ATI RN PEDIATRIC NURSING LEVEL 3 PROCTORED ASSESSMENT
Complete 70-Question Practice Exam & NGN Case Studies
Aligned with ATI Marking Schemes, Clinical Judgment Measurement Model (CJMM), and NGN
Formats
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Question 1 (Multiple Choice)
A nurse is caring for an 8-month-old infant hospitalized with acute respiratory syncytial virus (RSV)
bronchiolitis. Which of the following interventions should the nurse include?
A) Administer prophylactic oral corticosteroids every 6 hours.
B) Maintain droplet and contact precautions.
C) Suction nares and tracheobronchial tree routinely every 1 hour.
D) Encourage increased oral intake of cow's milk.
Answer: B
Rationale: RSV requires contact and droplet precautions to prevent spread. Corticosteroids are not
routinely indicated unless reactive airway disease is present. Deep routine suctioning causes
mucosal edema; suction PRN. Infants under 1 year should not have cow's milk.
Question 2 (NGN Bowtie)
Case Study: A 4-year-old child presents with high fever, drooling, severe sore throat, muffled voice,
and tripod positioning with inspiratory stridor.
Select: 1 Condition Suspected, 2 Immediate Actions, 2 Parameters to Monitor.
Options:
• Conditions: Acute Epiglottitis | Croup | Foreign Body Aspiration | Bacterial Tracheitis
• Actions: Inspect oropharynx with tongue depressor | Keep child calm in comfortable position |
Prepare for emergency endotracheal intubation | Administer racemic epinephrine
• Parameters: Respiratory rate & work of breathing | Serum electrolytes | Continuous pulse
oximetry | Urine specific gravity
Answer:
• Condition: Acute Epiglottitis
• Actions: Keep the child and parents calm in a comfortable position; Prepare for emergency
endotracheal intubation
• Parameters: Respiratory rate and work of breathing; Oxygen saturation via continuous pulse
oximetry
,Rationale: Epiglottitis is caused by Hib. Examining the throat can precipitate complete airway
obstruction. Keep child calm and secure airway equipment.
Question 3 (Matrix / Multiple Response)
A nurse assesses a 3-year-old toddler. Indicate whether each milestone is Expected or Unexpected:
1. Rides a tricycle with ease
2. Copies a circle when drawing
3. Uses 3-to-4-word sentences
4. Stands on one foot for 5 seconds
Options: Expected / Unexpected for each.
Answers:
1. Rides a tricycle with ease -> Expected (mastered at 3 years)
2. Copies a circle when drawing -> Expected (mastered at 3 years)
3. Uses 3-to-4-word sentences -> Expected (toddler speaks short sentences)
4. Stands on one foot for 5 seconds -> Unexpected (preschool milestone at 4 years)
Question 4 (Multiple Choice)
An emergency nurse cares for a school-age child who ingested acetaminophen 3 hours ago. Which
medication is the specific antidote?
A) Naloxone hydrochloride
B) N-acetylcysteine (NAC)
C) Flumazenil
D) Deferoxamine
Answer: B
Rationale: N-acetylcysteine (NAC) replenishes glutathione to prevent hepatic necrosis following
acetaminophen toxicity.
Question 5 (Multiple Response - SATA)
A nurse teaches parents of a school-age child with newly managed type 1 diabetes about sick-day
management. Which statements indicate understanding? (Select all that apply.)
A) 'We will check blood glucose every 3 hours while sick.'
B) 'We should stop insulin if our child is vomiting and unable to eat solid foods.'
C) 'We will test urine for ketones whenever blood glucose is greater than 240 mg/dL.'
, D) 'We will encourage sugar-free liquids to prevent dehydration.'
E) 'We will call the provider if blood glucose remains above 250 mg/dL despite correction doses.'
Answers: A, C, E
Rationale: Check blood glucose frequently during illness. Never stop insulin during illness (prevents
DKA). Check ketones when glucose >240 mg/dL. Provide carbohydrate-containing fluids if solids
aren't tolerated.
Question 6 (Multiple Choice)
A nurse is assessing a 2-month-old infant during a routine health examination. Which of the
following findings should the nurse report to the provider?
A) Presence of a head lag when pulled to sitting
B) Closure of the anterior fontanel
C) Lack of a social smile
D) Posterior fontanel is palpable
Answer: C
Rationale: A social smile typically emerges around 6 to 8 weeks of age. Head lag is expected at 2
months. The anterior fontanel closes between 12-18 months. The posterior fontanel closes by 2
months.
Question 7 (Multiple Choice)
A nurse is caring for an infant with tetralogy of Fallot who suddenly develops cyanosis and
tachypnea (hypercyanotic 'tet' spell). Which action should the nurse take first?
A) Administer morphine sulfate IV.
B) Place the infant in a knee-chest position.
C) Administer 100% oxygen via face mask.
D) Start an IV fluid bolus.
Answer: B
Rationale: Placing the infant in a knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow. Then administer oxygen and
calm the infant.
Question 8 (Multiple Response - SATA)
Complete 70-Question Practice Exam & NGN Case Studies
Aligned with ATI Marking Schemes, Clinical Judgment Measurement Model (CJMM), and NGN
Formats
---
Question 1 (Multiple Choice)
A nurse is caring for an 8-month-old infant hospitalized with acute respiratory syncytial virus (RSV)
bronchiolitis. Which of the following interventions should the nurse include?
A) Administer prophylactic oral corticosteroids every 6 hours.
B) Maintain droplet and contact precautions.
C) Suction nares and tracheobronchial tree routinely every 1 hour.
D) Encourage increased oral intake of cow's milk.
Answer: B
Rationale: RSV requires contact and droplet precautions to prevent spread. Corticosteroids are not
routinely indicated unless reactive airway disease is present. Deep routine suctioning causes
mucosal edema; suction PRN. Infants under 1 year should not have cow's milk.
Question 2 (NGN Bowtie)
Case Study: A 4-year-old child presents with high fever, drooling, severe sore throat, muffled voice,
and tripod positioning with inspiratory stridor.
Select: 1 Condition Suspected, 2 Immediate Actions, 2 Parameters to Monitor.
Options:
• Conditions: Acute Epiglottitis | Croup | Foreign Body Aspiration | Bacterial Tracheitis
• Actions: Inspect oropharynx with tongue depressor | Keep child calm in comfortable position |
Prepare for emergency endotracheal intubation | Administer racemic epinephrine
• Parameters: Respiratory rate & work of breathing | Serum electrolytes | Continuous pulse
oximetry | Urine specific gravity
Answer:
• Condition: Acute Epiglottitis
• Actions: Keep the child and parents calm in a comfortable position; Prepare for emergency
endotracheal intubation
• Parameters: Respiratory rate and work of breathing; Oxygen saturation via continuous pulse
oximetry
,Rationale: Epiglottitis is caused by Hib. Examining the throat can precipitate complete airway
obstruction. Keep child calm and secure airway equipment.
Question 3 (Matrix / Multiple Response)
A nurse assesses a 3-year-old toddler. Indicate whether each milestone is Expected or Unexpected:
1. Rides a tricycle with ease
2. Copies a circle when drawing
3. Uses 3-to-4-word sentences
4. Stands on one foot for 5 seconds
Options: Expected / Unexpected for each.
Answers:
1. Rides a tricycle with ease -> Expected (mastered at 3 years)
2. Copies a circle when drawing -> Expected (mastered at 3 years)
3. Uses 3-to-4-word sentences -> Expected (toddler speaks short sentences)
4. Stands on one foot for 5 seconds -> Unexpected (preschool milestone at 4 years)
Question 4 (Multiple Choice)
An emergency nurse cares for a school-age child who ingested acetaminophen 3 hours ago. Which
medication is the specific antidote?
A) Naloxone hydrochloride
B) N-acetylcysteine (NAC)
C) Flumazenil
D) Deferoxamine
Answer: B
Rationale: N-acetylcysteine (NAC) replenishes glutathione to prevent hepatic necrosis following
acetaminophen toxicity.
Question 5 (Multiple Response - SATA)
A nurse teaches parents of a school-age child with newly managed type 1 diabetes about sick-day
management. Which statements indicate understanding? (Select all that apply.)
A) 'We will check blood glucose every 3 hours while sick.'
B) 'We should stop insulin if our child is vomiting and unable to eat solid foods.'
C) 'We will test urine for ketones whenever blood glucose is greater than 240 mg/dL.'
, D) 'We will encourage sugar-free liquids to prevent dehydration.'
E) 'We will call the provider if blood glucose remains above 250 mg/dL despite correction doses.'
Answers: A, C, E
Rationale: Check blood glucose frequently during illness. Never stop insulin during illness (prevents
DKA). Check ketones when glucose >240 mg/dL. Provide carbohydrate-containing fluids if solids
aren't tolerated.
Question 6 (Multiple Choice)
A nurse is assessing a 2-month-old infant during a routine health examination. Which of the
following findings should the nurse report to the provider?
A) Presence of a head lag when pulled to sitting
B) Closure of the anterior fontanel
C) Lack of a social smile
D) Posterior fontanel is palpable
Answer: C
Rationale: A social smile typically emerges around 6 to 8 weeks of age. Head lag is expected at 2
months. The anterior fontanel closes between 12-18 months. The posterior fontanel closes by 2
months.
Question 7 (Multiple Choice)
A nurse is caring for an infant with tetralogy of Fallot who suddenly develops cyanosis and
tachypnea (hypercyanotic 'tet' spell). Which action should the nurse take first?
A) Administer morphine sulfate IV.
B) Place the infant in a knee-chest position.
C) Administer 100% oxygen via face mask.
D) Start an IV fluid bolus.
Answer: B
Rationale: Placing the infant in a knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow. Then administer oxygen and
calm the infant.
Question 8 (Multiple Response - SATA)
