Pediatric CMS Comprehensive Examination | ATI
Testing Pediatric Nursing Content Mastery Series
2026/2027 | Pediatric Nursing Study Guide & Exam Prep
| Growth & Development, Health Promotion, Pediatric
Disorders, Clinical Management, Safety, Infection
Control & Pharmacology | Practice Questions, Answers
& Detailed Rationales
Question 1: A 2-year-old child is brought to the emergency department with
inspiratory stridor, a barking cough, and low-grade fever. The parent reports
the symptoms worsened significantly during the night. Which of the following
is the priority nursing action?
A. Administer a nebulized racemic epinephrine treatment.
B. Prepare the child for an emergent tracheotomy.
C. Place the child in a position of comfort and allow them to sit upright.
D. Obtain a throat culture to rule out a bacterial infection.
CORRECT ANSWER: C. Place the child in a position of comfort and allow them
to sit upright.
Rationale: The presentation is classic for croup (laryngotracheobronchitis). While
racemic epinephrine and corticosteroids are medical treatments for moderate to severe
croup, the immediate priority nursing action is to place the child in a position of comfort
(often upright), which helps to maximize airway patency and reduce respiratory distress.
Agitation and crying can worsen stridor and airway obstruction. A throat culture is not a
priority and is not typically indicated for viral croup, and a tracheotomy is reserved for
severe, life-threatening airway obstruction that does not respond to other treatments.
Question 2: A 4-month-old infant is scheduled to receive their first set of
immunizations. Prior to administration, the nurse reviews the parent’s signed
consent. Which of the following components is legally required for valid
informed consent?
A. A witness signature from a notary public.
B. An explanation of the risks, benefits, and alternatives to the vaccination.
C. A guarantee of vaccine efficacy from the prescribing healthcare provider.
D. A signed statement from both parents or legal guardians.
CORRECT ANSWER: B. An explanation of the risks, benefits, and alternatives
to the vaccination.
Rationale: Informed consent requires that the parent or guardian receives sufficient
information to make a voluntary decision. This includes a clear explanation of the
procedure's risks, benefits, and available alternatives. A guarantee of efficacy is not
possible and is not a legal requirement. While some institutions require a witness, a
notary is not mandatory. Consent from one legal guardian is generally sufficient for
routine medical care, provided they have the legal authority to do so.
,Question 3: The nurse is assessing a 10-year-old child with a diagnosis of type
1 diabetes mellitus. The child’s parent reports that the child has been
experiencing frequent episodes of hypoglycemia in the late afternoon. Which
of the following interventions should the nurse recommend to address this
pattern?
A. Decrease the child’s morning dose of short-acting insulin.
B. Provide a carbohydrate snack before the child’s afternoon physical activity.
C. Administer an extra dose of insulin before lunch.
D. Increase the child’s morning dose of long-acting insulin.
CORRECT ANSWER: B. Provide a carbohydrate snack before the child’s
afternoon physical activity.
Rationale: Hypoglycemia in the late afternoon is frequently associated with increased
physical activity during the school day. Providing a carbohydrate snack (e.g., 15-30
grams) before or during periods of high activity can help to prevent this drop in blood
glucose. The morning insulin dose should not be altered without a specific medical plan
and a full review of the child's glucose patterns; it is more likely that an adjustment to
the insulin-to-carbohydrate ratio or snack schedule is needed, not an arbitrary decrease
or increase in the morning dose.
Question 4: A 6-year-old child is admitted to the pediatric unit with a diagnosis
of acute glomerulonephritis. The nurse’s assessment reveals generalized
edema, hypertension, and tea-colored urine. Which of the following dietary
modifications should the nurse anticipate being prescribed for this child?
A. High-protein, low-potassium diet.
B. Low-sodium, fluid-restricted diet.
C. High-calcium, low-phosphorus diet.
D. Low-fat, high-carbohydrate diet.
CORRECT ANSWER: B. Low-sodium, fluid-restricted diet.
Rationale: Acute glomerulonephritis is characterized by decreased glomerular filtration
rate, leading to fluid retention, hypertension, and edema. The standard medical
management includes dietary sodium restriction and, depending on the severity of the
fluid overload, fluid restriction. A high-protein diet is not indicated and can further stress
the kidneys, and the other dietary modifications are not specific to this condition.
Question 5: A 14-year-old female client is diagnosed with anorexia nervosa.
The nurse is planning care related to the client’s nutritional status. Which of
the following is the most appropriate initial goal for this client?
A. To gain 1 to 2 kilograms per week until the ideal body weight is achieved.
B. To consume 50% of all meals without the use of a supplement.
C. To maintain current weight until a psychological evaluation is complete.
D. To have a weight gain of 0.5 to 1 kilogram per week.
,CORRECT ANSWER: D. To have a weight gain of 0.5 to 1 kilogram per week.
Rationale: In the treatment of anorexia nervosa, the primary goal is to restore nutritional
health safely. A realistic and safe weight gain goal is 0.5 to 1 kg (1-2 lbs) per week,
typically in an inpatient or highly structured outpatient setting. A gain of 1-2 kg per
week is too rapid and carries the risk of refeeding syndrome. The goal is not just to
maintain weight but to initiate a structured weight gain plan.
Question 6: The nurse is providing discharge teaching to the parents of a 4-
month-old infant who just had a cleft lip repair. Which of the following
statements by the parent indicates an understanding of the postoperative care
instructions?
A. "I will place my baby on their stomach to prevent aspiration if they vomit."
B. "I will use a regular bottle nipple to feed my baby until the sutures dissolve."
C. "I will apply a thin layer of antibiotic ointment to the suture line as prescribed."
D. "I will clean the suture line with hydrogen peroxide to prevent infection."
CORRECT ANSWER: C. I will apply a thin layer of antibiotic ointment to the
suture line as prescribed.
Rationale: Postoperative care for a cleft lip repair includes keeping the suture line clean
and free of crusts. Applying a thin layer of antibiotic ointment, as prescribed, helps to
keep the incision moist, promotes healing, and reduces the risk of infection. The infant
should be positioned on their back or side to protect the surgical site, not on their
stomach. Feeding is typically done with a special feeder (e.g., a soft, squeezable bottle or
a syringe with a soft catheter) or a cup to avoid pressure on the sutures, not a regular
nipple. Hydrogen peroxide can be too harsh and is not typically recommended for
suture line care.
Question 7: A 7-year-old child with a history of asthma is brought to the clinic
for a scheduled check-up. The nurse is teaching the child and parents about
the correct use of a metered-dose inhaler (MDI) with a spacer. Which of the
following steps should the nurse include in the teaching?
A. "Wait 5 seconds between puffs from the inhaler."
B. "Hold your breath for 5 to 10 seconds after inhaling the medication."
C. "Inhale the medication while tilting your head back as far as possible."
D. "Shake the inhaler well before the first dose of the day only."
CORRECT ANSWER: B. Hold your breath for 5 to 10 seconds after inhaling the
medication.
Rationale: After actuating the MDI and inhaling the medication, the client should be
instructed to hold their breath for 5 to 10 seconds to allow the medication to deposit in
the airways. A spacer is used to improve drug delivery. The wait time between puffs
should be at least 30-60 seconds to allow for maximal bronchodilation before the next
puff. Tilt the head slightly back to open the airway, not as far back as possible. The
inhaler should be shaken well before every use, not just the first dose of the day.
, Question 8: The nurse is assessing a newborn infant who is 12 hours old. The
nurse notes a respiratory rate of 60 breaths per minute, nasal flaring, and
grunting. What is the nurse's priority action?
A. Document these findings as normal for a newborn.
B. Administer 100% oxygen via a non-rebreather mask.
C. Position the infant in a prone position to improve ventilation.
D. Notify the healthcare provider of these assessment findings immediately.
CORRECT ANSWER: D. Notify the healthcare provider of these assessment
findings immediately.
Rationale: A normal respiratory rate for a newborn is 30-60 breaths per minute.
However, a rate of 60, especially when accompanied by signs of respiratory distress
such as nasal flaring and grunting, is an abnormal finding. Grunting is an attempt to
generate positive end-expiratory pressure to keep alveoli open, indicating significant
respiratory compromise. The priority is to notify the healthcare provider immediately for
a prompt evaluation. While oxygen may be needed, it should be administered under a
provider's order and in the correct manner.
Question 9: A 16-year-old adolescent with cystic fibrosis is being discharged.
The nurse is teaching the adolescent about the importance of airway clearance
therapy (ACT). Which statement by the adolescent indicates a correct
understanding of the rationale for performing ACT?
A. "ACT helps to prevent infection by increasing the humidity in my lungs."
B. "ACT is performed to loosen and mobilize the thick secretions in my airways."
C. "ACT is most beneficial if I perform it only when I feel short of breath."
D. "ACT is done to expand my lung capacity and prevent scoliosis."
CORRECT ANSWER: B. ACT is performed to loosen and mobilize the thick
secretions in my airways.
Rationale: Cystic fibrosis is a genetic disorder that leads to the production of abnormally
thick, sticky mucus in the lungs. Airway clearance therapy (ACT), which includes
techniques like chest physiotherapy, positive expiratory pressure (PEP) devices, and
high-frequency chest wall oscillation, is specifically designed to loosen and mobilize
these secretions to facilitate their expectoration. ACT should be performed routinely, not
just when the client feels short of breath, to prevent mucus plugging and infection.
Question 10: The nurse is preparing to administer a dose of digoxin to a 2-
year-old child with a diagnosis of heart failure. The child's apical pulse is 84
beats per minute. Which of the following actions should the nurse take?
A. Administer the digoxin as prescribed.
B. Withhold the digoxin and recheck the pulse in 1 hour.
C. Withhold the digoxin and notify the healthcare provider.
D. Administer the digoxin and monitor for bradycardia.
Testing Pediatric Nursing Content Mastery Series
2026/2027 | Pediatric Nursing Study Guide & Exam Prep
| Growth & Development, Health Promotion, Pediatric
Disorders, Clinical Management, Safety, Infection
Control & Pharmacology | Practice Questions, Answers
& Detailed Rationales
Question 1: A 2-year-old child is brought to the emergency department with
inspiratory stridor, a barking cough, and low-grade fever. The parent reports
the symptoms worsened significantly during the night. Which of the following
is the priority nursing action?
A. Administer a nebulized racemic epinephrine treatment.
B. Prepare the child for an emergent tracheotomy.
C. Place the child in a position of comfort and allow them to sit upright.
D. Obtain a throat culture to rule out a bacterial infection.
CORRECT ANSWER: C. Place the child in a position of comfort and allow them
to sit upright.
Rationale: The presentation is classic for croup (laryngotracheobronchitis). While
racemic epinephrine and corticosteroids are medical treatments for moderate to severe
croup, the immediate priority nursing action is to place the child in a position of comfort
(often upright), which helps to maximize airway patency and reduce respiratory distress.
Agitation and crying can worsen stridor and airway obstruction. A throat culture is not a
priority and is not typically indicated for viral croup, and a tracheotomy is reserved for
severe, life-threatening airway obstruction that does not respond to other treatments.
Question 2: A 4-month-old infant is scheduled to receive their first set of
immunizations. Prior to administration, the nurse reviews the parent’s signed
consent. Which of the following components is legally required for valid
informed consent?
A. A witness signature from a notary public.
B. An explanation of the risks, benefits, and alternatives to the vaccination.
C. A guarantee of vaccine efficacy from the prescribing healthcare provider.
D. A signed statement from both parents or legal guardians.
CORRECT ANSWER: B. An explanation of the risks, benefits, and alternatives
to the vaccination.
Rationale: Informed consent requires that the parent or guardian receives sufficient
information to make a voluntary decision. This includes a clear explanation of the
procedure's risks, benefits, and available alternatives. A guarantee of efficacy is not
possible and is not a legal requirement. While some institutions require a witness, a
notary is not mandatory. Consent from one legal guardian is generally sufficient for
routine medical care, provided they have the legal authority to do so.
,Question 3: The nurse is assessing a 10-year-old child with a diagnosis of type
1 diabetes mellitus. The child’s parent reports that the child has been
experiencing frequent episodes of hypoglycemia in the late afternoon. Which
of the following interventions should the nurse recommend to address this
pattern?
A. Decrease the child’s morning dose of short-acting insulin.
B. Provide a carbohydrate snack before the child’s afternoon physical activity.
C. Administer an extra dose of insulin before lunch.
D. Increase the child’s morning dose of long-acting insulin.
CORRECT ANSWER: B. Provide a carbohydrate snack before the child’s
afternoon physical activity.
Rationale: Hypoglycemia in the late afternoon is frequently associated with increased
physical activity during the school day. Providing a carbohydrate snack (e.g., 15-30
grams) before or during periods of high activity can help to prevent this drop in blood
glucose. The morning insulin dose should not be altered without a specific medical plan
and a full review of the child's glucose patterns; it is more likely that an adjustment to
the insulin-to-carbohydrate ratio or snack schedule is needed, not an arbitrary decrease
or increase in the morning dose.
Question 4: A 6-year-old child is admitted to the pediatric unit with a diagnosis
of acute glomerulonephritis. The nurse’s assessment reveals generalized
edema, hypertension, and tea-colored urine. Which of the following dietary
modifications should the nurse anticipate being prescribed for this child?
A. High-protein, low-potassium diet.
B. Low-sodium, fluid-restricted diet.
C. High-calcium, low-phosphorus diet.
D. Low-fat, high-carbohydrate diet.
CORRECT ANSWER: B. Low-sodium, fluid-restricted diet.
Rationale: Acute glomerulonephritis is characterized by decreased glomerular filtration
rate, leading to fluid retention, hypertension, and edema. The standard medical
management includes dietary sodium restriction and, depending on the severity of the
fluid overload, fluid restriction. A high-protein diet is not indicated and can further stress
the kidneys, and the other dietary modifications are not specific to this condition.
Question 5: A 14-year-old female client is diagnosed with anorexia nervosa.
The nurse is planning care related to the client’s nutritional status. Which of
the following is the most appropriate initial goal for this client?
A. To gain 1 to 2 kilograms per week until the ideal body weight is achieved.
B. To consume 50% of all meals without the use of a supplement.
C. To maintain current weight until a psychological evaluation is complete.
D. To have a weight gain of 0.5 to 1 kilogram per week.
,CORRECT ANSWER: D. To have a weight gain of 0.5 to 1 kilogram per week.
Rationale: In the treatment of anorexia nervosa, the primary goal is to restore nutritional
health safely. A realistic and safe weight gain goal is 0.5 to 1 kg (1-2 lbs) per week,
typically in an inpatient or highly structured outpatient setting. A gain of 1-2 kg per
week is too rapid and carries the risk of refeeding syndrome. The goal is not just to
maintain weight but to initiate a structured weight gain plan.
Question 6: The nurse is providing discharge teaching to the parents of a 4-
month-old infant who just had a cleft lip repair. Which of the following
statements by the parent indicates an understanding of the postoperative care
instructions?
A. "I will place my baby on their stomach to prevent aspiration if they vomit."
B. "I will use a regular bottle nipple to feed my baby until the sutures dissolve."
C. "I will apply a thin layer of antibiotic ointment to the suture line as prescribed."
D. "I will clean the suture line with hydrogen peroxide to prevent infection."
CORRECT ANSWER: C. I will apply a thin layer of antibiotic ointment to the
suture line as prescribed.
Rationale: Postoperative care for a cleft lip repair includes keeping the suture line clean
and free of crusts. Applying a thin layer of antibiotic ointment, as prescribed, helps to
keep the incision moist, promotes healing, and reduces the risk of infection. The infant
should be positioned on their back or side to protect the surgical site, not on their
stomach. Feeding is typically done with a special feeder (e.g., a soft, squeezable bottle or
a syringe with a soft catheter) or a cup to avoid pressure on the sutures, not a regular
nipple. Hydrogen peroxide can be too harsh and is not typically recommended for
suture line care.
Question 7: A 7-year-old child with a history of asthma is brought to the clinic
for a scheduled check-up. The nurse is teaching the child and parents about
the correct use of a metered-dose inhaler (MDI) with a spacer. Which of the
following steps should the nurse include in the teaching?
A. "Wait 5 seconds between puffs from the inhaler."
B. "Hold your breath for 5 to 10 seconds after inhaling the medication."
C. "Inhale the medication while tilting your head back as far as possible."
D. "Shake the inhaler well before the first dose of the day only."
CORRECT ANSWER: B. Hold your breath for 5 to 10 seconds after inhaling the
medication.
Rationale: After actuating the MDI and inhaling the medication, the client should be
instructed to hold their breath for 5 to 10 seconds to allow the medication to deposit in
the airways. A spacer is used to improve drug delivery. The wait time between puffs
should be at least 30-60 seconds to allow for maximal bronchodilation before the next
puff. Tilt the head slightly back to open the airway, not as far back as possible. The
inhaler should be shaken well before every use, not just the first dose of the day.
, Question 8: The nurse is assessing a newborn infant who is 12 hours old. The
nurse notes a respiratory rate of 60 breaths per minute, nasal flaring, and
grunting. What is the nurse's priority action?
A. Document these findings as normal for a newborn.
B. Administer 100% oxygen via a non-rebreather mask.
C. Position the infant in a prone position to improve ventilation.
D. Notify the healthcare provider of these assessment findings immediately.
CORRECT ANSWER: D. Notify the healthcare provider of these assessment
findings immediately.
Rationale: A normal respiratory rate for a newborn is 30-60 breaths per minute.
However, a rate of 60, especially when accompanied by signs of respiratory distress
such as nasal flaring and grunting, is an abnormal finding. Grunting is an attempt to
generate positive end-expiratory pressure to keep alveoli open, indicating significant
respiratory compromise. The priority is to notify the healthcare provider immediately for
a prompt evaluation. While oxygen may be needed, it should be administered under a
provider's order and in the correct manner.
Question 9: A 16-year-old adolescent with cystic fibrosis is being discharged.
The nurse is teaching the adolescent about the importance of airway clearance
therapy (ACT). Which statement by the adolescent indicates a correct
understanding of the rationale for performing ACT?
A. "ACT helps to prevent infection by increasing the humidity in my lungs."
B. "ACT is performed to loosen and mobilize the thick secretions in my airways."
C. "ACT is most beneficial if I perform it only when I feel short of breath."
D. "ACT is done to expand my lung capacity and prevent scoliosis."
CORRECT ANSWER: B. ACT is performed to loosen and mobilize the thick
secretions in my airways.
Rationale: Cystic fibrosis is a genetic disorder that leads to the production of abnormally
thick, sticky mucus in the lungs. Airway clearance therapy (ACT), which includes
techniques like chest physiotherapy, positive expiratory pressure (PEP) devices, and
high-frequency chest wall oscillation, is specifically designed to loosen and mobilize
these secretions to facilitate their expectoration. ACT should be performed routinely, not
just when the client feels short of breath, to prevent mucus plugging and infection.
Question 10: The nurse is preparing to administer a dose of digoxin to a 2-
year-old child with a diagnosis of heart failure. The child's apical pulse is 84
beats per minute. Which of the following actions should the nurse take?
A. Administer the digoxin as prescribed.
B. Withhold the digoxin and recheck the pulse in 1 hour.
C. Withhold the digoxin and notify the healthcare provider.
D. Administer the digoxin and monitor for bradycardia.
