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 of the following findings should the nurse report
to the provider as a potential concern?
A. The infant has a positive Moro reflex.
B. The infant has a positive Babinski reflex.
C. The infant is unable to sit without support.
D. The infant has a closed anterior fontanel.
CORRECT ANSWER: D. The infant has a closed anterior fontanel.
Rationale: The anterior fontanel typically closes between 12 and 18 months
of age. A closed anterior fontanel at 6 months is an abnormal finding that
may indicate craniosynostosis or other pathology and should be reported.
The Moro reflex disappears by 4 months, but its presence at 6 months
would also be concerning; however, a closed fontanel is the most definitive
abnormal finding listed. The Babinski reflex can persist until 12 months.
Sitting without support is typically achieved by 8 months, so inability at 6
months is not necessarily a concern.
Question 2: A nurse is caring for a 2-year-old child who has been
diagnosed with croup. Which of the following clinical
manifestations should the nurse expect?
A. Inspiratory stridor and a barking cough
B. Expiratory wheezing and prolonged expiration
C. High fever and drooling
D. Unilateral wheezing and decreased breath sounds
CORRECT ANSWER: A. Inspiratory stridor and a barking cough
Rationale: Croup (laryngotracheobronchitis) is characterized by inspiratory
stridor, a barking or seal-like cough, hoarseness, and low-grade fever.
Expiratory wheezing and prolonged expiration are more consistent with
,asthma or bronchiolitis. High fever and drooling are classic signs of
epiglottitis. Unilateral wheezing and decreased breath sounds suggest a
foreign body aspiration.
Question 3: A nurse is preparing to administer digoxin to a 9-
month-old infant with heart failure. Which of the following
assessments should the nurse perform prior to administration?
A. Blood pressure
B. Apical heart rate for one full minute
C. Respiratory rate
D. Oxygen saturation
CORRECT ANSWER: B. Apical heart rate for one full minute
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. Before
administration, the nurse must assess the apical pulse for one full minute. In
infants, the dose should be withheld if the apical heart rate is below 90 to
110 beats per minute (depending on the institution's protocol). Blood
pressure, respiratory rate, and oxygen saturation are important assessments
but are not the priority before digoxin administration.
Question 4: A nurse is teaching the parents of a child with sickle
cell anemia about ways to prevent vaso-occlusive crises. Which of
the following instructions should the nurse include?
A. Encourage vigorous exercise daily
B. Maintain adequate hydration
C. Apply cold compresses to painful areas
D. Restrict fluids to prevent overload
CORRECT ANSWER: B. Maintain adequate hydration
Rationale: Hydration helps reduce blood viscosity and prevents sickling,
thereby reducing the risk of vaso-occlusive crises. Vigorous exercise can
precipitate a crisis due to increased oxygen demand and dehydration. Cold
compresses cause vasoconstriction, which can worsen sickling. Fluid
restriction is contraindicated; adequate hydration is essential.
,Question 5: A nurse is assessing a 4-year-old child who has
suspected epiglottitis. Which of the following actions should the
nurse take first?
A. Obtain a throat culture
B. Inspect the throat with a tongue blade
C. Keep the child calm and in a comfortable position
D. Administer a broad-spectrum antibiotic
CORRECT ANSWER: C. Keep the child calm and in a comfortable
position
Rationale: Epiglottitis is a medical emergency that can cause sudden airway
obstruction. The priority is to keep the child calm and avoid any
manipulation of the throat, as this can trigger laryngospasm and complete
airway obstruction. Inspecting the throat with a tongue blade and obtaining
a throat culture are contraindicated. Antibiotics are administered after the
airway is secured.
Question 6: A nurse is calculating the maintenance fluid
requirements for a 10 kg child using the Holliday-Segar method.
How many mL should the child receive per day?
A. 500 mL
B. 750 mL
C. 1000 mL
D. 1500 mL
CORRECT ANSWER: C. 1000 mL
Rationale: The Holliday-Segar method for maintenance fluids is: 100
mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20
mL/kg/day for each kg above 20 kg. For a 10 kg child: 10 kg × 100 mL/kg
= 1000 mL/day.
Question 7: A nurse is caring for a child who has just returned from
surgery following a tonsillectomy. Which of the following findings
should the nurse report immediately?
, A. Frequent swallowing
B. Slight blood-tinged saliva
C. Complaint of mild throat pain
D. Refusal to drink clear liquids
CORRECT ANSWER: A. Frequent swallowing
Rationale: Frequent swallowing after a tonsillectomy may indicate bleeding
in the throat that the child is swallowing. This is a sign of hemorrhage and
should be reported immediately. Slight blood-tinged saliva is expected. Mild
throat pain is expected and can be managed with analgesia. Refusal to
drink may indicate pain or nausea but is not the priority over potential
hemorrhage.
Question 8: A nurse is providing education to the parents of a child
with febrile seizures. Which of the following statements by the
parent indicates a need for further teaching?
A. "I will give my child acetaminophen or ibuprofen to reduce fever."
B. "I will place my child in a cool bath during a seizure."
C. "I will keep my child away from sharp objects during a seizure."
D. "I will call 911 if the seizure lasts longer than 5 minutes."
CORRECT ANSWER: B. "I will place my child in a cool bath during
a seizure."
Rationale: Placing a child in a cool bath during a seizure is dangerous and
can lead to aspiration, injury, or hypothermia. During a seizure, the child
should be placed on their side on a safe surface, with nothing in the mouth.
Antipyretics are appropriate for fever management. Removing sharp objects
is correct. Calling 911 for a seizure lasting longer than 5 minutes is
appropriate.
Question 9: A nurse is assessing a newborn 1 minute after birth.
The newborn has a heart rate of 110 bpm, a slow weak cry, some
flexion of extremities, a grimace when stimulated, and a blue body
with pink extremities. What is the Apgar score?
A. 4
B. 5
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 of the following findings should the nurse report
to the provider as a potential concern?
A. The infant has a positive Moro reflex.
B. The infant has a positive Babinski reflex.
C. The infant is unable to sit without support.
D. The infant has a closed anterior fontanel.
CORRECT ANSWER: D. The infant has a closed anterior fontanel.
Rationale: The anterior fontanel typically closes between 12 and 18 months
of age. A closed anterior fontanel at 6 months is an abnormal finding that
may indicate craniosynostosis or other pathology and should be reported.
The Moro reflex disappears by 4 months, but its presence at 6 months
would also be concerning; however, a closed fontanel is the most definitive
abnormal finding listed. The Babinski reflex can persist until 12 months.
Sitting without support is typically achieved by 8 months, so inability at 6
months is not necessarily a concern.
Question 2: A nurse is caring for a 2-year-old child who has been
diagnosed with croup. Which of the following clinical
manifestations should the nurse expect?
A. Inspiratory stridor and a barking cough
B. Expiratory wheezing and prolonged expiration
C. High fever and drooling
D. Unilateral wheezing and decreased breath sounds
CORRECT ANSWER: A. Inspiratory stridor and a barking cough
Rationale: Croup (laryngotracheobronchitis) is characterized by inspiratory
stridor, a barking or seal-like cough, hoarseness, and low-grade fever.
Expiratory wheezing and prolonged expiration are more consistent with
,asthma or bronchiolitis. High fever and drooling are classic signs of
epiglottitis. Unilateral wheezing and decreased breath sounds suggest a
foreign body aspiration.
Question 3: A nurse is preparing to administer digoxin to a 9-
month-old infant with heart failure. Which of the following
assessments should the nurse perform prior to administration?
A. Blood pressure
B. Apical heart rate for one full minute
C. Respiratory rate
D. Oxygen saturation
CORRECT ANSWER: B. Apical heart rate for one full minute
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. Before
administration, the nurse must assess the apical pulse for one full minute. In
infants, the dose should be withheld if the apical heart rate is below 90 to
110 beats per minute (depending on the institution's protocol). Blood
pressure, respiratory rate, and oxygen saturation are important assessments
but are not the priority before digoxin administration.
Question 4: A nurse is teaching the parents of a child with sickle
cell anemia about ways to prevent vaso-occlusive crises. Which of
the following instructions should the nurse include?
A. Encourage vigorous exercise daily
B. Maintain adequate hydration
C. Apply cold compresses to painful areas
D. Restrict fluids to prevent overload
CORRECT ANSWER: B. Maintain adequate hydration
Rationale: Hydration helps reduce blood viscosity and prevents sickling,
thereby reducing the risk of vaso-occlusive crises. Vigorous exercise can
precipitate a crisis due to increased oxygen demand and dehydration. Cold
compresses cause vasoconstriction, which can worsen sickling. Fluid
restriction is contraindicated; adequate hydration is essential.
,Question 5: A nurse is assessing a 4-year-old child who has
suspected epiglottitis. Which of the following actions should the
nurse take first?
A. Obtain a throat culture
B. Inspect the throat with a tongue blade
C. Keep the child calm and in a comfortable position
D. Administer a broad-spectrum antibiotic
CORRECT ANSWER: C. Keep the child calm and in a comfortable
position
Rationale: Epiglottitis is a medical emergency that can cause sudden airway
obstruction. The priority is to keep the child calm and avoid any
manipulation of the throat, as this can trigger laryngospasm and complete
airway obstruction. Inspecting the throat with a tongue blade and obtaining
a throat culture are contraindicated. Antibiotics are administered after the
airway is secured.
Question 6: A nurse is calculating the maintenance fluid
requirements for a 10 kg child using the Holliday-Segar method.
How many mL should the child receive per day?
A. 500 mL
B. 750 mL
C. 1000 mL
D. 1500 mL
CORRECT ANSWER: C. 1000 mL
Rationale: The Holliday-Segar method for maintenance fluids is: 100
mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20
mL/kg/day for each kg above 20 kg. For a 10 kg child: 10 kg × 100 mL/kg
= 1000 mL/day.
Question 7: A nurse is caring for a child who has just returned from
surgery following a tonsillectomy. Which of the following findings
should the nurse report immediately?
, A. Frequent swallowing
B. Slight blood-tinged saliva
C. Complaint of mild throat pain
D. Refusal to drink clear liquids
CORRECT ANSWER: A. Frequent swallowing
Rationale: Frequent swallowing after a tonsillectomy may indicate bleeding
in the throat that the child is swallowing. This is a sign of hemorrhage and
should be reported immediately. Slight blood-tinged saliva is expected. Mild
throat pain is expected and can be managed with analgesia. Refusal to
drink may indicate pain or nausea but is not the priority over potential
hemorrhage.
Question 8: A nurse is providing education to the parents of a child
with febrile seizures. Which of the following statements by the
parent indicates a need for further teaching?
A. "I will give my child acetaminophen or ibuprofen to reduce fever."
B. "I will place my child in a cool bath during a seizure."
C. "I will keep my child away from sharp objects during a seizure."
D. "I will call 911 if the seizure lasts longer than 5 minutes."
CORRECT ANSWER: B. "I will place my child in a cool bath during
a seizure."
Rationale: Placing a child in a cool bath during a seizure is dangerous and
can lead to aspiration, injury, or hypothermia. During a seizure, the child
should be placed on their side on a safe surface, with nothing in the mouth.
Antipyretics are appropriate for fever management. Removing sharp objects
is correct. Calling 911 for a seizure lasting longer than 5 minutes is
appropriate.
Question 9: A nurse is assessing a newborn 1 minute after birth.
The newborn has a heart rate of 110 bpm, a slow weak cry, some
flexion of extremities, a grimace when stimulated, and a blue body
with pink extremities. What is the Apgar score?
A. 4
B. 5
