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 (Extended Multiple Response)
Patient Scenario: A 4-month-old infant (weight 5.8 kg) is brought to the clinic for a
well-child visit. Parents report she can hold her head steady when upright, laughs aloud,
and reaches for a toy but does not yet transfer it hand-to-hand. She is breast-feeding
every 3–4 h and wakes twice nightly. Birth history: term, NSVD, no complications. Vital
signs: temp 36.8 °C, HR 145 bpm, RR 32/min, BP 82/48 mmHg, SpO₂ 99 % room air.
Head circumference 41 cm (50th percentile). No immunizations received today.
Question Stem:
Which findings require immediate follow-up or intervention today? (Select all that apply.)
A. Head control achieved
B. Absent toy transfer
C. No immunizations received
D. Night waking twice
E. Heart rate 145 bpm
F. Head circumference 41 cm
,(Correct Answer: B and C)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: B and C
● Pediatric Clinical Judgment Rationalization: By 4 months, 90 % of infants transfer
objects hand-to-hand (CDC 2026 milestone). Absence suggests possible
developmental delay requiring referral. No immunizations violates the 2026 CDC
schedule (2-, 4-, 6-month visits); catch-up is mandated. Head control is
appropriate by 4 months, HR 145 is normal range (100–160 bpm), night waking is
typical, and HC 41 cm is 50th percentile—none require intervention.
● Distractor Justification: A, D, E, F are age-appropriate; selecting them
overestimates normal variation or misses critical public-health action.
Item ID: ATI-PEDS-2026-002
Item Type: NGN - Pediatric Focus (Bowtie)
Patient Scenario: A 22-month-old toddler (11.5 kg) arrives with a 3-day history of runny
nose, low-grade fever (38.2 °C), and increasing work of breathing. Today he refuses
fluids, has only 1 wet diaper in 8 h, and audible wheezing. Parents deny previous
wheeze. Assessment: HR 168, RR 42, SpO₂ 91 % RA, moderate intercostal retractions,
nasal flaring, capillary refill 3 s. Breath sounds diminished with diffuse wheeze.
Question Stem:
Place an X on the bowtie diagram where the nurse recognizes impending respiratory
failure.
[Diagram left-to-right: Early distress → Compensated → Decompensated → Failure]
(Correct Answer: Decompensated)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
, ● Correct Answer: Decompensated
● Pediatric Clinical Judgment Rationalization: Toddler shows decreased urine
output (1 diaper/8 h = 50 % maintenance), SpO₂ <92 %, prolonged cap refill, and
moderate retractions—signs of decompensation. Early intervention
(bronchodilator, O₂, IVF) prevents failure.
● Distractor Justification: Selecting “Compensated” underestimates hypoxemia
and oliguria; “Failure” would require apnea or cyanosis despite O₂.
Item ID: ATI-PEDS-2026-003
Item Type: Complex Peds App
Patient Scenario: A 7-year-old girl (24 kg) with newly diagnosed type 1 diabetes is
admitted in DKA. Labs: pH 7.18, HCO₃ 12 mEq/L, glucose 420 mg/dL, K⁺ 3.2 mEq/L.
Orders: IV insulin 0.1 units/kg/h after 0.1 units/kg bolus. Physician also orders
potassium chloride 40 mEq/L to infuse at maintenance.
Question Stem:
What is the priority nursing action before starting the insulin bolus?
A. Obtain blood pressure every 15 min
B. Confirm patent IV with normal saline flush
C. Check urine for ketones
D. Correct hypokalemia to ≥3.5 mEq/L
(Correct Answer: D)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: D
, ● Pediatric Clinical Judgment Rationalization: Insulin drives K⁺ intracellularly;
starting with K⁺ 3.2 risks fatal dysrhythmia. 2026 ADA DKA guideline mandates
K⁺ ≥3.3 mEq/L before insulin.
● Distractor Justification: B is routine but not life-threatening; A and C are
assessments, not corrective actions.
Item ID: ATI-PEDS-2026-004
Item Type: NGN - Pediatric Focus (Drag-and-Drop Calculation)
Patient Scenario: A 9-month-old infant (8.2 kg) is prescribed oral amoxicillin 45
mg/kg/day divided bid for bilateral acute otitis media. Pharmacy supplies amoxicillin
suspension 400 mg/5 mL.
Question Stem:
Drag the correct dose volume (mL) the parent should give every 12 h.
(Correct Answer: 2.3 mL)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 2.3 mL
● Pediatric Clinical Judgment Rationalization: Total daily dose = 45 mg/kg × 8.2 kg
= 369 mg. Per dose = 369 mg ÷ 2 = 184.5 mg. Concentration 400 mg/5 mL → 80
mg/mL. Volume = 184.5 mg ÷ 80 mg/mL = 2.3 mL. AAP 2026 OM guideline
endorses 45 mg/kg/day high-dose for resistant organisms.
● Distractor Justification: Common errors: 1.15 mL (forgetting bid), 4.6 mL (using
daily dose once), 5 mL (assuming 250 mg/dose).
Item ID: ATI-PEDS-2026-005
Item Type: NGN - Pediatric Focus (Matrix Grid)
Questions and Verified Rationalized Answers,
100% Guarantee Pass
Item ID: ATI-PEDS-2026-001
Item Type: NGN - Pediatric Focus (Extended Multiple Response)
Patient Scenario: A 4-month-old infant (weight 5.8 kg) is brought to the clinic for a
well-child visit. Parents report she can hold her head steady when upright, laughs aloud,
and reaches for a toy but does not yet transfer it hand-to-hand. She is breast-feeding
every 3–4 h and wakes twice nightly. Birth history: term, NSVD, no complications. Vital
signs: temp 36.8 °C, HR 145 bpm, RR 32/min, BP 82/48 mmHg, SpO₂ 99 % room air.
Head circumference 41 cm (50th percentile). No immunizations received today.
Question Stem:
Which findings require immediate follow-up or intervention today? (Select all that apply.)
A. Head control achieved
B. Absent toy transfer
C. No immunizations received
D. Night waking twice
E. Heart rate 145 bpm
F. Head circumference 41 cm
,(Correct Answer: B and C)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: B and C
● Pediatric Clinical Judgment Rationalization: By 4 months, 90 % of infants transfer
objects hand-to-hand (CDC 2026 milestone). Absence suggests possible
developmental delay requiring referral. No immunizations violates the 2026 CDC
schedule (2-, 4-, 6-month visits); catch-up is mandated. Head control is
appropriate by 4 months, HR 145 is normal range (100–160 bpm), night waking is
typical, and HC 41 cm is 50th percentile—none require intervention.
● Distractor Justification: A, D, E, F are age-appropriate; selecting them
overestimates normal variation or misses critical public-health action.
Item ID: ATI-PEDS-2026-002
Item Type: NGN - Pediatric Focus (Bowtie)
Patient Scenario: A 22-month-old toddler (11.5 kg) arrives with a 3-day history of runny
nose, low-grade fever (38.2 °C), and increasing work of breathing. Today he refuses
fluids, has only 1 wet diaper in 8 h, and audible wheezing. Parents deny previous
wheeze. Assessment: HR 168, RR 42, SpO₂ 91 % RA, moderate intercostal retractions,
nasal flaring, capillary refill 3 s. Breath sounds diminished with diffuse wheeze.
Question Stem:
Place an X on the bowtie diagram where the nurse recognizes impending respiratory
failure.
[Diagram left-to-right: Early distress → Compensated → Decompensated → Failure]
(Correct Answer: Decompensated)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
, ● Correct Answer: Decompensated
● Pediatric Clinical Judgment Rationalization: Toddler shows decreased urine
output (1 diaper/8 h = 50 % maintenance), SpO₂ <92 %, prolonged cap refill, and
moderate retractions—signs of decompensation. Early intervention
(bronchodilator, O₂, IVF) prevents failure.
● Distractor Justification: Selecting “Compensated” underestimates hypoxemia
and oliguria; “Failure” would require apnea or cyanosis despite O₂.
Item ID: ATI-PEDS-2026-003
Item Type: Complex Peds App
Patient Scenario: A 7-year-old girl (24 kg) with newly diagnosed type 1 diabetes is
admitted in DKA. Labs: pH 7.18, HCO₃ 12 mEq/L, glucose 420 mg/dL, K⁺ 3.2 mEq/L.
Orders: IV insulin 0.1 units/kg/h after 0.1 units/kg bolus. Physician also orders
potassium chloride 40 mEq/L to infuse at maintenance.
Question Stem:
What is the priority nursing action before starting the insulin bolus?
A. Obtain blood pressure every 15 min
B. Confirm patent IV with normal saline flush
C. Check urine for ketones
D. Correct hypokalemia to ≥3.5 mEq/L
(Correct Answer: D)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: D
, ● Pediatric Clinical Judgment Rationalization: Insulin drives K⁺ intracellularly;
starting with K⁺ 3.2 risks fatal dysrhythmia. 2026 ADA DKA guideline mandates
K⁺ ≥3.3 mEq/L before insulin.
● Distractor Justification: B is routine but not life-threatening; A and C are
assessments, not corrective actions.
Item ID: ATI-PEDS-2026-004
Item Type: NGN - Pediatric Focus (Drag-and-Drop Calculation)
Patient Scenario: A 9-month-old infant (8.2 kg) is prescribed oral amoxicillin 45
mg/kg/day divided bid for bilateral acute otitis media. Pharmacy supplies amoxicillin
suspension 400 mg/5 mL.
Question Stem:
Drag the correct dose volume (mL) the parent should give every 12 h.
(Correct Answer: 2.3 mL)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 2.3 mL
● Pediatric Clinical Judgment Rationalization: Total daily dose = 45 mg/kg × 8.2 kg
= 369 mg. Per dose = 369 mg ÷ 2 = 184.5 mg. Concentration 400 mg/5 mL → 80
mg/mL. Volume = 184.5 mg ÷ 80 mg/mL = 2.3 mL. AAP 2026 OM guideline
endorses 45 mg/kg/day high-dose for resistant organisms.
● Distractor Justification: Common errors: 1.15 mL (forgetting bid), 4.6 mL (using
daily dose once), 5 mL (assuming 250 mg/dose).
Item ID: ATI-PEDS-2026-005
Item Type: NGN - Pediatric Focus (Matrix Grid)
