RN Pediatrics ATI Proctored Exam 2026 with
Questions and Verified Rationalized Answers,
100% Guarantee Pass
Item ID: ATI-PEDS-2026-001
Item Type: NGN - Pediatric Focus
Patient Scenario: 4-month-old infant, birth weight 3.2 kg, now 5.8 kg. Parents report
“cold symptoms” for 2 days. Assessment: RR 48/min, HR 160 bpm, axillary temp 38.1
°C, SpO₂ 94 % room air. Nasal flaring + moderate intercostal retractions. Parents ask if
they can use over-the-counter cough syrup “like we use for our 5-year-old.”
Question Stem: Which parent teaching is essential? (Select all that apply.)
A. “You may give 2 mL of infant acetaminophen every 4 hours for fever.”
B. “OTC cough syrup is safe if you use half the toddler dose.”
C. “Keep baby upright in your arms after feeds to ease breathing.”
D. “Watch for 10 seconds to count respirations when baby is quiet.”
E. “Bring baby to ED if you see blue color around lips.”
(Correct Answer: C, D, E)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: C, D, E
● Pediatric Clinical Judgment Rationalization: 4-month-olds are obligate
nose-breathers; positioning helps reduce airway obstruction (AAP 2026).
, Respiratory count must be obtained when infant is calm to avoid false elevation.
Cyanosis is a late sign of respiratory failure requiring immediate care.
● Distractor Justification: A is incorrect—dosing should be weight-based (10–15
mg/kg) and interval 6 h for term infants >3 months. B violates AAP warning
against OTC cough/cold products <4 years.
Item ID: ATI-PEDS-2026-002
Item Type: Complex Peds App
Patient Scenario: 13-year-old adolescent, weight 48 kg, newly diagnosed type 1
diabetes. Blood glucose 420 mg/dL, serum ketones 4.8 mmol/L, pH 7.22. Physician
orders 0.9 % NS 20 mL/kg bolus.
Question Stem: Calculate the exact fluid volume for the bolus.
A. 480 mL
B. 720 mL
C. 960 mL
D. 1000 mL
(Correct Answer: 960 mL)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 960 mL
● Pediatric Clinical Judgment Rationalization: 48 kg × 20 mL/kg = 960 mL. ADA
2026 DKA guidelines specify 20 mL/kg over 30–60 min for pediatric patients.
● Distractor Justification: 480 mL is 10 mL/kg (under-resuscitation); 720 mL is 15
mL/kg; 1000 mL exceeds calculated need and disregards weight-based
precision.
Item ID: ATI-PEDS-2026-003
,Item Type: NGN - Pediatric Focus
Patient Scenario: 18-month-old toddler, weight 11 kg, admitted with moderate
dehydration (5 %). IV access unsuccessful after 3 attempts. Physician orders
nasogastric rehydration.
Question Stem: Drag-and-drop the correct steps for safe nasogastric rehydration. (Place
an “X” on the 4 correct steps in order.)
1. Measure tube from nose to earlobe to mid-umbilicus.
2. Use plain water for initial fluid.
3. Confirm placement with pH ≤5 and auscultation.
4. Administer 50 mL/kg over 4 h.
5. Secure tube with transparent dressing.
6. Use WHO low-osmolarity ORS at 10 mL/kg/h.
(Correct Sequence: 1, 3, 6, 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Sequence: 1, 3, 6, 5
● Pediatric Clinical Judgment Rationalization: NEXUS length ensures correct
gastric placement; pH ≤5 confirms acid environment. WHO ORS osmolarity 245
mOsm/L prevents osmotic diarrhea. Rate 10 mL/kg/h replaces deficit safely over
4 h.
● Distractor Justification: Step 2 (plain water) causes hyponatremia; Step 4 (50
mL/kg over 4 h) equals 12.5 mL/kg/h—exceeds gastric emptying rate for
toddlers (max 10 mL/kg/h).
Item ID: ATI-PEDS-2026-004
Item Type: Complex Peds App
Patient Scenario: 6-year-old child, weight 22 kg, admitted with acute asthma
exacerbation. Continuous albuterol at 20 mg/h is infusing. Respiratory rate 36/min,
SpO₂ 91 %, accessory muscles used.
Question Stem: Which intervention is priority?
, A. Switch to levalbuterol 15 mg/h
B. Add magnesium sulfate 50 mg/kg IV over 20 min (max 2 g)
C. Initiate high-flow nasal cannula at 2 L/kg/min
D. Obtain immediate chest X-ray
(Correct Answer: B)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: B
● Pediatric Clinical Judgment Rationalization: 2026 EPR-4 guidelines list
magnesium as first-line adjunct for severe exacerbation (FEV₁ <50 % or
persistent hypoxemia). Dose 50 mg/kg smooths bronchodilation within 20 min.
● Distractor Justification: Levalbuterol offers no outcome advantage over racemic
albuterol per 2026 Cochrane. High-flow may be beneficial but does not address
underlying bronchospasm. CXR is low yield unless focal findings.
Item ID: ATI-PEDS-2026-005
Item Type: NGN - Pediatric Focus
Patient Scenario: 2-day-old newborn, 38 weeks’ gestation, weight 3.1 kg. Screening CBG
47 mg/dL. Baby is jittery but not feeding well. Mother plans to breastfeed.
Question Stem: Which actions are appropriate? (Select all that apply.)
A. Offer 15 mL sterile water orally.
B. Provide 10 mL expressed breast milk via syringe.
C. Apply heel warm pack for 5 min before repeat CBG.
D. Maintain skin-to-skin contact.
Questions and Verified Rationalized Answers,
100% Guarantee Pass
Item ID: ATI-PEDS-2026-001
Item Type: NGN - Pediatric Focus
Patient Scenario: 4-month-old infant, birth weight 3.2 kg, now 5.8 kg. Parents report
“cold symptoms” for 2 days. Assessment: RR 48/min, HR 160 bpm, axillary temp 38.1
°C, SpO₂ 94 % room air. Nasal flaring + moderate intercostal retractions. Parents ask if
they can use over-the-counter cough syrup “like we use for our 5-year-old.”
Question Stem: Which parent teaching is essential? (Select all that apply.)
A. “You may give 2 mL of infant acetaminophen every 4 hours for fever.”
B. “OTC cough syrup is safe if you use half the toddler dose.”
C. “Keep baby upright in your arms after feeds to ease breathing.”
D. “Watch for 10 seconds to count respirations when baby is quiet.”
E. “Bring baby to ED if you see blue color around lips.”
(Correct Answer: C, D, E)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: C, D, E
● Pediatric Clinical Judgment Rationalization: 4-month-olds are obligate
nose-breathers; positioning helps reduce airway obstruction (AAP 2026).
, Respiratory count must be obtained when infant is calm to avoid false elevation.
Cyanosis is a late sign of respiratory failure requiring immediate care.
● Distractor Justification: A is incorrect—dosing should be weight-based (10–15
mg/kg) and interval 6 h for term infants >3 months. B violates AAP warning
against OTC cough/cold products <4 years.
Item ID: ATI-PEDS-2026-002
Item Type: Complex Peds App
Patient Scenario: 13-year-old adolescent, weight 48 kg, newly diagnosed type 1
diabetes. Blood glucose 420 mg/dL, serum ketones 4.8 mmol/L, pH 7.22. Physician
orders 0.9 % NS 20 mL/kg bolus.
Question Stem: Calculate the exact fluid volume for the bolus.
A. 480 mL
B. 720 mL
C. 960 mL
D. 1000 mL
(Correct Answer: 960 mL)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 960 mL
● Pediatric Clinical Judgment Rationalization: 48 kg × 20 mL/kg = 960 mL. ADA
2026 DKA guidelines specify 20 mL/kg over 30–60 min for pediatric patients.
● Distractor Justification: 480 mL is 10 mL/kg (under-resuscitation); 720 mL is 15
mL/kg; 1000 mL exceeds calculated need and disregards weight-based
precision.
Item ID: ATI-PEDS-2026-003
,Item Type: NGN - Pediatric Focus
Patient Scenario: 18-month-old toddler, weight 11 kg, admitted with moderate
dehydration (5 %). IV access unsuccessful after 3 attempts. Physician orders
nasogastric rehydration.
Question Stem: Drag-and-drop the correct steps for safe nasogastric rehydration. (Place
an “X” on the 4 correct steps in order.)
1. Measure tube from nose to earlobe to mid-umbilicus.
2. Use plain water for initial fluid.
3. Confirm placement with pH ≤5 and auscultation.
4. Administer 50 mL/kg over 4 h.
5. Secure tube with transparent dressing.
6. Use WHO low-osmolarity ORS at 10 mL/kg/h.
(Correct Sequence: 1, 3, 6, 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Sequence: 1, 3, 6, 5
● Pediatric Clinical Judgment Rationalization: NEXUS length ensures correct
gastric placement; pH ≤5 confirms acid environment. WHO ORS osmolarity 245
mOsm/L prevents osmotic diarrhea. Rate 10 mL/kg/h replaces deficit safely over
4 h.
● Distractor Justification: Step 2 (plain water) causes hyponatremia; Step 4 (50
mL/kg over 4 h) equals 12.5 mL/kg/h—exceeds gastric emptying rate for
toddlers (max 10 mL/kg/h).
Item ID: ATI-PEDS-2026-004
Item Type: Complex Peds App
Patient Scenario: 6-year-old child, weight 22 kg, admitted with acute asthma
exacerbation. Continuous albuterol at 20 mg/h is infusing. Respiratory rate 36/min,
SpO₂ 91 %, accessory muscles used.
Question Stem: Which intervention is priority?
, A. Switch to levalbuterol 15 mg/h
B. Add magnesium sulfate 50 mg/kg IV over 20 min (max 2 g)
C. Initiate high-flow nasal cannula at 2 L/kg/min
D. Obtain immediate chest X-ray
(Correct Answer: B)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: B
● Pediatric Clinical Judgment Rationalization: 2026 EPR-4 guidelines list
magnesium as first-line adjunct for severe exacerbation (FEV₁ <50 % or
persistent hypoxemia). Dose 50 mg/kg smooths bronchodilation within 20 min.
● Distractor Justification: Levalbuterol offers no outcome advantage over racemic
albuterol per 2026 Cochrane. High-flow may be beneficial but does not address
underlying bronchospasm. CXR is low yield unless focal findings.
Item ID: ATI-PEDS-2026-005
Item Type: NGN - Pediatric Focus
Patient Scenario: 2-day-old newborn, 38 weeks’ gestation, weight 3.1 kg. Screening CBG
47 mg/dL. Baby is jittery but not feeding well. Mother plans to breastfeed.
Question Stem: Which actions are appropriate? (Select all that apply.)
A. Offer 15 mL sterile water orally.
B. Provide 10 mL expressed breast milk via syringe.
C. Apply heel warm pack for 5 min before repeat CBG.
D. Maintain skin-to-skin contact.
