ATI PEDIATRIC CMS COMPREHENSIVE EXAM PRACTICE
2026-2027 – ADVANCED PEDIATRIC NURSING
QUESTIONS, ANSWERS AND RATIONALES STUDY GUIDE
QUESTION 1
A nurse is caring for a 4-year-old child admitted with bacterial meningitis. The child
has received the first dose of IV antibiotics. Four hours later, the child becomes
increasingly irritable and develops repeated vomiting, a temperature of 40.1°C
(104.2°F), and a heart rate of 156/min. The nurse notes a new unequal pupil
response and a decrease in the child's level of consciousness. Which action should
the nurse take first?
A. Administer the prescribed antipyretic and reassess in 30 minutes.
B. Place the child in a darkened room to decrease environmental stimulation.
C. Notify the rapid response team and prepare for interventions to reduce
intracranial pressure.
D. Obtain a repeat blood culture before notifying the provider.
Answer: C
Rationale: A declining level of consciousness with new pupillary asymmetry and
vomiting suggests increasing intracranial pressure and possible cerebral herniation.
This is an immediately life-threatening deterioration requiring emergency escalation
and preparation for airway and intracranial-pressure management.
QUESTION 2
A 7-year-old child with asthma arrives in the emergency department with severe
dyspnea. The child is sitting upright, has intercostal retractions, speaks only one or
two words at a time, and has an oxygen saturation of 88% on room air. After
receiving an initial short-acting bronchodilator treatment, the child's wheezing
becomes markedly quieter, but respiratory effort remains severe. Which
interpretation is most appropriate?
A. The child is demonstrating therapeutic response because wheezing has
decreased.
B. The child is developing worsening airway obstruction despite reduced audible
wheezing.
C. The child is experiencing anxiety-related hyperventilation.
D. The child is ready for discharge because oxygen saturation should normalize
gradually.
Answer: B
Rationale: In severe asthma, a suddenly diminished or absent wheeze can indicate
critically reduced airflow rather than improvement. Persistent respiratory distress and
hypoxemia require immediate escalation, supplemental oxygen, additional
bronchodilator therapy, systemic corticosteroids, and preparation for advanced
respiratory support if deterioration continues.
QUESTION 3
,A nurse evaluates a 2-month-old infant before administering routine immunizations.
The infant was born at 35 weeks' gestation and currently weighs 3.2 kg (7 lb). The
parent states, "Because my baby was premature and is still small, the vaccines
should be delayed until the baby catches up." Which response is most appropriate?
A. "Most vaccines should be delayed until the infant reaches 5 kg."
B. "Prematurity generally does not require delaying routine immunizations when the
infant is clinically stable."
C. "Only vaccines containing live organisms should be delayed until 12 months."
D. "The immunization schedule should be based on corrected age rather than
chronological age."
Answer: B
Rationale: Clinically stable preterm infants generally receive routine vaccines
according to chronological age rather than corrected age. Prematurity and low weight
alone are not reasons to postpone standard immunization.
QUESTION 4
A 6-year-old child with type 1 diabetes mellitus has vomiting and abdominal pain.
Laboratory results include glucose 468 mg/dL, pH 7.18, bicarbonate 11 mEq/L, and
positive serum ketones. The child is lethargic and has deep, rapid respirations.
Which prescription should the nurse anticipate implementing first?
A. IV regular insulin bolus followed immediately by subcutaneous insulin.
B. IV isotonic fluid replacement with careful monitoring of electrolytes.
C. Oral carbohydrate administration to prevent hypoglycemia.
D. Immediate IV sodium bicarbonate administration.
Answer: B
Rationale: The child has diabetic ketoacidosis with significant dehydration and
metabolic acidosis. Initial management prioritizes restoration of circulating volume
with isotonic IV fluids, followed by carefully controlled insulin therapy and electrolyte
monitoring. Routine bicarbonate administration is not indicated.
QUESTION 5
A 10-year-old child with nephrotic syndrome has generalized edema and a serum
albumin of
1.7 g/dL. The child suddenly develops dyspnea, pleuritic chest pain, and tachycardia.
Which complication should the nurse suspect?
A. Pulmonary embolism
B. Acute appendicitis
C. Hypoglycemia
D. Increased intracranial pressure
Answer: A
Rationale: Nephrotic syndrome causes urinary loss of anticoagulant proteins and
creates a hypercoagulable state. Sudden dyspnea, pleuritic chest pain, and
tachycardia are concerning for pulmonary embolism and require immediate
evaluation and escalation.
QUESTION 6
,A child with tetralogy of Fallot becomes acutely cyanotic and tachypneic while
crying. The child's oxygen saturation decreases to 72%. Which nursing
intervention is most appropriate initially?
A. Place the child in a knee-chest position.
B. Encourage the child to walk to improve circulation.
C. Place the child supine with the legs extended.
D. Restrict oxygen administration to prevent oxygen toxicity.
Answer: A
Rationale: During a hypercyanotic or "tet" spell, the knee-chest position increases
systemic vascular resistance and reduces right-to-left shunting. Oxygen and calming
measures should also be provided while additional emergency treatment is initiated.
QUESTION 7
A 3-year-old child with suspected epiglottitis is drooling, sitting upright, and leaning
forward with the neck extended. The child has inspiratory stridor and appears
frightened. Which nursing action is safest?
A. Inspect the throat with a tongue blade.
B. Obtain a throat culture immediately at the bedside.
C. Keep the child calm and prepare for controlled airway management.
D. Place the child supine for a complete physical examination.
Answer: C
Rationale: Manipulation of the airway in suspected epiglottitis can precipitate
complete airway obstruction. The child should be kept calm and in a position of
comfort while personnel prepare for controlled airway management.
QUESTION 8
A 9-year-old child receiving chemotherapy has an absolute neutrophil count of
400/mm³. Which finding requires the nurse to intervene most urgently?
A. Temperature of 38.3°C (100.9°F)
B. Decreased appetite for 1 day
C. Mild alopecia
D. Hemoglobin of 9.8 g/dL
Answer: A
Rationale: Severe neutropenia substantially increases the risk of life-threatening
infection. Fever in a profoundly neutropenic child is an oncologic emergency requiring
prompt cultures and empiric antimicrobial treatment according to institutional
protocols.
QUESTION 9
, A 5-year-old child is admitted with Kawasaki disease. The child has received IVIG
and aspirin therapy. Which finding is most important for the nurse to monitor during
the acute phase?
A. Development of coronary artery abnormalities
B. Development of dental caries
C. Increasing muscle strength
D. Improvement in visual acuity
Answer: A
Rationale: Kawasaki disease causes systemic vasculitis with a major risk of coronary
artery aneurysm and other cardiac complications. Cardiac monitoring and follow-up
echocardiography are therefore essential.
QUESTION 10
A 15-month-old child is brought to the clinic because the parent reports that the child
"lost several words" previously used consistently and has stopped making eye
contact. Which nursing response is most appropriate?
A. "Language regression is expected during the second year of life."
B. "This is probably caused by normal separation anxiety."
C. "Regression warrants prompt developmental evaluation."
D. "Wait until age 3 before pursuing developmental assessment."
Answer: C
Rationale: Loss of previously acquired developmental skills is a red flag and
warrants prompt evaluation. Regression is not considered a normal developmental
milestone.
QUESTION 11
A child with sickle cell disease is hospitalized with severe vaso-occlusive pain.
The child rates pain as 9/10 and has received prescribed opioid analgesia.
Which additional nursing intervention is most appropriate?
A. Restrict oral fluids to reduce renal workload.
B. Encourage adequate hydration and oxygenation as clinically indicated.
C. Apply prolonged cold packs directly to painful joints.
D. Encourage strenuous exercise to improve circulation.
Answer: B
Rationale: Hydration helps reduce blood viscosity, while oxygen should be
administered when hypoxemia is present. Pain management, rest, warmth, and
treatment of precipitating factors are important components of vaso-occlusive crisis
management.
QUESTION 12
2026-2027 – ADVANCED PEDIATRIC NURSING
QUESTIONS, ANSWERS AND RATIONALES STUDY GUIDE
QUESTION 1
A nurse is caring for a 4-year-old child admitted with bacterial meningitis. The child
has received the first dose of IV antibiotics. Four hours later, the child becomes
increasingly irritable and develops repeated vomiting, a temperature of 40.1°C
(104.2°F), and a heart rate of 156/min. The nurse notes a new unequal pupil
response and a decrease in the child's level of consciousness. Which action should
the nurse take first?
A. Administer the prescribed antipyretic and reassess in 30 minutes.
B. Place the child in a darkened room to decrease environmental stimulation.
C. Notify the rapid response team and prepare for interventions to reduce
intracranial pressure.
D. Obtain a repeat blood culture before notifying the provider.
Answer: C
Rationale: A declining level of consciousness with new pupillary asymmetry and
vomiting suggests increasing intracranial pressure and possible cerebral herniation.
This is an immediately life-threatening deterioration requiring emergency escalation
and preparation for airway and intracranial-pressure management.
QUESTION 2
A 7-year-old child with asthma arrives in the emergency department with severe
dyspnea. The child is sitting upright, has intercostal retractions, speaks only one or
two words at a time, and has an oxygen saturation of 88% on room air. After
receiving an initial short-acting bronchodilator treatment, the child's wheezing
becomes markedly quieter, but respiratory effort remains severe. Which
interpretation is most appropriate?
A. The child is demonstrating therapeutic response because wheezing has
decreased.
B. The child is developing worsening airway obstruction despite reduced audible
wheezing.
C. The child is experiencing anxiety-related hyperventilation.
D. The child is ready for discharge because oxygen saturation should normalize
gradually.
Answer: B
Rationale: In severe asthma, a suddenly diminished or absent wheeze can indicate
critically reduced airflow rather than improvement. Persistent respiratory distress and
hypoxemia require immediate escalation, supplemental oxygen, additional
bronchodilator therapy, systemic corticosteroids, and preparation for advanced
respiratory support if deterioration continues.
QUESTION 3
,A nurse evaluates a 2-month-old infant before administering routine immunizations.
The infant was born at 35 weeks' gestation and currently weighs 3.2 kg (7 lb). The
parent states, "Because my baby was premature and is still small, the vaccines
should be delayed until the baby catches up." Which response is most appropriate?
A. "Most vaccines should be delayed until the infant reaches 5 kg."
B. "Prematurity generally does not require delaying routine immunizations when the
infant is clinically stable."
C. "Only vaccines containing live organisms should be delayed until 12 months."
D. "The immunization schedule should be based on corrected age rather than
chronological age."
Answer: B
Rationale: Clinically stable preterm infants generally receive routine vaccines
according to chronological age rather than corrected age. Prematurity and low weight
alone are not reasons to postpone standard immunization.
QUESTION 4
A 6-year-old child with type 1 diabetes mellitus has vomiting and abdominal pain.
Laboratory results include glucose 468 mg/dL, pH 7.18, bicarbonate 11 mEq/L, and
positive serum ketones. The child is lethargic and has deep, rapid respirations.
Which prescription should the nurse anticipate implementing first?
A. IV regular insulin bolus followed immediately by subcutaneous insulin.
B. IV isotonic fluid replacement with careful monitoring of electrolytes.
C. Oral carbohydrate administration to prevent hypoglycemia.
D. Immediate IV sodium bicarbonate administration.
Answer: B
Rationale: The child has diabetic ketoacidosis with significant dehydration and
metabolic acidosis. Initial management prioritizes restoration of circulating volume
with isotonic IV fluids, followed by carefully controlled insulin therapy and electrolyte
monitoring. Routine bicarbonate administration is not indicated.
QUESTION 5
A 10-year-old child with nephrotic syndrome has generalized edema and a serum
albumin of
1.7 g/dL. The child suddenly develops dyspnea, pleuritic chest pain, and tachycardia.
Which complication should the nurse suspect?
A. Pulmonary embolism
B. Acute appendicitis
C. Hypoglycemia
D. Increased intracranial pressure
Answer: A
Rationale: Nephrotic syndrome causes urinary loss of anticoagulant proteins and
creates a hypercoagulable state. Sudden dyspnea, pleuritic chest pain, and
tachycardia are concerning for pulmonary embolism and require immediate
evaluation and escalation.
QUESTION 6
,A child with tetralogy of Fallot becomes acutely cyanotic and tachypneic while
crying. The child's oxygen saturation decreases to 72%. Which nursing
intervention is most appropriate initially?
A. Place the child in a knee-chest position.
B. Encourage the child to walk to improve circulation.
C. Place the child supine with the legs extended.
D. Restrict oxygen administration to prevent oxygen toxicity.
Answer: A
Rationale: During a hypercyanotic or "tet" spell, the knee-chest position increases
systemic vascular resistance and reduces right-to-left shunting. Oxygen and calming
measures should also be provided while additional emergency treatment is initiated.
QUESTION 7
A 3-year-old child with suspected epiglottitis is drooling, sitting upright, and leaning
forward with the neck extended. The child has inspiratory stridor and appears
frightened. Which nursing action is safest?
A. Inspect the throat with a tongue blade.
B. Obtain a throat culture immediately at the bedside.
C. Keep the child calm and prepare for controlled airway management.
D. Place the child supine for a complete physical examination.
Answer: C
Rationale: Manipulation of the airway in suspected epiglottitis can precipitate
complete airway obstruction. The child should be kept calm and in a position of
comfort while personnel prepare for controlled airway management.
QUESTION 8
A 9-year-old child receiving chemotherapy has an absolute neutrophil count of
400/mm³. Which finding requires the nurse to intervene most urgently?
A. Temperature of 38.3°C (100.9°F)
B. Decreased appetite for 1 day
C. Mild alopecia
D. Hemoglobin of 9.8 g/dL
Answer: A
Rationale: Severe neutropenia substantially increases the risk of life-threatening
infection. Fever in a profoundly neutropenic child is an oncologic emergency requiring
prompt cultures and empiric antimicrobial treatment according to institutional
protocols.
QUESTION 9
, A 5-year-old child is admitted with Kawasaki disease. The child has received IVIG
and aspirin therapy. Which finding is most important for the nurse to monitor during
the acute phase?
A. Development of coronary artery abnormalities
B. Development of dental caries
C. Increasing muscle strength
D. Improvement in visual acuity
Answer: A
Rationale: Kawasaki disease causes systemic vasculitis with a major risk of coronary
artery aneurysm and other cardiac complications. Cardiac monitoring and follow-up
echocardiography are therefore essential.
QUESTION 10
A 15-month-old child is brought to the clinic because the parent reports that the child
"lost several words" previously used consistently and has stopped making eye
contact. Which nursing response is most appropriate?
A. "Language regression is expected during the second year of life."
B. "This is probably caused by normal separation anxiety."
C. "Regression warrants prompt developmental evaluation."
D. "Wait until age 3 before pursuing developmental assessment."
Answer: C
Rationale: Loss of previously acquired developmental skills is a red flag and
warrants prompt evaluation. Regression is not considered a normal developmental
milestone.
QUESTION 11
A child with sickle cell disease is hospitalized with severe vaso-occlusive pain.
The child rates pain as 9/10 and has received prescribed opioid analgesia.
Which additional nursing intervention is most appropriate?
A. Restrict oral fluids to reduce renal workload.
B. Encourage adequate hydration and oxygenation as clinically indicated.
C. Apply prolonged cold packs directly to painful joints.
D. Encourage strenuous exercise to improve circulation.
Answer: B
Rationale: Hydration helps reduce blood viscosity, while oxygen should be
administered when hypoxemia is present. Pain management, rest, warmth, and
treatment of precipitating factors are important components of vaso-occlusive crisis
management.
QUESTION 12
