ATI PEDIATRICS 2026/2027 | ATI RN
PEDIATRIC NURSING PROCTORED EXAM &
CMS PRACTICE QUESTIONS WITH CORRECT
ANSWERS AND DETAILED RATIONALES
ATI PEDIATRICS 2026/2027 | RN PEDIATRIC NURSING PROCTORED EXAM & CMS
PRACTICE QUESTIONS
DOCUMENT OVERVIEW
• This comprehensive study guide contains 200 carefully curated multiple-choice
questions designed to mirror the ATI RN Pediatric Nursing Proctored Exam format
and CMS practice assessments, covering all major pediatric nursing competencies
and clinical scenarios.
• Study this material by working through questions in focused blocks (20-30
questions per session), reviewing detailed rationales for both correct and incorrect
answers, and identifying knowledge gaps to target with additional study—
consistent daily practice will strengthen clinical reasoning and exam readiness.
QUESTIONS
1. A 4-month-old infant is being evaluated for developmental milestones.
Which of the following is an expected gross motor milestone for this age?
A) Sitting without support for short periods
B) Rolling from prone to supine
C) Walking with assistance
D) Crawling on hands and knees
E) Standing while holding furniture
CORRECT ANSWER: B) Rolling from prone to supine
RATIONALE: At 4-5 months, infants typically begin to roll from prone to supine as
they develop neck and trunk control. Sitting without support occurs around 6
months. Walking with assistance and standing while holding furniture occur around
,9-12 months. Crawling typically begins around 7-8 months. Rolling from prone to
supine represents the appropriate gross motor development for a 4-month-old.
2. A 2-year-old toddler is admitted to the pediatric unit with acute
gastroenteritis. The child weighs 14 kg. Which fluid replacement rate is most
appropriate for this child's maintenance needs using the Holliday-Segar
method?
A) 800 mL per day
B) 1000 mL per day
C) 1200 mL per day
D) 1400 mL per day
E) 1600 mL per day
CORRECT ANSWER: D) 1400 mL per day
RATIONALE: Using the Holliday-Segar formula: First 10 kg = 100 mL/kg/day = 1000
mL; remaining 4 kg = 50 mL/kg/day = 200 mL; total = 1200 mL base maintenance.
However, for acute gastroenteritis with losses, an additional 200 mL replacement is
typically added, totaling approximately 1400 mL per day. This accounts for baseline
maintenance plus replacement of ongoing fluid losses.
3. A nurse is assessing a 6-month-old infant with suspected developmental hip
dysplasia. Which clinical finding is most characteristic of this condition?
A) Symmetrical gluteal folds
B) Barlow sign positive with hip abduction**
C) Increased hip abduction bilaterally
D) Equal leg lengths
E) Positive Ortolani sign
CORRECT ANSWER: E) Positive Ortolani sign
,RATIONALE: A positive Ortolani sign is the most reliable clinical indicator of
developmental hip dysplasia, demonstrated by a "clunk" heard when the flexed and
adducted hip is gently abducted. The Barlow sign indicates hip instability
(hyperlaxity), while the Ortolani sign indicates reduction of a dislocated hip.
Asymmetrical gluteal folds, unequal leg lengths, and limited hip abduction are
supporting findings but the Ortolani sign is the most characteristic clinical finding
for this condition.
4. A 10-year-old child with asthma is experiencing an acute exacerbation.
Which peak flow reading would indicate moderate persistent asthma?
A) Greater than 80% of personal best
B) 50-80% of personal best
C) 25-50% of personal best
D) Less than 25% of personal best
E) Unable to measure peak flow
CORRECT ANSWER: B) 50-80% of personal best
RATIONALE: According to asthma severity classification: Greater than 80%
indicates mild exacerbation, 50-80% indicates moderate exacerbation, and less
than 50% indicates severe exacerbation or status asthmaticus requiring emergency
intervention. Moderate exacerbations require increased bronchodilator use and
possible corticosteroid therapy. Understanding these classifications helps guide
appropriate treatment intensity.
5. A newborn is born at 34 weeks gestation and weighs 2000 grams. During the
first week of life, which thermoregulation intervention is most critical for this
preterm infant?
A) Immediate bathing to remove vernix caseosa
B) Skin-to-skin contact in an open crib
, C) Placement in an isolette with controlled temperature
D) Delayed bathing until temperature stabilizes
E) Frequent position changes to encourage heat loss
CORRECT ANSWER: C) Placement in an isolette with controlled temperature
RATIONALE: Preterm infants have immature thermoregulation mechanisms,
minimal subcutaneous fat, and increased surface area-to-body weight ratio, making
them highly susceptible to heat loss. A temperature-controlled isolette is essential
to maintain neutral thermal environment and prevent hypothermia, which can lead
to increased metabolic rate, hypoglycemia, and respiratory distress. Skin-to-skin
contact is beneficial but only after initial stabilization. Bathing should be delayed,
and position changes should be minimized to reduce heat loss.
6. A 5-year-old child is hospitalized with acute leukemia and is scheduled to
begin chemotherapy. Which intervention is most important in preventing
tumor lysis syndrome?
A) Strict intake and output monitoring
B) Aggressive hydration and allopurinol administration
C) Limiting fluid intake to prevent overload
D) Monitoring white blood cell count only
E) Restricting potassium intake immediately
CORRECT ANSWER: B) Aggressive hydration and allopurinol administration
RATIONALE: Tumor lysis syndrome occurs when large numbers of leukemic cells
are destroyed, releasing cellular contents (potassium, phosphate, uric acid) that can
cause hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury.
Aggressive IV hydration maintains urine output (200-300 mL/m²/hour), dilutes uric
acid, and prevents crystal formation in renal tubules. Allopurinol or rasburicase
inhibits xanthine oxidase to reduce uric acid production. Both interventions
together are critical for prevention.
PEDIATRIC NURSING PROCTORED EXAM &
CMS PRACTICE QUESTIONS WITH CORRECT
ANSWERS AND DETAILED RATIONALES
ATI PEDIATRICS 2026/2027 | RN PEDIATRIC NURSING PROCTORED EXAM & CMS
PRACTICE QUESTIONS
DOCUMENT OVERVIEW
• This comprehensive study guide contains 200 carefully curated multiple-choice
questions designed to mirror the ATI RN Pediatric Nursing Proctored Exam format
and CMS practice assessments, covering all major pediatric nursing competencies
and clinical scenarios.
• Study this material by working through questions in focused blocks (20-30
questions per session), reviewing detailed rationales for both correct and incorrect
answers, and identifying knowledge gaps to target with additional study—
consistent daily practice will strengthen clinical reasoning and exam readiness.
QUESTIONS
1. A 4-month-old infant is being evaluated for developmental milestones.
Which of the following is an expected gross motor milestone for this age?
A) Sitting without support for short periods
B) Rolling from prone to supine
C) Walking with assistance
D) Crawling on hands and knees
E) Standing while holding furniture
CORRECT ANSWER: B) Rolling from prone to supine
RATIONALE: At 4-5 months, infants typically begin to roll from prone to supine as
they develop neck and trunk control. Sitting without support occurs around 6
months. Walking with assistance and standing while holding furniture occur around
,9-12 months. Crawling typically begins around 7-8 months. Rolling from prone to
supine represents the appropriate gross motor development for a 4-month-old.
2. A 2-year-old toddler is admitted to the pediatric unit with acute
gastroenteritis. The child weighs 14 kg. Which fluid replacement rate is most
appropriate for this child's maintenance needs using the Holliday-Segar
method?
A) 800 mL per day
B) 1000 mL per day
C) 1200 mL per day
D) 1400 mL per day
E) 1600 mL per day
CORRECT ANSWER: D) 1400 mL per day
RATIONALE: Using the Holliday-Segar formula: First 10 kg = 100 mL/kg/day = 1000
mL; remaining 4 kg = 50 mL/kg/day = 200 mL; total = 1200 mL base maintenance.
However, for acute gastroenteritis with losses, an additional 200 mL replacement is
typically added, totaling approximately 1400 mL per day. This accounts for baseline
maintenance plus replacement of ongoing fluid losses.
3. A nurse is assessing a 6-month-old infant with suspected developmental hip
dysplasia. Which clinical finding is most characteristic of this condition?
A) Symmetrical gluteal folds
B) Barlow sign positive with hip abduction**
C) Increased hip abduction bilaterally
D) Equal leg lengths
E) Positive Ortolani sign
CORRECT ANSWER: E) Positive Ortolani sign
,RATIONALE: A positive Ortolani sign is the most reliable clinical indicator of
developmental hip dysplasia, demonstrated by a "clunk" heard when the flexed and
adducted hip is gently abducted. The Barlow sign indicates hip instability
(hyperlaxity), while the Ortolani sign indicates reduction of a dislocated hip.
Asymmetrical gluteal folds, unequal leg lengths, and limited hip abduction are
supporting findings but the Ortolani sign is the most characteristic clinical finding
for this condition.
4. A 10-year-old child with asthma is experiencing an acute exacerbation.
Which peak flow reading would indicate moderate persistent asthma?
A) Greater than 80% of personal best
B) 50-80% of personal best
C) 25-50% of personal best
D) Less than 25% of personal best
E) Unable to measure peak flow
CORRECT ANSWER: B) 50-80% of personal best
RATIONALE: According to asthma severity classification: Greater than 80%
indicates mild exacerbation, 50-80% indicates moderate exacerbation, and less
than 50% indicates severe exacerbation or status asthmaticus requiring emergency
intervention. Moderate exacerbations require increased bronchodilator use and
possible corticosteroid therapy. Understanding these classifications helps guide
appropriate treatment intensity.
5. A newborn is born at 34 weeks gestation and weighs 2000 grams. During the
first week of life, which thermoregulation intervention is most critical for this
preterm infant?
A) Immediate bathing to remove vernix caseosa
B) Skin-to-skin contact in an open crib
, C) Placement in an isolette with controlled temperature
D) Delayed bathing until temperature stabilizes
E) Frequent position changes to encourage heat loss
CORRECT ANSWER: C) Placement in an isolette with controlled temperature
RATIONALE: Preterm infants have immature thermoregulation mechanisms,
minimal subcutaneous fat, and increased surface area-to-body weight ratio, making
them highly susceptible to heat loss. A temperature-controlled isolette is essential
to maintain neutral thermal environment and prevent hypothermia, which can lead
to increased metabolic rate, hypoglycemia, and respiratory distress. Skin-to-skin
contact is beneficial but only after initial stabilization. Bathing should be delayed,
and position changes should be minimized to reduce heat loss.
6. A 5-year-old child is hospitalized with acute leukemia and is scheduled to
begin chemotherapy. Which intervention is most important in preventing
tumor lysis syndrome?
A) Strict intake and output monitoring
B) Aggressive hydration and allopurinol administration
C) Limiting fluid intake to prevent overload
D) Monitoring white blood cell count only
E) Restricting potassium intake immediately
CORRECT ANSWER: B) Aggressive hydration and allopurinol administration
RATIONALE: Tumor lysis syndrome occurs when large numbers of leukemic cells
are destroyed, releasing cellular contents (potassium, phosphate, uric acid) that can
cause hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury.
Aggressive IV hydration maintains urine output (200-300 mL/m²/hour), dilutes uric
acid, and prevents crystal formation in renal tubules. Allopurinol or rasburicase
inhibits xanthine oxidase to reduce uric acid production. Both interventions
together are critical for prevention.
