ATI Pediatrics Nursing Exam 2026/2027 |
ACTUAL-Style Practice Questions & Answers,
Pediatric Nursing, Growth and Development,
Childhood Disorders, Medication Safety, and
Detailed Rationales
Question 1: A nurse is assessing a 6-month-old infant during a well-
child visit. Which finding should the nurse report to the provider as a
concern?
A. The infant has a positive Babinski reflex.
B. The infant can sit without support.
C. The infant has a persistent Moro reflex.
D. The infant has a grasp reflex that is fading.
CORRECT ANSWER: C. The infant has a persistent Moro reflex.
Rationale: The Moro reflex is a primitive reflex that typically disappears by 3
to 4 months of age. Persistence beyond 6 months may indicate
neurological impairment and should be reported. The Babinski reflex can
remain positive until 12 months, sitting without support is expected by 8
months but may be seen earlier, and the grasp reflex fades by 3 to 4
months.
Question 2: A nurse is caring for a 4-year-old child who has been
diagnosed with acute otitis media. Which manifestation should the
nurse expect?
A. Clear drainage from the ear canal
B. Increased appetite
C. Pulling at the affected ear
D. Decreased temperature
CORRECT ANSWER: C. Pulling at the affected ear
Rationale: Children with acute otitis media often pull at the affected ear
due to pain and pressure. Fever, irritability, and decreased appetite are
common. Clear drainage is more consistent with serous otitis media or a
ruptured tympanic membrane, not acute infection.
Question 3: A nurse is preparing to administer digoxin to a 2-year-old
child with heart failure. Which assessment finding should the nurse
report before administering the medication?
,A. Heart rate of 80 beats per minute
B. Blood pressure of 100/60 mm Hg
C. Respiratory rate of 24 breaths per minute
D. Serum potassium level of 5.8 mEq/L
CORRECT ANSWER: A. Heart rate of 80 beats per minute
Rationale: Digoxin should be withheld if the heart rate is below 90 beats per
minute in infants and young children, as bradycardia is a sign of digoxin
toxicity. The nurse should hold the medication and notify the provider.
Blood pressure and respiratory rate are within normal limits, and potassium
level should be monitored but is not the priority for withholding digoxin.
Question 4: A nurse is teaching the parents of a child with sickle cell
anemia about preventing vaso-occlusive crises. Which instruction
should the nurse include?
A. Encourage strenuous exercise daily.
B. Administer aspirin for pain.
C. Ensure adequate hydration.
D. Restrict fluids to prevent edema.
CORRECT ANSWER: C. Ensure adequate hydration.
Rationale: Hydration helps prevent sickling and vaso-occlusion by
decreasing blood viscosity. Strenuous exercise can precipitate a crisis,
aspirin is avoided in children due to Reye syndrome risk, and fluid
restriction would worsen sickling.
Question 5: A nurse is assessing a newborn immediately after delivery.
Which finding should the nurse identify as a sign of respiratory
distress?
A. Respiratory rate of 40 breaths per minute
B. Nasal flaring and grunting
C. Acrocyanosis
D. Heart rate of 130 beats per minute
CORRECT ANSWER: B. Nasal flaring and grunting
Rationale: Nasal flaring, grunting, and intercostal retractions are signs of
respiratory distress in newborns. A respiratory rate of 40 is normal,
,acrocyanosis is common in the first hours after birth, and a heart rate of
130 is within normal limits.
Question 6: A nurse is caring for a 10-year-old child with type 1 diabetes
mellitus. Which finding indicates the child is experiencing
hypoglycemia?
A. Blood glucose 250 mg/dL, thirst, and polyuria
B. Blood glucose 50 mg/dL, shakiness, and confusion
C. Blood glucose 300 mg/dL, Kussmaul respirations, and fruity breath
D. Blood glucose 180 mg/dL, weight loss, and fatigue
CORRECT ANSWER: B. Blood glucose 50 mg/dL, shakiness, and
confusion
Rationale: Hypoglycemia is defined as blood glucose below 70 mg/dL and
manifests with shakiness, confusion, sweating, and hunger. Hyperglycemia
presents with thirst, polyuria, and fatigue. Kussmaul respirations and fruity
breath indicate diabetic ketoacidosis.
Question 7: A nurse is reviewing the immunization schedule for a 2-
month-old infant. Which vaccine should the nurse anticipate
administering?
A. Measles, mumps, rubella (MMR)
B. Varicella
C. Diphtheria, tetanus, acellular pertussis (DTaP)
D. Human papillomavirus (HPV)
CORRECT ANSWER: C. Diphtheria, tetanus, acellular pertussis (DTaP)
Rationale: DTaP is administered at 2, 4, 6, and 15 to 18 months, and 4 to 6
years. MMR and varicella are given at 12 to 15 months. HPV is
recommended at 11 to 12 years.
Question 8: A nurse is assessing a 3-year-old child with suspected
epiglottitis. Which action should the nurse take first?
A. Obtain a throat culture.
B. Inspect the throat with a tongue depressor.
C. Keep the child calm and upright.
D. Administer oral antibiotics.
CORRECT ANSWER: C. Keep the child calm and upright.
, Rationale: Epiglottitis can cause sudden airway obstruction. The nurse
should avoid examining the throat or using a tongue depressor, which can
trigger laryngospasm. Keeping the child calm and upright helps maintain
airway patency. Antibiotics are given after airway stabilization.
Question 9: A nurse is caring for a child with nephrotic syndrome.
Which finding should the nurse expect?
A. Hematuria and hypertension
B. Proteinuria and edema
C. Polyuria and dehydration
D. Hypoglycemia and seizures
CORRECT ANSWER: B. Proteinuria and edema
Rationale: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, edema, and hyperlipidemia. Hematuria and
hypertension are more consistent with acute glomerulonephritis.
Question 10: A nurse is teaching a parent about car seat safety for a 3-
year-old child who weighs 35 lb (15.9 kg). Which instruction should the
nurse include?
A. Use a rear-facing car seat until age 4.
B. Use a forward-facing car seat with a harness.
C. Use a booster seat with a lap belt only.
D. Allow the child to sit in the front seat.
CORRECT ANSWER: B. Use a forward-facing car seat with a harness.
Rationale: Children should remain in a forward-facing car seat with a
harness until they reach the maximum height and weight for the seat,
typically around 40 to 65 lb. A booster seat is used after the harnessed
seat, and children under 13 should sit in the back seat.
Question 11: A nurse is assessing a 6-month-old infant for
developmental milestones. Which finding indicates a need for further
evaluation?
A. The infant can roll from back to abdomen.
B. The infant can hold a bottle with both hands.
C. The infant cannot sit without support.
D. The infant cannot transfer objects from hand to hand.
ACTUAL-Style Practice Questions & Answers,
Pediatric Nursing, Growth and Development,
Childhood Disorders, Medication Safety, and
Detailed Rationales
Question 1: A nurse is assessing a 6-month-old infant during a well-
child visit. Which finding should the nurse report to the provider as a
concern?
A. The infant has a positive Babinski reflex.
B. The infant can sit without support.
C. The infant has a persistent Moro reflex.
D. The infant has a grasp reflex that is fading.
CORRECT ANSWER: C. The infant has a persistent Moro reflex.
Rationale: The Moro reflex is a primitive reflex that typically disappears by 3
to 4 months of age. Persistence beyond 6 months may indicate
neurological impairment and should be reported. The Babinski reflex can
remain positive until 12 months, sitting without support is expected by 8
months but may be seen earlier, and the grasp reflex fades by 3 to 4
months.
Question 2: A nurse is caring for a 4-year-old child who has been
diagnosed with acute otitis media. Which manifestation should the
nurse expect?
A. Clear drainage from the ear canal
B. Increased appetite
C. Pulling at the affected ear
D. Decreased temperature
CORRECT ANSWER: C. Pulling at the affected ear
Rationale: Children with acute otitis media often pull at the affected ear
due to pain and pressure. Fever, irritability, and decreased appetite are
common. Clear drainage is more consistent with serous otitis media or a
ruptured tympanic membrane, not acute infection.
Question 3: A nurse is preparing to administer digoxin to a 2-year-old
child with heart failure. Which assessment finding should the nurse
report before administering the medication?
,A. Heart rate of 80 beats per minute
B. Blood pressure of 100/60 mm Hg
C. Respiratory rate of 24 breaths per minute
D. Serum potassium level of 5.8 mEq/L
CORRECT ANSWER: A. Heart rate of 80 beats per minute
Rationale: Digoxin should be withheld if the heart rate is below 90 beats per
minute in infants and young children, as bradycardia is a sign of digoxin
toxicity. The nurse should hold the medication and notify the provider.
Blood pressure and respiratory rate are within normal limits, and potassium
level should be monitored but is not the priority for withholding digoxin.
Question 4: A nurse is teaching the parents of a child with sickle cell
anemia about preventing vaso-occlusive crises. Which instruction
should the nurse include?
A. Encourage strenuous exercise daily.
B. Administer aspirin for pain.
C. Ensure adequate hydration.
D. Restrict fluids to prevent edema.
CORRECT ANSWER: C. Ensure adequate hydration.
Rationale: Hydration helps prevent sickling and vaso-occlusion by
decreasing blood viscosity. Strenuous exercise can precipitate a crisis,
aspirin is avoided in children due to Reye syndrome risk, and fluid
restriction would worsen sickling.
Question 5: A nurse is assessing a newborn immediately after delivery.
Which finding should the nurse identify as a sign of respiratory
distress?
A. Respiratory rate of 40 breaths per minute
B. Nasal flaring and grunting
C. Acrocyanosis
D. Heart rate of 130 beats per minute
CORRECT ANSWER: B. Nasal flaring and grunting
Rationale: Nasal flaring, grunting, and intercostal retractions are signs of
respiratory distress in newborns. A respiratory rate of 40 is normal,
,acrocyanosis is common in the first hours after birth, and a heart rate of
130 is within normal limits.
Question 6: A nurse is caring for a 10-year-old child with type 1 diabetes
mellitus. Which finding indicates the child is experiencing
hypoglycemia?
A. Blood glucose 250 mg/dL, thirst, and polyuria
B. Blood glucose 50 mg/dL, shakiness, and confusion
C. Blood glucose 300 mg/dL, Kussmaul respirations, and fruity breath
D. Blood glucose 180 mg/dL, weight loss, and fatigue
CORRECT ANSWER: B. Blood glucose 50 mg/dL, shakiness, and
confusion
Rationale: Hypoglycemia is defined as blood glucose below 70 mg/dL and
manifests with shakiness, confusion, sweating, and hunger. Hyperglycemia
presents with thirst, polyuria, and fatigue. Kussmaul respirations and fruity
breath indicate diabetic ketoacidosis.
Question 7: A nurse is reviewing the immunization schedule for a 2-
month-old infant. Which vaccine should the nurse anticipate
administering?
A. Measles, mumps, rubella (MMR)
B. Varicella
C. Diphtheria, tetanus, acellular pertussis (DTaP)
D. Human papillomavirus (HPV)
CORRECT ANSWER: C. Diphtheria, tetanus, acellular pertussis (DTaP)
Rationale: DTaP is administered at 2, 4, 6, and 15 to 18 months, and 4 to 6
years. MMR and varicella are given at 12 to 15 months. HPV is
recommended at 11 to 12 years.
Question 8: A nurse is assessing a 3-year-old child with suspected
epiglottitis. Which action should the nurse take first?
A. Obtain a throat culture.
B. Inspect the throat with a tongue depressor.
C. Keep the child calm and upright.
D. Administer oral antibiotics.
CORRECT ANSWER: C. Keep the child calm and upright.
, Rationale: Epiglottitis can cause sudden airway obstruction. The nurse
should avoid examining the throat or using a tongue depressor, which can
trigger laryngospasm. Keeping the child calm and upright helps maintain
airway patency. Antibiotics are given after airway stabilization.
Question 9: A nurse is caring for a child with nephrotic syndrome.
Which finding should the nurse expect?
A. Hematuria and hypertension
B. Proteinuria and edema
C. Polyuria and dehydration
D. Hypoglycemia and seizures
CORRECT ANSWER: B. Proteinuria and edema
Rationale: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, edema, and hyperlipidemia. Hematuria and
hypertension are more consistent with acute glomerulonephritis.
Question 10: A nurse is teaching a parent about car seat safety for a 3-
year-old child who weighs 35 lb (15.9 kg). Which instruction should the
nurse include?
A. Use a rear-facing car seat until age 4.
B. Use a forward-facing car seat with a harness.
C. Use a booster seat with a lap belt only.
D. Allow the child to sit in the front seat.
CORRECT ANSWER: B. Use a forward-facing car seat with a harness.
Rationale: Children should remain in a forward-facing car seat with a
harness until they reach the maximum height and weight for the seat,
typically around 40 to 65 lb. A booster seat is used after the harnessed
seat, and children under 13 should sit in the back seat.
Question 11: A nurse is assessing a 6-month-old infant for
developmental milestones. Which finding indicates a need for further
evaluation?
A. The infant can roll from back to abdomen.
B. The infant can hold a bottle with both hands.
C. The infant cannot sit without support.
D. The infant cannot transfer objects from hand to hand.
