formula is used to
calculate maintenance fluid requirements for children and accounts for metabolic
needs based on body weight.
QUESTION 5
, A 9-month-old infant presents to the clinic with a fever of 39.2°C (102.5°F),
clear rhinorrhea, and a cough. Which respiratory finding would the nurse
expect to auscultate?
A) Bronchial breath sounds over the lung periphery
B) Crackles in the lower lobes
C) Wheezes throughout all lung fields
D) Clear breath sounds bilaterally
E) Stridor on inspiration
CORRECT ANSWER: D) Clear breath sounds bilaterally
A viral upper respiratory infection typically presents with clear breath sounds
despite the presence of rhinorrhea and cough. The infection is localized to the
upper airway (nasal passages and throat). Bronchial breath sounds indicate
consolidation. Crackles suggest fluid in the alveoli or bronchioles. Wheezes indicate
airway narrowing or obstruction. Stridor suggests upper airway obstruction, which
may occur with croup but is not typical of a simple viral rhinitis.
QUESTION 6
A nurse is assessing the deep tendon reflexes of a 4-year-old child and
documents a grade of 3+. What does this reflex grade indicate?
A) Absent reflex
B) Diminished reflex
C) Normal reflex
D) Brisk reflex
E) Hyperreflexia with clonus
CORRECT ANSWER: C) Normal reflex
Reflex grading uses a scale from 0 to 4+, where: 0 = absent, 1+ = diminished, 2+ =
normal, 3+ = brisker than normal but without clonus, and 4+ = hyperactive with
EXAM 2026 | PRACTICE QUESTIONS,
VERIFIED ANSWERS & NGN RATIONALES |
PEDIATRICS STUDY GUIDE
• This comprehensive 200-question practice exam mirrors the ATI RN Pediatric
Nursing Proctored format with NGN-style rationales, covering all major pediatric
topics to prepare you for high-stakes testing.
• Study by completing questions by topic area, reviewing detailed rationales for
both correct and incorrect options, and focusing on areas where you score below
80% before attempting full-length practice tests.
QUESTION 1
A nurse is assessing a 6-month-old infant. Which of the following findings
would the nurse expect to observe as a normal developmental milestone at
this age?
A) Pulling to stand independently
B) Speaking 2-3 word sentences
C) Rolling from supine to prone
D) Pincer grasp with thumb and forefinger
E) Walking with a wide-based gait
CORRECT ANSWER: C) Rolling from supine to prone
At 6 months of age, infants typically demonstrate the ability to roll from supine to
prone and prone to supine positions. This motor milestone indicates developing
trunk control and is part of normal gross motor development. Pulling to stand
independently typically occurs between 9-12 months. Speaking 2-3 word sentences
is expected around 18-24 months. A refined pincer grasp typically develops
between 8-10 months, with the crude raking grasp present at 6 months. Walking
with a wide-based gait occurs around 12-15 months after independent walking
begins.
,QUESTION 2
A nurse is caring for a 3-year-old child who has been hospitalized for 5 days.
The child exhibits behaviors including crying when parents leave, refusing to
eat, and withdrawal from play activities. The nurse recognizes these findings
as characteristic of which stage of separation anxiety?
A) Protest phase
B) Despair phase
C) Detachment phase
D) Denial phase
E) Regression phase
CORRECT ANSWER: B) Despair phase
The despair phase of separation anxiety occurs after the initial protest phase and is
characterized by withdrawal, decreased appetite, apathy, and little interest in play
or activities. The child may cry less but appears sad and depressed. The protest
phase involves active crying, resistance, and aggression. The detachment phase is
the final stage where the child appears to have adjusted but may show indifference.
Denial and regression are not recognized phases of separation anxiety but may
occur as defense mechanisms.
QUESTION 3
A nurse is providing education to the parents of a newborn regarding
breastfeeding. Which statement by the parent indicates an understanding of
proper latch technique?
A) "My baby should have just the nipple in their mouth"
B) "Most of the areola should be in my baby's mouth, with the lower lip turned
outward"
C) "I should hear clicking or smacking sounds during feeding"
D) "The baby's chin should be tucked to their chest during feeding"
,E) "I need to pull my breast away if my baby creates any suction"
CORRECT ANSWER: B) Most of the areola should be in my baby's mouth, with
the lower lip turned outward
Proper latch technique involves the baby taking most of the areola into the mouth
with the lower lip turned outward (everted). This allows the baby to compress the
milk ducts and extract milk efficiently while minimizing nipple trauma. Having only
the nipple in the mouth leads to poor milk transfer and nipple pain. Clicking or
smacking sounds indicate an inadequate latch. The baby's chin should be tilted
slightly away from the chest, not tucked. Pulling the breast away disrupts feeding
and prevents milk transfer.
QUESTION 4
A nurse is calculating the daily maintenance fluid requirements for a 22-kg
child using the Holliday-Segar formula. What is the appropriate daily
maintenance fluid volume for this child?
A) 1,300 mL
B) 1,500 mL
C) 1,700 mL
D) 1,900 mL
E) 2,100 mL
CORRECT ANSWER: C) 1,700 mL
Using the Holliday-Segar formula: 100 mL/kg for the first 10 kg, 50 mL/kg for the
next 10 kg, and 20 mL/kg for each additional kg. For this 22-kg child: (100 × 10) + (50
× 10) + (20 × 2) = 1,000 + 500 + 200 = 1,700 mL per 24 hours. This formula is used to
calculate maintenance fluid requirements for children and accounts for metabolic
needs based on body weight.
QUESTION 5
, A 9-month-old infant presents to the clinic with a fever of 39.2°C (102.5°F),
clear rhinorrhea, and a cough. Which respiratory finding would the nurse
expect to auscultate?
A) Bronchial breath sounds over the lung periphery
B) Crackles in the lower lobes
C) Wheezes throughout all lung fields
D) Clear breath sounds bilaterally
E) Stridor on inspiration
CORRECT ANSWER: D) Clear breath sounds bilaterally
A viral upper respiratory infection typically presents with clear breath sounds
despite the presence of rhinorrhea and cough. The infection is localized to the
upper airway (nasal passages and throat). Bronchial breath sounds indicate
consolidation. Crackles suggest fluid in the alveoli or bronchioles. Wheezes indicate
airway narrowing or obstruction. Stridor suggests upper airway obstruction, which
may occur with croup but is not typical of a simple viral rhinitis.
QUESTION 6
A nurse is assessing the deep tendon reflexes of a 4-year-old child and
documents a grade of 3+. What does this reflex grade indicate?
A) Absent reflex
B) Diminished reflex
C) Normal reflex
D) Brisk reflex
E) Hyperreflexia with clonus
CORRECT ANSWER: C) Normal reflex
Reflex grading uses a scale from 0 to 4+, where: 0 = absent, 1+ = diminished, 2+ =
normal, 3+ = brisker than normal but without clonus, and 4+ = hyperactive with
